Opinion | Why the New Obesity Guidelines for Kids Terrify Me

This month, the American Academy of Pediatrics published the first comprehensive guidelines for the evaluation and treatment of children and adolescents with obesity. Paperco-written by 21 renowned doctors, health researchers and obesity experts, advice health care providers that they can refer children as young as 2 years old to “intensive lifestyle and behavioral health treatment” programs if they have a body mass index in the overweight range or obesity. For children 12 years of age and older with an obese BMI, doctors are encouraged to prescribe weight-loss medications and refer children over 13 with severe obesity to a bariatric surgery center.

The paper’s authors see the new guidance as a brave step forward in the fight against childhood obesity, which they see as a “complex and often persistent disease” that requires early and aggressive treatment. .

But the guidelines stem from a premise that should have been disproved long ago: that weight loss is the best path to health and happiness.

The academy guidelines are the latest in the fight against obesity that healthcare providers, public health officials and the general public have waged to shrink our bodies in more than 40 years. Ineffective approach; American, including childrennot thinned out.

Instead, we face an epidemic of anti-fat bias, leading to stigmatization of fat people in schools, workplaces, doctors’ offices and other public spaces. In research Of the nearly 14,000 people enrolled in behavioral weight management programs in six countries, the researchers found that more than half of the participants had experienced weight stigma, with more than half of the participants experiencing weight stigma. 2/3 of people have it because of the doctor.

In dozens of interviews with families, I’ve heard about doctors shaming low-income mothers for buying dollar store ramen instead of more expensive fresh vegetables. I’ve talked to teenagers who are gaining weight while dealing with depression or anxiety and their doctors have asked them to cut back on carbs. Families describe doctors talking hurriedly, holding their bellies or making jokes about the bodies of their children.

The guidelines acknowledge that experiencing “weight stigma, victimization, teasing and bullying” are major challenges faced by children with large bodies, contributing to undereating drinking in moderation and worse mental health. They note that some healthcare providers are biased against obese patients in a way that affects quality of care and contributes to worsening illness and even death.

And yet, by releasing new guidelines on the best ways to pursue and achieve children’s weight loss goals, the academy has reinforced that bias. It mainly relies on BMI as an indicator of health status, although sure proof reveal its limits. BMI may be less reliable when used for children because it doesn’t consider a child’s muscle mass or pubertal growth spurt, both of which affect body composition.

Significant weight changes in children can signal an underlying health condition such as diabetes or an eating disorder or food insecurity. (Some children just genetic tend to be larger.) But our weight-based medical model trains doctors to make “normalizing” a child’s BMI a priority rather than treating that number as a data point. need to be curious. That leaves providers and patients focused on weight loss in the hopes that thinness will fix everything else. However, child health approaches that explicitly focus on behavioral change for weight control “rarely lead to health improvements or sustainable weight loss but are instead associated with eating disorderly and gaining more weight,” according to the 2020 report Editor in JAMA Pediatrics launched.

The American Academy of Pediatrics argues that their recommended “lifestyle and behavioral health treatment” program is different from the diets we’ve long known that can increase the risk of dementia. eating disorders in children. One study three years A study of nearly 2,000 children published in 1999 by Australian researchers found that teenage girls on a “severe” diet were 18 times more likely to develop an eating disorder than those on a “severe” diet. Non-dieters and even moderate dieters are five times more likely to develop the disease than non-dieters. – peer-to-peer diet. (Next learn confirmed the link between dieting and eating disorders.)

We also know that most efforts to Sustainable weight loss results through lifestyle changes often fail in all age groups. This may be why the academy has added new tools to doctors’ arsenal, including bariatric surgery and weight loss pills. One drug, Wegovy, the brand name for semaglutide, was recently approved by the Food and Drug Administration for ages 12 and older. Such strategies could help children with weight-related health complications, like Type 2 diabetes and non-alcoholic fatty liver disease, say the pediatricians group.

But it’s worth noting that Wegovy and other drugs can cause side effects like diarrhea and vomiting, and long-term use of these drugs hasn’t been well studied in children. While, research used to support the academy’s guideline for bariatric surgery involving 81 Swedish adolescents; While heart health and other conditions improved, 25% of patients required additional surgery to address complications from the first procedure or from rapid weight loss, and 72% reported nutritional deficiencies. Other studies show that bariatric surgery is associated with an increased risk of disease Alcoholism and Suicide.

What should the obesity guidelines say instead? Stop classifying children and their health by body size altogether. This will involve a paradigm shift to methods include weight, consider weight change as a possible symptom or a contributing factor to a greater health concern or difficulty. These approaches focus providers on solving that problem rather than managing weight loss. This means looking at the numbers less on the scale and talking more with families about their health priorities and challenges. Can they add healthy foods instead of restricting calories? Can they find a way to move the body they like? It also means avoiding discriminatory discussions about weight and weight loss prescriptions.

An approach that includes weights is called Health of all sizes has shown promising results in adults: 2020 meta-analysis out of 10 randomized controlled studies found that it showed similar efficacy to weight loss approaches in terms of promoting physical health and greater improvement in eating disorder outcomes. And evidence assessment 2021 of the adolescent approach concluded, “The benefits of HAES interventions for eating behavior and overall psychological health far outweigh the potential risks of childcare. focus on weight.”

We can’t address the anti-fat bias by making fat kids skinny. Our current approach only teaches them that trusted adults believe the bullies are right – that being fat is just a problem to deal with. That’s not the place to start a conversation about anyone’s health.

Virginia Sole-Smith is the author of the forthcoming book Fat Talk: Parenting in the Age of Diet Culture. She also wrote Burnt smella newsletter on anti-fat bias and diet culture.

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