By: Chelsea Tobias, MSSA, LISW-S
Within the last month, the American Academy of Pediatrics (AAP) released new clinical practice guidelines regarding the medical treatment of children and adolescents with obesity. In the ensuing weeks there has been a significant response from the eating disorder treatment community citing concerns that these recommendations could potentially lead to the development of eating disorders and contribute to further weight bias and weight stigma. The aim of this post is to help you to understand these new guidelines, how they may impact your child, and what you can do to advocate for weight-neutral care.
Side Note: Throughout this post, I will be using the medical terms for higher weight bodies used within the medical community and the AAP recommendations. The terms “overweight” and “obese/obesity” are controversial and are derived from the Body Mass Index (BMI), a common assessment tool used within the medical field to assess for health status. Yet the BMI was not developed to be used on an individual basis and was created only using the health data of White European men. Of further concern for this context, is that the BMI is an even less reliable tool when used in children. That’s because the BMI doesn’t factor a child’s level of pubertal development nor muscle mass before labeling the child as overweight or obese.
What to Expect
Following the adoption of these recommendations, at your child’s annual medical checkup, their doctor will be assessing the expected changes in their height, weight, and their body mass index. While this is no different than in past years, the new recommendations proposed by the AAP have shifted treatment for children who fall into the overweight and obese categories of BMI. Including the recommendation for referrals for weight loss surgery in children as young as 13, the use of weight loss medications in children as young as 12, and the recommendation for Health Behavior and Lifestyle Treatment (26 or more face-to-face hours over a 3-12 month period) for children as young as 2.
As a social worker and therapist who treats children and teens with eating disorders, I have significant concerns about the AAP’s recommendations, and I think you should too. Children are expected to gain weight annually as their bodies grow and develop on their own unique timeline and trajectory. To pathologize normative weight gain, or weight gain following stress, trauma, or other social inequalities causes undue fear and anxiety in both caregivers and growing children. Plus, none of the recommendations for weight loss provided by the AAP are known to be safe and effective ways to lose weight and keep it off long-term, and are known to contribute to additional weight gain and eating disorders. These recommendations also come at significant cost to families both in terms of time and money and contribute to the belief that thinness equates to health.
Weight stigma within the medical community is a commonly cited reason why children and adults avoid attending medical appointments. Patients believe their doctors see their weights as a personal failure or a lack of willpower instead of acknowledging the complexities of body weight, shape, and size. By avoiding routine medical care, children are at an increased risk of missing vaccinations, screening for mental health concerns including eating disorders, and opportunities for doctors to catch non-weight related medical concerns.
Eating Disorder Experts Weigh In
The Academy for Eating Disorders (AED), an international organization whose mission is to advance eating disorder prevention, education, treatment, and research by expanding the global community of committed professional, issued a statement encouraging the AAP to revise these guidelines. AED cited concerns that the guidelines make only “minimal reference to eating disorder screening and treatment referral[s].” As a provider, I’m very concerned about the potential for missed screening for eating disorder behaviors because eating disorders affect people of all weights and body sizes. I’m further concerned that doctors will inadvertently harm their patients because of their weight bias or lack of skill in how to have nuanced conversations about health that aren’t focused solely on weight. Many people with eating disorders have shared that it was a comment from their doctor that either directly led to the development of their eating disorder or made it worse.
AED further makes issue with the limited research into the long-term efficacy and safety of medications and weight loss surgeries referenced within the recommendations for the pediatric population. Without more research, these recommendations feel extremely dangerous and too short-sighted. As a parent, you always have the option to decline a medical recommendation that you do not agree with, but it can feel uncomfortable to go against the provider you’ve been told to trust with your child’s health.
What Can Parents Do?
As a parent, it can feel challenging to navigate discussions about weight, shape, and size in a non-stigmatizing fashion. I encourage you to educate yourself further on weight stigma and to have open and regular conversations with your child about it as well. By helping your child to spot weight stigma in the world around them, they’ll be better about to call it out and recognize that it’s someone else’s bias and not a personal problem of their own. This can be extremely helpful and empowering for your child out in the world and in the medical setting.
Other families have made cards asking their doctor’s office to do blind weights or to not weigh at all unless it’s medically necessary. Others have requested their care providers to refrain from making comments about their own weight, shape, or dieting behaviors or that of the child’s without their consent to reduce the likelihood of unintended harm.
Lastly, I encourage parents and children to ask follow-up questions for any weight loss recommendations made by a medical provider. Here are some examples provided by Aubrey Gordon in her most recent book (referenced below):
- “Is weight loss the most successful course of treatment here? Are other treatments available? What are their success rates?”
- “What methods do you recommend for weight loss? What are their success rates in the short and long term?”
- “Most attempts to lose weight in the short term lead to weight gain in the long term. What happens if I don’t lose weight, or if I regain it?”
EBHA’s Response and Philosophy
Here at EBHA, we support our clients in feeling safe and empowered in their bodies. We believe that all bodies are good bodies, and all bodies are worthy of being taken care of. We are here to advocate and educate medical providers and the broader community with the goal that all bodies should be free from weight stigma and shame, and should never feel forced to engage in harmful or not-proven-effective interventions in the pursuit of health. We stand with AED and the Collaborative of Eating Disorders Organizations (CEDO) and strongly request that the AAP revise their treatment guidelines and include professionals from the eating disorder field on their committee.
If you’d like to learn more about these topics, below are some of our favorite resources:
Virginia Sole-Smith’s podcast & newsletter for parents, Burnt Toast – and soon to be released book, Fat Talk
Aubrey Gordon’s podcast Maintenance Phase or her most recent book “You Just Need to Lose Weight” and 19 Other Myths About Fat People
Ragan Chastain https://weightandhealthcare.substack.com/