Last month, the American Academy of Pediatrics (AAP) released new guidelines for treating childhood obesity. Professional organizations, like the AAP, often release practice guidelines that generally support and inform practitioners in a given field. However, these recent guidelines have been met with questions, concern, and outrage by practitioners and parents alike.
Why are these new guidelines from a highly trusted association receiving such opposition? As we gear up for Eating Disorder Awareness Week (Feb. 27-March 5), here is what you need to know about the guidelines and their dangerous implications for kids.
What is the AAP, and how do their guidelines affect kids?
The AAP is a professional association composed of pediatricians and pediatric medical and surgical subspecialists from across the United States with the goal of promoting optimal physical, mental, and social health for infants, children, adolescents, and young adults. The Academy is seen as the source of “best practices” when it comes to pediatric health care. Therefore, you will often see pediatricians considering and adapting how they provide medical care to children based on the recommendations of this group.
What do the new guidelines say?
The new guidelines are a departure from this same group’s past recommendations when it comes to childhood obesity. Instead of “watchful waiting,” the new guidance recommends early and intensive treatment based on a child’s weight and body mass index (BMI) – which includes medications and surgery for children and adolescents.
The guidelines recommend prescribing weight-loss pharmaceuticals for children 12 years old or older who have “obesity” (a BMI above the 95th percentile). For children 13 and older with “severe obesity,” the guidelines state it is appropriate for a pediatrician to consider bariatric (weight loss) surgery. Read the full guidelines.
What do the guidelines get right?
On the positive side, our children’s mental and physical health around food and body needs increased attention. Concerns about sedentary behavior, too much screen time, and highly available processed foods that offer little or no nourishment are issues that demand increased attention. However, the AAP’s recommended approach advances the premise that we must focus on weight and BMI instead of focusing on the other concerning behaviors.
The AAP is right to reevaluate its treatment of childhood obesity since the old way isn’t working. The problem is the new guidelines amount to pushing, with increased intensity, broken approaches that have failed our kids for decades. A new evidenced-based, destigmatizing approach focused on health instead of weight is needed.
Two reasons these guidelines are dangerous for kids
1. They do not mention or caution pediatricians around eating disorders and disordered eating
It is disappointing that the AAP failed to release little guidance about eating disorder prevention and treatment in kids. Instead, the AAP released guidelines that recommend actions that are known top risk factors for eating disorders with almost no reference to how discussing weight and BMI can increase eating disorder risk (see the Academy for Eating Disorders’ response on the harm of this oversight). It is not helpful to reduce the number of children with obesity if they are driven toward the top risk factors for the second most deadly mental health illness.
2. Focusing on weight does not lead to health. It leads to shame and unhealthy behaviors
These guidelines encourage pediatricians to center health conversations around weight rather than actual health and well-being. Many kids are highly likely to feel shame or self-doubt when they sense an adult is judging or criticizing their weight or food relationship, especially someone in a professional capacity. It is staggering the number of individuals I encounter who have experienced an eating disorder and can link the beginning of their disordered eating behaviors to a conversation with a doctor who negatively talked about their weight. Every pediatrician must approach weight or body conversations with this awareness, or they will cause irreparable harm.
How can I respond?
Although the AAP’s approach is disheartening, we can take action and speak out. Consider doing one of the following to protect our kids and raise awareness around the harm of eating disorders:
Let’s change the conversation this Eating Disorder Awareness Week to reflect health-positive behaviors instead of shame.
Lisa Radzak is the executive director of WithAll, a nonprofit organization committed to ending eating disorders by raising awareness and equipping adults to support kids’ healthy body image and positive relationship with food.