The Problem with the AAP Guidelines for Childhood Obesity

Written by CCTC Staff Writer

On January 9th, 2023rd the American Academy of Pediatrics issued its first comprehensive guideline on evaluating and treating children and adolescents with obesity. This new guide focuses on treating obesity rather than its prevention, which they state will be addressed in another statement. Behind the American Academy of Academy is a group of of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists that treat infants, children, adolescents and young adults.

While the American Academy of Pediatrics believes this treatment is safe and effective, many are expressing concern about the dangers and irreparable damage this type of intervention may provide.

In this article we will discuss:

What the new AAP guidelines proposes
The dangers of these guidelines
A look at weight bias
How dieting behaviors can lead to the development of disordered eating or eating disorders
Alternative solutions to promoting health in children and adolescents
How to protect your children from these guidelines

The New American Academy of Pediatrics Evaluating, Treating Children and Adolescents With Obesity

The new guideline encourages health care providers to refer children as young as 2 years old to “intensive health behavior and lifestyle treatment” programs if they have a body mass index in the overweight or obese range. In addition, it encourages healthcare professionals to offer adolescents ages 12 years and older with obesity weight loss medications. In addition to medication, it recommends that teens age 13 and older with severe obesity (BMI ≥120% of the 95th percentile for age and sex) should be evaluated for metabolic and bariatric surgery.

The Concerns & Dangers of these Guidelines

Many healthcare providers and mental health professionals, including the team here at Central Coast Treatment Center, have many concerns about these guidelines and the impact it may have on the wellbeing of children and adolescents it targets. While these guidelines say these interventions will ultimately help decrease the amount of stigma the child will experience in their lives due to size, it begs the question, can a healthcare professional really delicately bring up these issues in a way that does not increase the shame and stigma a child experiences?

Even if a doctor comes across as well-intentioned in exploring weight and possible treatments such as medication or weight-loss surgery, a child may only hear “there is something wrong with me.”

Not to mention that certain interventions at the age of as young as 2 years old prevent the opportunity for a child to even attempt to build a healthy relationship with food and exercise that is intuitive and developing the skills to listen to their body’s innate cues. There is also no long-term research to show the benefits or consequences of these interventions.

It is also worth noting that weight-loss interventions such as these are not proven to be effective. As Virginia Sole-Smith shared for the New York Times, this approach hasn't worked for the last 40 years as healthcare providers have tried to fight the 'war on obesity.' So, why would we think it would work now on children and adolescents?

The guideline also encourages the same rhetoric that has caused many people decades of suffering and disordered relationships with food: that losing weight is the key to health, happiness and a 'good' life.

Another concern is that the new guidelines use outdated methods like Body Mass Index (BMI) to determine which children need intervention. BMI, which is calculated by dividing a person’s weight by their height, has been criticized in medical circles for its inability to accurately take into account physical outliers.

A Look at Weight Bias

Weight bias is a form of discrimination that takes the shape of negative attitudes, beliefs, judgements and stereotyping towards people who are overweight or obese.

Many health specialists have suggested that by recognizing obesity as a medical condition, it will minimize the social prejudice surrounding excessive body weight; however, even after the American Medical Association (AMA) labeled obesity as an ailment in 2013, a research indicated that around 66% of Americans experienced stigma from physicians due to their weight.

This means that doctors continue to unknowingly, or perhaps knowingly, engage in unhelpful conversations with their patients around the topic of weight and nutrition. And when dealing with vulnerable populations such as children and adolescents, the concern is that these seemingly well-intentioned comments or suggestions will do more harm than good.

More often than not, when teenagers struggling with eating disorders are asked about the onset of disordered eating habits and developing an unhealthy relationship to food, weight and body image, the answer is comments made by doctors or other prominent figures in their lives such as coaches or teachers. The comments may be a well-intentioned encouragement to focus on weight and food choices to promote health, but instead, the opposite occurs.

Dieting and Eating Disorders

Eating disorders aren't always directly connected to dieting, yet it's often the beginning of an unhealthy relationship with food. The National Eating Disorders Association discovered that 35% of "normal dieters" can quickly transition into pathological dieting and in turn, 20-25% of those individuals will develop a full-fledged eating disorder.

A shocking number of teenagers are participating in diets; with approximately half of all teenage girls and one fourth of boys using dieting strategies. Unfortunately, these adolescents often suffer from a decrease in their self-worth, as well as feeling isolated from family members and peers, resulting in an overall decreased sense of control over their lives.

According to a 2018 study published in the Journal of General Internal Medicine, it is suggested that young adults with higher body mass indexes are more predisposed to developing an eating disorder or exhibiting disordered eating habits like gorging on food, purging through vomit or laxatives, and omitting meals.

It is no surprise that nearly 3% of youths between the ages 13-18 have been clinically diagnosed with an eating disorder when they are praised for weight loss tactics such as fasting, vomiting or overworking out. This reinforcement encourages increasingly detrimental behaviors; inadvertently perpetuating this growing issue in our society.

We need to reconsider how we discuss weight and BMI with teenagers who have a weight issue, since this emphasis is not only ineffective in creating healthier bodies, but it may also cause unintended effects like food obsession, yo-yo dieting, poor self-esteem and eating disorders.

It is also important to address that many children who fit into the ‘obese’ or ‘overweight’ category are more prone to experiencing adverse childhood experiences and the odds of a child being ‘obese’ are 5 times higher for children in food insecure households. These often stressful and unpredictable living conditions can increase the development of emotional issues. For some, following a diet can be the perfect way to avoid addressing deeper emotional issues. Dieting and weight loss may act as an effective cover for individuals living with eating disorders who are seeking anonymity.

The Alternative of Health Promoting Behaviors

Rather than concentrate on weight loss, a more productive approach would be urging providers to explore encouraging health promoting behaviors. This emphasizes conversations with families concerning their health priorities and issues rather than just looking at a number on the scale. How can they incorporate healthy foods instead of limiting calories? Can they find ways to be physically active that are enjoyable for them?

Moreover, this would involve avoiding any discussions or prescriptions regarding weight loss which could lead to shaming of individuals.

Let us discard the stigmatizing term "obesity" when it comes to young children, and instead opt for a weight-inclusive approach. We must take into account that fluctuating weights can be an indication of deeper underlying medical problems or hardships—not just their sole defining feature in terms of overall health. As such, let's work towards a supportive atmosphere where we promote healthy habits without any more stigma linked with physical size.

Protecting our Youth

If you are a parent of a young child and are worried about the potential impact of these guidelines, remember, you have the right to advocate for your child. Requesting that your child's healthcare provider not discuss weight, BMI, dieting, weight loss drugs or surgery in front of your child is your right. You can also order “Don’t Talk About My Child’s Weight” cards from More-Love.org. If that means going against medical advice, remember you are in charge.

If you or your loved one is struggling with disordered eating or body dissatisfaction, it can be helpful to remember that there are resources available. Eating disorder treatment centers and therapists specialize in helping people develop healthier relationships with food and their bodies. Reach out to us at Central Coast Treatment Center to learn more about our eating disorder treatment programs.

Ai PonoFebruary 21, 2023