The American Academy of Pediatrics Guidelines on Ob*sity are Sure to Cause Harm
Note: the terms “Obese” or “Obesity” will be found moving forward in quotations marks and edited as “ob*se” OR “ob*sity”, due to the harmful & stigmatizing nature of these descriptors.
By now, I’m sure you’ve all heard the horrendous news coming out of the American Academy of Pediatrics (or AAP). Their most recent Critical Practice Guidelines (on the Evaluation & Treatment on Children/Adolescents with “Ob*sity.”) have caused quite a stir in the healthcare and advocacy worlds. Anti-diet dietitians, social justice advocates, eating disorder recovery professionals, and other Health at Every Size R providers (including myself) are downright outraged by this seemingly step backward in ethical or evidenced based healthcare. As both a parent & healthcare professional - working with the eating disorder AND pediatric populations - I’m so concerned with the consequences this news is sure to have on families and children.
The entire document is too lengthy to dissect word for word, but if you are interested in diving into the actual physical copy yourself, you can do so HERE. (Trigger warning if you do decide to read). And while I can’t address every single grievance I have with the guidelines as written, below are some of the major key concerning points:
Regardless of the authors’ continued eagerness on short-term outcomes for weight loss, no study (including the ones referenced) have achieved substantial “success” rates past a few years. As most weight-loss studies go, the “results” only show the short term, and NOT the eventual protective weight gain past the study period. It is a well-known fact and hundreds of studies continue to show: restrictive diets have a direct correlation with future weight cycling, disordered eating patterns, decreased metabolism, and subsequently negative health outcomes due to the unnecessary erratic stress the body is put under.
A key point of media literacy: ALWAYS check who is funding these studies or encouraging news releases. Conflicts of interest between weight-loss programs and pharmaceuticals in these recommendations is sadly not surprising, but still infuriating.
Let’s just say - the authors lack awareness, or simply general comprehension on the true definition of non-stigmatizing healthcare. When they attempt to disclose concerns with weight bias or stigma in healthcare, there is obviously a clear disconnect between their words and expected actions. As the amazing advocate Ragen Chastain recently shared in a webinar for families and professionals on this topic (paraphrased): “Never should the treatment of stigma be to eradicate the stigmatized population.” (I.e. The solution of bullying would not be to eliminate humans who experience this type of trauma, but instead, to change the SYSTEM that allows bullying to continue thriving).
A huge red flag: medical professionals ignoring the serious and high likelihood of life-threatening consequences if children take weight-loss medications and/or undergo organ mutilation (AKA bariatric surgery). When as a society are we going to accept that children and humans are naturally diverse, and pre-pubescents are still growing and developing?! These “treatments” are the exactly opposite of healthcare - medications and surgeries of this nature are putting humans in extreme malnourished states, encouraging macro- and micronutrient deficiencies, altering gastrointestinal function…just to name a few side effects. All in the name to maybe lose a few pounds? That doesn’t sound like health to me - it’s putting hands in the pockets of big pharma and insurance companies, causing more complications than actually helping.
It should be no surprise that many persons with disordered eating or long dieting histories report that their unhealthy food behaviors often start in childhood or adolescence. Being in this field and seeing first hand the harm intentional weight shame and dieting puts on kids, I fear that the rates of eating disorders (which have the highest mortality risk of any mental health diagnosis) will only continue to rise in the next few years.
As you can see, my anger and emotional response are pretty blatant in my writing above. Although this feels like a giant blow to the weight neutral conversation, it is surely not the end to the hundreds and thousands of advocates who spend countless hours fighting against these large systems. As a Registered Dietitian, I know personally there are much better ways to promote health and educate on nutrition topics without a side of shame or stigma. Take the Health at Every Size R principles for example (weight inclusivity, health enhancement, eating for well-being, respectful care, and life enhancing movement). Nowhere in this type of curriculum does it put shame or blame on children or families (especially on a single marker, such as weight, which is not 100% in our control anyways). This means that we as nutrition educators can easily discuss all the health benefits of produce consumption, mindful movement, stress management, or other interventions without carelessly diluting the broad term of ‘health’ to only equal weight. This is just one example of a framework of care that truly puts individuals' values first - which meets the true definition of HEALTHcare.
Hopefully, the AAP can someday soon see the light, and revoke their ties with weight management companies. But until then - we will keep fighting the good fight…because our patients (and children) deserve the best from us.