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MAD! New AAP Guidelines for the “Treatment of Childhood Obesity”

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Have you heard of the new recommendations from the American Academy of Pediatrics (AAP) for the treatment of “childhood obesity?” If not, this will probably make your head spin. Before I get into the specific guidelines, what they mean, and the concerns of medical professionals, I want you to think back to your own childhood.

If you grew into a larger body, focus on how doctors, family, parents, and peers treated you, and focus on your body size.

Has your doctor ever insisted on testing your blood sugar at every visit simply because of your weight with no other indication that you might be diabetic? Did your parents force you into a weight loss program like Weight Watchers or LA Weightloss?

Have you ever been treated differently by your peers because you didn’t have the same clothes as them? Were you made to wear a completely different uniform or costume than everyone else because it was the only option available in your size?

“Obesity” as a disease

If you research how “obesity” has been classified as a disease, it might surprise you. About 10 years ago, the American Medical Association (AMA) asked its Committee on Science and Public Health to decide whether to classify obesity as a disease or simply continue to consider it a risk of chronic diseases.

The committee produced a 5-page opinion suggesting that obesity should NOT be classified as a disease for several reasons. The reasons for this are: Obesity does not meet the definition of a medical disease, if you consider the human history of adaptation to store calories during times of starvation – it actually indicates that larger bodies are more effective, and they fear that the medicalization of obesity could harm patients by creating more stigma and leading to ultimately useless ‘treatments’.

At WADA’s annual meeting in the summer of 2013, Resolution 420: “That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance the treatment and prevention of obesity” passed by an overwhelming vote, in complete disregard of their own committee’s recommendations.

Ok, now that we’re in the right frame of mind to discuss these new AAP guidelines, let’s get started…and get ready.

What do the new guidelines say?

One of the main recommendations of the new guidelines for the treatment of “childhood obesity” is intensive behavioral and lifestyle therapy. This includes things like nutritional advice, physical activity and ‘behaviour changes’. Ideally, this would involve 26 hours of in-person treatment over the months. One problem with this recommendation is that it will take some time before the therapy is available, which brings us to the most concerning parts of these guidelines, as they are more readily available.

The AAP now recommends weight-loss drugs for children 12 and older diagnosed as “obese.” It is recommended that children 13 years and older who are “severely obese” undergo bariatric surgery. This would include those whose body weight is in the 99th percentile for age and sex.

Why are these new guidelines problematic?

If there’s one thing we already know about these fad weight-loss drugs that will now be prescribed to children, when people stop taking these drugs, most gain weight back. This means that once a child receives these drugs, they will need to take them for the rest of their life.

People who undergo bariatric surgery are at risk of suffering from eating disorders after the surgery, which can be very dangerous due to the way the body needs nutrients after the operation. They are also at risk for alcohol problems as they age after the operation.

Medications and surgery are the parts of the guidelines most discussed by online health professionals, as these are likely to be the options chosen by health professionals, as behavioral and lifestyle therapy is not readily available at the moment.

We asked @paulina.the.therapist (MHC-LP) on TikTok for her take on these guidelines as a mental health counselor. She declares, “Big ones are not a problem to be solved. The negative consequences of weight stigma are well documented, yet obese people are treated as subhuman at systemic and interpersonal levels.

“The AAP does not mention or warn pediatricians about eating disorders or eating disorders. Instead, they recommend actions that are known and documented risk factors for eating disorders. diet with a totally inadequate mention of how weight stigma and discussion about weight can increase the risk of developing an eating disorder.Our children are among our most vulnerable and impressionable populations. It has been shown time and time again that a focus on weight does not lead to positive health outcomes, quite the contrary, and yet the anti-fat bias runs so deep throughout the medical industrial complex that recommendations as dangerous are made in spite of everything. It was never a question of health.

@nursingtheoryprof (PhD RN) on TikTok states, “As a self-management researcher, I am also troubled by how these guidelines do not meaningfully address weight stigma, including how the approach recommended here might make children feel stigmatized by their suppliers. This could be demotivating over the course of a child’s life, especially if most visits focus on weight. If children feel reduced to their weight in the eyes of their caregiver, and then their home life is constantly focused on weight, they are likely to become discouraged and resistant to health behaviors as they progress. and as they develop into adolescence.

“What I find most important about these guidelines is that they pay lip service to the social determinants of health. All behavior change plays assume that all families have access to the same food choices, safe spaces for physical activity, the ability to enroll in after-school activities, and so on. In fact, the families least able to make the healthy choices asked of them are also the least likely to have access to recommended medications and surgery.

What are we doing to fight against these recommendations?

Weight Inclusive Nutrition and Dietetics (WIND) brings together a team of health professionals and advocates for the inclusive weight space, including Patrilie Hernandez of Embody Lib, Dawn Lundin of Restore Dietetics, Ragen Chastain and others to address these new guidelines.

WIND focuses on how these guidelines affect the most marginalized communities, the future implications and impact on families, and how this may shape provider and insurance plan policies.

WIND states, “Clinical practice guidelines have the potential to harm children and further perpetuate weight stigma. This working group is dedicated to reviewing guidelines and promoting evidence-based, weight-informed approaches to healthy children. In the weeks and months since the guidelines were released, the group has met regularly and is working on:

  • An in-depth review of over 800 cited references, including analysis of a handful of studies to identify design flaws and flawed conclusions
  • A resource that serves as a one-stop-shop for articles, podcasts, and media responses to clinical practice guidelines so far
  • A signature letter outlining the potentially harmful consequences for children if the guidelines are implemented in their current form. The letter also provides a call to action for anyone looking to engage in advocacy around this issue.

All of this will be revealed to the public during a webinar organized by WIND in mid-summer 2023.

If you are concerned about these new guidelines for your own child, we recommend that you ask your pediatrician about not talk to your child about his weight.

You always have the option of telling your child’s doctor not to comment on your child’s body or discuss BMI in front of him. If the provider does not agree, it is worth looking for a new doctor.

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