WithAll’s Response to the American Academy of Pediatrics New Guidelines on Evaluating and Treating Children with Obesity

Lisa Radzak, Executive Director

Earlier this month the American Academy of Pediatrics released Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,[1] emphasizing a need for early and intensive treatment as childhood obesity rates have continued to rise over the past decade and a half.

Our children’s physical and mental health need our increased attention. But when the American Academy of Pediatrics and other health organizations and policymakers focus on our children’s weight as a proxy for our children’s health, we fail our kids, again and again.

There are three primary reasons focusing on childhood obesity is not only ineffective, but dangerous to our kids.

First, we are missing the reality that our kids’ health, not their weight, is what needs our full attention. Our culture has linked health and weight such that most adults actually need to pause and consider this point: Health and weight are not synonymous. When we use weight as a proxy for health, we miss the complete and oftentimes most important aspects of our kid’s health.

For kids of all body sizes and weights—focusing on weight misses the key questions of health and childhood development. To make the point: picture a child that has a weight in the “normal” range, who eats only highly processed, trans-fat and sodium-laden foods, who never leaving their couch, and who is always on social media on a digital device. Is this child healthy? Conversely, imagine a child with a high weight who is very active, spends very little time on screens, has a lot of friends, eats a nourishing diet, and is mentally healthy. Which of these two children are healthier?

The second reason a hyperfocus on obesity prevention is ineffective is it creates a false sense that health practitioner or other adult role model can change a child’s weight by raising it as an issue with children and families. Research and practice have shown that when pediatric practitioners use weight, BMI, or percentiles as a communication tool with children, it does not result in positive health outcomes.[2]

Instead, researchers have found doing so increases the shame and stigma the child feels about their body. Which, in turn, contributes to continued or increased unhealthy behaviors. Contrast that to when practitioners talk with adolescent patients about health behaviors the child can control. This is what drives positive health outcomes, according to research.

Lastly, and perhaps most concerning, if the American Academy of Pediatricians continues to hold forth that childhood obesity is a top health concern –while failing to incorporate caution and education about our children’s risks for eating disorders and disordered eating – they are derelict in their duties as children’s health organization. In the 100-page Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity, there is only one mention of eating disorders—set within a large table, as an aside. Every 52 minutes someone in the United States someone dies from an eating disorder. Nearly two million kids who are healthy today will –will—have an eating disorder before they are adults, if nothing is done to change their trajectory.[3]

Yes, childhood obesity rates have risen in the past decade and a half, and at the same time we have seen an explosion of eating disorders—including in children as young as age 5.

For decades the AAP has known of the deep and unaddressed issues of eating disorders in the United States, yet it remains largely silent on the issue at moments when it matters most, including when issuing guidelines on childhood obesity.

The American Academy of Pediatrians needs to apologize for their dereliction of duty. They need to apologize to the thousands of kids who are being diagnosed with eating disorders younger than ever before while the AAP remains largely silent. And the AAP needs to apologize to the millions of kids, now adults, who were treated by pediatricians who caused significant and lasting harm by offhandedly commenting, while in a unique and significant position of authority and power, to a child already living with feelings of shame and helplessness about their weight.

Our kids’ doctors have extreme power when they comment to a kid about their weight. Ask any adult who has lived with an eating disorder their story of the childhood doctor contributing to the eating disorder or setting it off, just by what they said about the child’s weight, BMI or growth chart percentile. Pediatricians do not cause eating disorders, but they are in the most unique and powerful position to stop contributing to the start of eating disorders.

As the guideline states, childhood obesity rates have continued to rise—in spite of billions of dollars and massive, nation-wide efforts to reduce childhood obesity. Why then is the American Academy of Pediatricians doubling down on the already-tried-and-failed approach of a blinders-on focus on children’s weight, instead of focusing on health, overall. Our kids do not doctors teaching them that the priority is “fixing” weight. Our kids need doctors and other adults to teach them that health is what matters. Doctors and other adults need to underscore the importance of key health behaviors that children can control and implement. When our kids learn to focus on these positive health choices that support a healthy mind and body, their weight will follow. And it will be a weight that is healthiest for each child. This, instead of weight-loss drugs for 12-year-olds or bariatric surgery for 13-year-olds, which the AAP is recommending.

WithAll is a not-for-profit organization committed to ending eating disorders by raising awareness and equipping adults to support kids’ healthy body image and positive relationship with food.

What Can I Do?

Although the AAP’s approach is disheartening, we can take action to speak out. And we can advocate for our own children by talking to their doctor about avoiding a harmful focus on BMI, weight, and percentiles.  There is much we cannot control related to our kids’ health and safety, but there is also much we can do.

Would you use your voice in one of these ways this week?

  1. Raise Awareness: Share our response to the AAP’s guidelines with a friend, family member, or news outlet.
  2. Be the Voice Our Kids Need: Share our Guide for Health Care Professionals with your child’s doctor to easily ask them to not talk about weight or BMI in front of your child at well visits.
  3. Share Your Story: As a child or teen, were you negatively impacted by the words of a doctor or trusted adult about weight and diet? Click here or the button below to share your story.
  4. Support Others: Your donation to WithAll will help us reach more parents and health care professionals with simple and actionable ways to protect our kids from eating disorders.

[1] https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/
[2]“Two Girls, One Struggle: Obesity and eating disorders in teens spring from some of the same causes,” by Julie Flaherty, Summer 2012 issue of Tufts Nutrition magazine.
[3] https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/