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At their base, the guidelines recommend intentional weight loss for higher-weight children via “Intensive Health Behavior and Lifestyle Training” starting as early as age two (2) with drugs as young as twelve (12) and surgeries starting as early as age thirteen (13).

There is a lot to unpack here, and this will be a multi-part series but I have had a flood of requests to write about them since they came out, and I had to get very familiar with them because I presented Grand Rounds at Children’s Minnesota this morning, so I thought I would get started with this first ever special edition of the newsletter so that I could get this info to you sooner and keep Saturday’s newsletter from becoming a novel!

I’m going to start with conflicts of interest because I believe these form the rickety scaffolding upon which the rest of these recommendations rest.

When I think about conflicts of interest, I generally feel that having a conflict of interest is not proof of bias, but is certainly a red flag indicating the need for taking a deeper look. Failing to freely and openly disclose a conflict of interest, on the other hand, seems more to me like a red flag doused in gasoline and set on fire. There’s a lot of the latter type of red flags in these guidelines.

To address conflicts of interest, the guidelines themselves state:

FINANCIAL/CONFLICT OF INTEREST DISCLOSURES: An Independent review for bias was completed by the American Academy of Pediatrics. Dr Barlow has disclosed a financial relationship with the Eunice Kennedy Shriver National Institute of Child Health and Human Development as a co-investigator.

That’s it. That is the only conflict of interest information provided. The same language is provided at the top of the guidelines and under the section “competing interests.” I cannot find any link to the actual review that they performed (if I missed it/you have it, please feel free to leave it in the comments!) I have to tell you that Dr. Barlow’s disclosed relationship is pretty much the least of my concerns here.

For example, based on their disclosure language you might not guess that, of the 14 authors who are medical doctors, at least 7 have taken money from companies that are developing or sell weight loss products that either directly benefit, or may benefit from these recommendations either through the development of a new drug, or approval of an existing drug for adolescents. The amount ranged from less than $20 for food and beverage (amounts like this typically indicate that the doctor had attended one or more “educational” seminars by these companies and have been found to influence behavior,) to one author who took more than $50,000 primarily for consulting and speaking engagements on behalf of these companies.

One of the companies that many took money from was Novo Nordisk, the pharmaceutical company that is aggressively marketing the drugs that are discussed in the guidelines (with an acknowledgment that they were included in the guidelines even though the research for them was published after the evidence review had already been completed.) Also, these numbers are only for 2015-2021 and where data is available. We know that Novo Nordisk has been pouring money into their effort to promote Wegovy and make good on their promise to shareholders that they would use the drug to double their “ob*sity* sales” by 2025, so it’s possible that quite a bit more money has changed hands th