This article gets it right in my opinion. We should not be screening all kids for cholesterol. If you are curious, it’s well done, fairly short and worth the read…
I first started this post last December, when I believe a smaller panel recommended routine screening, and now I see that the Academy of Pediatrics is recommending routine cholesterol screening for children ages 9-11 and it’s back in the news…(I would like to know how many of the docs making the guidelines had ties to pharmaceutical companies who would benefit greatly from even a tiny percentage of children being place on life-long statins, or cholesterol lowering medications. I believe these docs think it is in the best interest of the child, but those connections are problematic.)
There are far more questions than answers, and I think we need to listen to “first do no harm” rather than a knee-jerk, “Think of the children!” grasping at “answers.”
For a start, we don’t know what to do with high numbers. (Oh, they do recommend life-style and healthy behaviors etc, but shouldn’t that hold true regardless of the cholesterol numbers?) I actually called in on a local radio show and said I was worried that this screening would lead to more children being put on diets, with the predictable consequences of increased disordered eating, weight gain and food preoccupation. The gentlemen replied that the APA doesn’t recommend diets. I didn’t have time to reply that perhaps they could do a better job educating their APA members, since I see far too many clients put on diets and restriction by pediatricians, many before their first birthday, but, I digress, which I tend to do a lot.)
Here is the thing that has changed apparently since in 1992 when they did NOT recommend screening, “The sense is that knowing is better than not knowing.” BUT, is knowing better than not knowing? Is a “sense” good enough motivation to make such a sweeping and costly recommendation? Does “knowing” help?
So far when it comes to children and health, “knowing” has not helped. Take BMI for example. There is a big push to label kids and let parents know about BMI.
My biggest fear is that this will be one more hammer to hit parents with, to freak them out. The problem is, not “sugarcoating,” and BMI report cards, and maybe scary cholesterol numbers, none of these tactics that are meant to scare or shame parents into making their kids healthier have been shown to improve children’s health, and may actually harm children.
And, what if, the child is not “healthy,” but the lab tests are normal? Does this then also make the family more or less likely to address healthy behaviors? What if it is abnormal, and the family gives up? What if it is abnormal, and in a panic to “do something” these kids are started on statins, the safety of which has not been tested adequately in children, and since it would be a long term medication, we just don’t know. Safe? Effective? A recent study on over 30,000 adults for “primary” prevention of cardiovascular disease was unimpressive, meaning it didn’t work to prevent disease in people with risk factors, but no disease. (Which would be the case in children with no symptoms or evidence of the disease.)
Is “knowing” better? Not likely.
1) parental knowledge of high BMI does not lead to better health, it makes parents scared, which leads them to the counterproductive feeding practice of trying to get their kid to eat less.
Your kid is fat. “Well then, Timmy, no sweets for you! Count calories, diet!” (All of which leads to higher rates of disordered eating and ironically, weight gain.)
2) regardless of actual BMI, when a child thinks she is fat, she is less physically active, diets more, feels worse about herself in every way. All leading to worse, not better health.
What do you think? Would you allow your child to have the screening? Would you want to know? (FYI, that is a LEGO syringe, cool, no?)