To address obesity in children, advocacy and drastic policy changes are necessary | Expert Opinion

“It’s not about the number on the scale.”

I am talking to a young mother of one of my pediatric patients who I’ve just examined at my hospital’s clinic in Upper Manhattan, where we provide health-care services to a mostly Latino, low-income, and underserved community. I do my best to explain my concern for the downstream consequences that her son’s weight will have on his health. He already has elevated blood pressure and is starting to show signs that his body is unable to process the amount of sugar that’s in his blood.

“But he’s only 7!” she exclaims.

It’s a conversation I have almost weekly at the clinic. Around the country, pediatricians are seeing younger and younger overweight children. Over 14 million children and adolescents in the United States today are obese. That’s more people than the entire population of Pennsylvania. Many already have conditions usually seen in overweight or obese adults, such as high blood pressure, fatty liver disease, and diabetes.

The risk isn’t equal among all kids. Children who live in poverty and in underresourced communities are more than twice as likely to be obese as those whose families have never struggled with low income. And throughout America, roughly one-quarter of Black and Latino kids are obese, vs. 17% of white and 9% of Asian children.

So it should be no surprise that childhood obesity is a particular problem in Philadelphia, the country’s poorest big city. More than four out of 10 Philly kids between the ages of 6 and 17 are overweight or obese. In North Philadelphia, the rate climbs to seven out of 10, affecting mostly Black and Latino kids.

“More than four out of 10 Philly kids between the ages of 6 and 17 are overweight or obese.”

Obesity is now one of the most common chronic illnesses of childhood. It’s also one of the most stigmatized and complex. Neither the causes nor the consequences of a child’s extra weight are as simple as their body mass index percentile. Obesity is a consequence of various psychosocial, genetic, economic, and sociopolitical factors. Yet, too often, health providers place the blame on patients for carrying extra weight.

The epidemic of obesity among U.S. children highlights how our health-care system and political system are failing our children on multiple levels. We criticize these children — and their parents — for being overweight, when they often don’t have access to enough nutritional food, safe environments where they can run and play, or accessible pediatric care for nutrition counseling.

The epidemic of childhood obesity is a symptom of a much larger problem, the tip of the iceberg of negative health consequences perpetuated by poverty and other inequities.

» READ MORE: People with obesity face persistent stigma and discrimination. It must stop.

Recently, for the first time in 15 years, the American Academy of Pediatrics released new guidelines on how to diagnose and treat obesity in kids, which reject the old “watch and wait” philosophy, in which providers simply monitor kids without intervening. That’s a good thing. The guidelines identify obesity as a complex medical condition that should be addressed and give guidance on newly approved medications shown to help with weight loss and reduce metabolic disease in children. More good news.

But without accompanying drastic efforts in advocacy and public policy change, continuing to pathologize weight and “elevated BMI” is dangerous.

What’s more, this guidance for increased medical intervention comes at a time when many children already lack access to regular pediatric care and essential medical services. Even if insurers cover direct costs related to obesity in kids, families often have to wait for months to obtain appropriate nutritional or psychological services. Beyond direct costs, there are various indirect costs associated with obesity (transportation to appointments, missed school, or time required for physical activity) or difficulty accessing care in a family’s primary language, so it is often the most vulnerable children who miss out on the services they desperately need.

Excess weight is often the symptom of a problem, not the problem itself. To make a difference, we must tackle the social factors that increase children’s risk. The way health providers talk to families about food and nutrition matters — for instance, they can’t simply criticize parents and tell them to swap their processed foods for fruits and vegetables when, in the Philadelphia region, one out of 10 households doesn’t have consistent access to healthy, affordable food.

All of us — pediatricians, parents, and others invested in children’s health — must demand that Pennsylvania and other states fill in those gaps in coverage for obesity treatment from public and private insurers, and tackle the social factors that make it harder for families to be healthy. Children need more time for physical activity at school and to have safe green spaces and playgrounds to be active in their communities, without the threat of gun violence or the dangers of pollution.

Without interventions targeted toward public infrastructure, the simple messages to “eat healthier” or “get more exercise” becomes cruelly unachievable.

Amelia B. Warshaw is a second-year pediatric resident in the Columbia-NYP Pediatrics Division at the Morgan Stanley Children’s Hospital of New York. www.amelia.media @Meelzy8