Examining the Harmful Implications of the AAP's Guidelines on Weight Loss Medication and Surgery for Children with Jessica Setnick, MS, RD, CEDRD-S
The AAP put out new guidelines on obesity and weight loss in children, and they’re horrifying.
Here’s the back story:
The American Association of Pediatrics put out new guidelines in January of 2023 concerning children and adolescents who the medical community have deemed “obese.”
Some points of the new guidelines include:
Behavioral and nutritional changes (AKA, a diet) for kids considered “obese” at the age of 2
Weight loss medication by the age of 12
Referrals for weight loss surgery by the age of 13
It’s utterly insane. And today, Jessica Setnick and I are breaking down why that’s insane and all the nuances attached to it.
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You might remember Jessica from Episode 30, where we talked about eating disorders as a solution to a larger problem. She has worked in the eating disorder field for 25 years and has acted as an advocate for those in the eating disorder treatment community: she does trainings, workshops, and podcasts like this one. She started a professional organization for eating disorder dietitians and she advocates for legislation for more access to care.
Neither of us are telling you what to think, I always encourage independent thinking. The point is to try to provide as much information so you can make an informed opinion for yourself.Read on and let me know what you think! (To be fair, though, when we chatted on the podcast, I don’t think we did the “neutral journalism” thing. Our personal and professional opinions are crystal clear. Reader and listener beware.)
Past Guidelines
In the past, the AAP told pediatricians they need to talk to their patients about BMI and weight loss in children. Then, in 2016, they told them to stop because it was causing eating disorders. And here we thought we were making progress. 🙄
Now, we have the current guidelines that have the most extreme recommendations of all.
The outrage is this: anyone who works in the eating disorder field knows that singling out children based on their size is damaging. We know failed weight loss interventions in childhood can lead to disordered eating in adolescence and adulthood.
Profit-Driven Guidelines
So if the AAP guidelines are so ridiculous, how did they get published?
It’s possible that many of these guidelines are profit-driven. There are many people who make money based on stigmatizing people who are bigger and solving this “problem” (which, for many people, isn’t a problem at all).
There has been research done about the authors of these guidelines, and every one of them have received profit from places like big pharm for the recommended products. So even if they are basing these guidelines on conducted research, it’s not necessarily “clean” research, because it’s biased in terms of how it was funded.
This research was done by Ragen Chastain. If you’re interested in signing up for her newsletter to get more research like this, you can do that here!
For instance, if you look at the original research behind the guidelines, you would see that none of the studies were done with the populations or ages that were mentioned in the guidelines. Sometimes there were even negative outcomes or only short-term positive outcomes in the studies! Basically, the research results didn’t support the guidelines.
So these guidelines could change someone’s life and potentially harm them, and they’re not even based in science. That’s terrifying.
Weight as a Red Flag
I actually agree that approaching significant weight fluctuations as a red flag to do further testing is true, especially if the testing is not harmful. As long as one doesn’t single out children who have larger bodies… but that’s exactly what these guidelines are doing.
The key AAP guidelines say to treat children and adolescents using a family-centered and non-stigmatizing approach. The problem is, trying to shrink a child’s body by any method IS stigmatizing.
Some children are meant to be larger, and others have an underlying medical condition or eating disorder. The key is to not single out kids in larger bodies; to treat the medical condition, if it’s present, and NOT the size.
Conversations with a Doctor
I get it: when you’re speaking to someone who is an authority figure, such as a doctor, it’s difficult to question their advice. If you want some rebuttals to have ready in that situation, you could try:
“Are you saying my child has a medical condition or are you saying they’re bigger than they should be?”
“If you’re saying my child has a medical condition, we’d like to get treatment for the medical condition. But if you’re saying his size is a problem, that’s not a conversation I’m willing to have.”
It’s especially difficult if you’re a new parent who is looking for guidance from your pediatrician. The last thing you want is to get advice that is detrimental to your child’s health. This is why it’s so important to find a weight inclusive pediatrician and not be afraid to question advice.
Detrimental Effects of AAP Guidelines
The advice outlined in the AAP guidelines can cause potential complications that are life-altering.
The stomach-altering surgery recommended for children is done with the intent of causing malnutrition. The effects of this can include:
Diarrhea
Hair loss
Cognitive deficits
Stunted physical growth
These effects are life-long, and these surgeries are irreversible. Not to mention, while the child’s body is malnourished, they will likely gain the weight back over time (so it doesn’t even work!).
The side effects of the recommended weight-loss medication are unknown, but we do know that there is no medication that has been shown to provide long-term weight loss. A child would have to be on this medication potentially forever, despite the side effects. If they stopped taking the medication, sometimes there’s weight gain beyond what they weighed in the first place.
Bottom line? These recommendations are harmful and ineffective.
“Medical Complications” of Obesity
So the theory is that pediatricians are recommending these new AAP guidelines in order to prevent children from having medical complications from obesity. But exactly what complications are they talking about?
Herein lies the problem: no one has identified any medical complications that are exclusive to bigger people. It’s just stigmatized when it’s a bigger person.
For instance, it’s a common myth that diabetes is caused by weight; there are many slender people with diabetes. The sad reality is that often, bigger people receive worse medical care because their issues are blamed on their weight.
This begs the question: is it possible all the illnesses we equate with medical complications of weight are ACTUALLY medical complications of bad medical care?
Additionally, the complications of weight stigma – not being able to fly on a plane, not being able to ride on a roller coaster, not being able to find comfortable clothing – lead to stress. And of course, stress leads to high blood pressure, high cholesterol, and diabetes… which is often blamed on weight alone.
Weight Gain or Loss as Information
As we all know, there are stories of people with medical complications who lose weight and see their medical complications improve. There are two problems with this:
It’s not sustainable. If they gain the weight back, we haven’t really solved anything.
They usually still have the medical condition, but it just has to be managed differently.
Sometimes, it might seem like they’ve been cured of their illness. But it’s usually just temporarily masked by the results of starvation.
Weight change is what dietitians care about. Not what someone’s weight is compared to a chart or someone else, but what their weight is compared to themselves. When someone dramatically gains or loses weight, that can be an indicator of an underlying problem.
Weight can’t be the thing we say causes every medical issue. Often, it’s the result of their issue.
Ultimately, weight should be taken as information. The hope is that all medical providers are weight inclusive, and will treat someone’s medical conditions independent of their size. We have a long way to go, sadly – but we’ll keep progressing, one step at a time.
Tweetable Quotes
“Anyone who works in the eating disorder field at all – and probably many humans – know multiple people, if not themselves, that have had failed weight loss interventions when they were children that then resulted in bigger problems.” – Jessica Setnick
“The key is not to just single out the big kids. Any kid with an eating disorder should be evaluated. Any kid with a medical condition should be evaluated.” – Jessica Setnick
“Shrinking children does not change their medical conditions.” – Jessica Setnick
“‘Does my child have a medical condition or are you saying my child is too big? Because if it’s a medical condition, we’d like to get treatment independent of his size. But if you’re saying his size is a problem, that’s not a conversation I’m willing to have.’” – Jessica Setnick
Resources
News release for the AAP new guidelines
More From Rachelle
Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
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