The backlash was swift following the American Academy of Pediatrics release of its first new guidance for treating childhood obesity in 15 years. In addition to exercise, nutrition support and behavioral therapy, the pediatricians’ recommendations included more aggressive interventions, such as prescription drugs and weight-loss surgery for adolescents. The surgery and medication recommendations struck a nerve. Readers left nearly 800 comments in response to a New York Times article on the update. Some comments boiled down to a familiar perspective: Kids today are coddled. They need to exercise more and eat less junk food. Obesity researchers told Erin that viewpoint is facile: “It’s the most stigmatized disease in the world,” said Justin Ryder, vice chair of research in the surgery department at Lurie Children’s Hospital of Chicago, who wasn’t involved in developing the new guidelines. “In America, we view obesity as a personal behavior problem and not as a disease.” Stigma is baked into the language we use to talk about obesity, those researchers explained. In fact, when Erin talked with Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota, he corrected her when she used the term “weight-loss drugs” instead of the preferred “anti-obesity medication.” The latter phrasing more closely aligns with how people talk about drugs for other diseases, Kelly said, such as anti-hypertensive and anti-diabetic drugs, and it avoids an association with cosmetic procedures. “That’s on us as a scientific community, to educate the public,” Ryder said, adding, “We have these treatments available. We need to get them to the 7 million kids with severe obesity.” Kelly framed that problem as an opportunity. “We have tools. Now we need to find out how to deploy them.” When the bill arrives: It’s almost impossible to get insurance companies to cover medication or surgery for kids younger than 18 even when doctors and parents agree to move forward with such interventions for a child who’s clinically eligible, Kelly said. “If the health care providers and families work hard enough, it’s a war of attrition. Fight and fight and appeal and appeal,” Kelly said. “Typically, mostly it will be covered, but the insurance companies can make it extremely difficult to where many families and providers will sometimes just give up on trying.” For families on Medicaid, the fight can be even more challenging. “In addition to variation from state to state in what’s covered by Medicaid, there’s also variation within a state across different doctors,” said Timothy Waidmann, a senior fellow at the Health Policy Center at the Urban Institute in Washington. Some doctors prescribe anti-obesity drugs off-label. Others don’t. “That’s one of the complications of even talking about what’s really happening on the ground. The rules are maybe not for everybody,” Waidmann said. Still, Minnesota recently changed state law to cover medication for children on Medicaid — a change that Ryder lobbied for. The kids on medical assistance who need treatment the most have the least access, Ryder explained. "It becomes an equity issue,” he said. But Waidmann is unconvinced that the American Academy of Pediatrics’ updated guidelines alone will change states’ coverage decisions. “There’s a concern for the cost,” he said. “That’s often how states make decisions about covering new classes of treatments.”
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