The New AAP Childhood O*esity [Misguided] Guidelines: Unpacking Weight Bias, Stigma, and Fatphobia

Content warning: The following contains language and topics surrounding childhood “o*esity,” weight stigma and bias, and fatphobia that may be triggering to some. 

Alright, we’re going to get right to it. Wit and anecdotes escape me in the face of something that has me teetering on the brink of both distress and outrage. If you haven’t heard yet, the American Academy of Pediatrics (AAP) recently released new clinical guidelines for the treatment of o*esity in children. The report is long and comprehensive, but the key changes lie within the level of ferocity pediatricians and other medical professionals now address treatment for children who they label as "o*bese."

The New Guidelines: A Summary of the Alarming Recommendations

Rather than “watchful waiting” (the previous approach to “treating” children labeled as o*ese), the guidelines now give the nod for clinicians to:

• Evaluate and “treat” children labeled as o*ese from ages 2 and up, which could include weight-loss dieting and food restriction.
• Advise and prescribe children as young as 12 years old to take weight loss pills and supplements as a part of a “treatment approach”
• Consider metabolic and bariatric surgery to promote weight loss in children as young as 13 years old

Several problematic (at best) assumptions underpin these guidelines: 

• That living in a larger body is a problem to be fixed – and one that potentially needs to be fixed by means of pills and surgery
• That BMI – the measure used to define and determine “obesity” – is a valid and reliable measure for physical health
• The physical “benefits” of these proposed treatments for children outweigh the potential long term physical and mental health problems that could be created and perpetuated by the treatment itself

Implications of the AAP Guidelines: Connections to Eating Disorder Development

These “treatment options” are unsettling, dangerous, and serve to further stigmatize children who may already be experiencing stigmatization because of the fatphobic lens through which others see them. As a child, having a medical professional label you as “o*ese” can, in and of itself, cause and perpetuate negative self-esteem, depression, and even disordered eating behaviors – all of which have potential long-term consequences on the child’s physical and mental health.

Consider the Following Eating Disorder Statistics:

• As of right now, 9% of the population will develop an eating disorder in their lifetime. 
• During and immediately following the initial stages of the Covid-19 pandemic, admissions to in-patient eating disorder treatment centers doubled in adolescents
• Children who use diet pills are six times (!!) more likely to be diagnosed with an eating disorder within 3 years, compared to those who do not use diet pills (National Alliance for Eating Disorders). 
• Eating disorders are the second most deadly mental illness, only after opioid overdose.

Bearing these few statistics in mind (that merely and hardly scrape the surface of the severity and danger eating disorders pose), we must ask ourselves what is at stake. What message do these guidelines send to our children? And what will be the impact of that message?

The Message the Guidelines Send: Weight Bias, Stigma, and Fatphobia

Plainly stated, these guidelines serve to legitimize fatphobia and vilify larger bodies. With so many people already at odds with their own bodies as a result of fatphobic messaging, marketing, and societal functioning, these guidelines normalize and perpetuate the false narrative that one is most worthy and valuable when they exist in a small body. And if this feels like a lot to take in as an adult, please remember that these guidelines now serve to direct conversations about weight for children as young as 2 years old. 
What's more is the irony in the fact that, conveniently tucked into the comprehensive guidelines that attempt to justify the use of drastic weight loss interventions for children, there is a call to end weight bias and stigma. There is even a line that implores pediatricians to, “ . . .uncover and address their own attitudes regarding children with obesity.”

Perhaps that’s where the guideline should have both started and stopped.

The report itself is predicated on the very stigma that it acknowledges as problematic. The guidelines now provide a “justifiable reason” for medical professionals and those in the community to act on their fatphobia by means of drastic weight loss intervention in children. It is imperative, now more than ever, that we demand for health professionals who care for children to shift their focus from “treating o*esity” to addressing, recognizing, and ending the stigma and discrimination children will now be even more subject to as a result of these guidelines.

The children in our lives – our own children, siblings, nieces and nephews, students, friends – are looking to us to determine the lens through which they see themselves: their lives, their bodies, their worth. They are looking to us to help them make sense of the world and the messages it throws at them. They are looking to the adults in their lives to help them approach their health and well-being in a way that sets them up to live a life in color, one where they know they have value and are worthy– in a small, medium, or large-sized body – and the AAP's guidelines not only fail to aid in that mission, they actively hinder it. 

It is critical that we unite around the shared goal of promoting the long term physical and mental health and wellbeing of the children and adolescents in our lives, and one of the most important places to start is to ensure they know that their body is not a problem to be fixed. And it is up to us to model this in our own lives and advocate for it in theirs.

By: Erika Muller, Assistant for Wildflower Therapy LLC

All images via Unsplash

How Can Eating Disorder Therapy in Philadelphia Help You?

If you’re looking for someone to come alongside you to help you unpack and approach the the complex set of emotions you may experience throughout your eating disorder recovery journey, our therapists in Pennsylvania are honored to help!  You can get to know a little bit more about them here and book a free consultation here.

Other Mental Health Services Provided by Wildflower Therapy, Philadelphia, PA

Life is a unique journey for each of us, and we all have our individual battles to fight. Our therapists know there is no one-size-fits-all approach to any of life’s difficulties and we offer many unique perspectives and approaches to help meet you where you are with our Philadelphia, PA Therapy services.

We offer services for eating disorder therapy, services for anxiety, and depression, and have practitioners who specialize in perinatal mental health , maternal mental health, therapy for college students and athletes. As well as LGBTQIA+ Affirming Therapy. As you can see, we have something to offer just about anyone in our Philadelphia, PA office. Reaching out is often the most difficult step you can take to improve your mental health. We look forward to helping you on this journey!