The Danger of the New AAP Guidelines for Children and Weight

Dec 6, 2023 | Opinion

CW: Mentions of specific, harmful treatment methods and use of the words o*esity and o*erweight, which is language taken directly from the studies, articles, and AAP guidance that inform this post.

This past January, the American Academy of Pediatrics released new guidance for treating o*esity in children. They are now recommending that doctors offer weight loss drugs to kids 12 and older, that providers should evaluate kids as young as 13 for bariatric surgery, and that health care professionals can refer children as young as 2 years old to “intensive health behavior and lifestyle treatment” programs if they are in the o*erweight or o*ese BMI range. 

Here’s why this is so dangerous:

The update came on the heels of an alarming surge in eating disorder rates in children during COVID. Patients who have been diagnosed as o*erweight or o*ese and patients who diet have a higher risk of developing an ED, with the highest prevalence of onset occurring during adolescence, particularly for girls. EDs are increasingly recognized in children as young as 5.

Data shows that patients need to keep taking weight loss drugs, or else gain the weight back, meaning that children who start on weight loss drugs will need to be on them for life, if they are to maintain that weight loss. That’s without enough science to show the long-term effects of those drugs on children, whose bodies are still developing. Also, our bodies naturally change during puberty, which is the age group that the AAP is targeting. 

Bariatric surgery has led to eating disorders and physical complications for some patients, with very little science to show the effects for children. Bariatric surgery completely changes the way patients receive nourishment from their bodies, again at a time when kids’ bodies are still growing and developing. The complications for bariatric surgery include malnutrition, bowel obstruction, hernias, internal bleeding, leakage, and perforation of the stomach and intestines.

The BMI is junk “science.” Despite the BMI being proven time and time again to be unscientific and racist, it remains the most relied-upon measure of health related to weight. The o*erweight and o*ese criteria for children was broadened in 2022, meaning that an entire cohort of children previously considered “normal” weight were suddenly diagnosed as o*erweight or o*ese. Again, our bodies naturally grow and change during puberty.

Classifying o*esity as a disease reinforces weight stigma, which prevents patients from receiving proper care. Linking health risks to o*esity, when those same health risks are present in “normal” weight patients, and despite no causal evidence, also overlooks weight stigma and disordered eating as contributing factors. The new guidelines are rooted in an assumption that should have been abandoned long ago: That weight loss is the best and only way to achieve health and happiness.

The prescription of weight loss for a myriad of health concerns too often overlooks serious and potentially lethal underlying causes and health conditions. The only mention of weight stigma in the AAP guidance is around what language providers can use to be more sensitive toward larger patients, with the focus still being on weight loss. Weight continues to be the primary indicator of health, despite evidence that this approach does not work.

Fat patients experience discrimination on a regular basis in most medical offices, and so avoid going altogether. Medical providers receive little to no training on identifying and diagnosing eating disorders, meaning they often miss them until they are life-threatening, especially in larger patients. There is a focus on what individual patients need to do, instead of addressing the policies, environments, oppression, stigma and prevalence of disordered eating that lead to poor health outcomes.

It is worth noting who is on this AAP subcommittee:⁠ ⁠13 physicians who specialize in pediatric o*esity (2 of whom are bariatric surgeons), a pediatrician with self-reported research interests in “minority health” but with few actual research publications, 4 public health professionals with expertise in child o*esity practice, a family clinical psychologist, a project manager, and an attorney. ⁠ ⁠Not one contributor represented perspectives on weight stigma, trauma, oppression, anti-fat bias, or the harm and ineffectiveness of weight-focused treatment. ⁠In fact, it can be argued that many of the panelists professionally and financially benefit from the new AAP guidance, considering their area of practice. ⁠

So, what comes next? To develop more resources and training for evaluating eating disorders in patients, the AAP plans to work with the Academy for Eating Disorders (AED) and the National Eating Disorder Association (NEDA), two organizations that continually come under fire for excluding fat voices and representation and their glaring lack of fat-affirmative and anti-racist care.

What can you do? If you are a parent or caregiver of children, please know that we cannot solve the issue of anti-fat bias by making kids lose weight. Resist making your child’s weight the focal point. Question the weight-focused guidance of your healthcare providers. Insist on weight-neutral and affirmative care, or find a doctor who is open to this approach, if you can. Learn more about the weight-inclusive Health a Every Size approach. Understand and teach your kids that fat bodies are not a problem to solve.

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