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In its new guidelines for the evaluation and treatment of children and adolescents with "obesity," the American Academy of Pediatrics (AAP) claims “there’s more evidence than ever” that childhood “obesity” treatment is safe and effective.1
In response, the International Association of Eating Disorder Professionals (IAEDP) prepared a joint statement from its member organizations to the AAP condemning the new guidelines and urging the AAP to revise them.
The “comprehensive obesity treatment” mentioned in the guidelines includes nutrition and weight management, support, physical activity treatment, behavioral therapy, pharmacotherapy, and metabolic and bariatric surgery. Specifically:1
Intensive health behavior and lifestyle treatment (IHBLT)
For adolescents ages 12 years and older with “obesity,” physicians should offer weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment
Teens age 13 and older with severe “obesity” (BMI ≥120% of the 95th percentile for age and sex) should be evaluated for metabolic and bariatric surgery
What’s wrong with these AAP guidelines? According to the International Association of Eating Disorder Professionals, a lot.
The IAEDP's Position
The IAEDP spoke through an emergency task force, comprising a group that included pediatricians, psychiatrists, other physicians, dietitians, nurses, nurse practitioners, and mental health clinicians.
While the task force said it appreciated the good intentions behind the AAP guidelines, the group believes they are uninformed and unsubstantiated by evidence-based research, especially regarding children.
At the same time, the task force argued that these guidelines have the potential to do serious physical and psychological harm to kids and teens, including causing the very outcomes they’re trying desperately to reduce—weight gain and the physical health concerns that can come with higher weight bodies.
The task force believes the guidelines are also steeped in the “harsh and unfair stigma” of the fatphobia in healthcare the AAP claims to denounce. (5) This same attitude can also result in weight gain and worse health outcomes.2
The task force also took issue with a few specific aspects of the guidelines.
Larger body size or higher weight are not valid markers for disease diagnosis. Obesity is not a disease. It is, however, fatphobic.
Rather than define a medical issue, the concept of “obesity” pathologizes larger body size and higher weight. This is stigmatizing, and studies have shown that weight stigma is more responsible for causing poor health outcomes blamed on “obesity” rather than the weight itself.2
IAEDP task force pediatricians were concerned because they know many pediatricians aren’t trained in the complexities, risk factors, signs, and symptoms of disordered eating and potential medical and psychological complications.
Eating disorders have the second-highest mortality rate of all mental health disorders3, yet medical professionals who specialize in treating eating disorders weren’t asked for their input.
AAP treatment guidelines include practices that can cause eating disorders and serious health complications. And we’re seeing this happen to kids who are younger and younger.
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Fighting weight stigma and finding help
Everyone at Within and other IAEDP member organizations have a wealth of experience demonstrating the physical and psychological harm caused by trying to control the body’s relationship with food, interrupting natural hunger and fullness cues, restricting calories, pursuing intentional weight loss, and telling a patient their body is defective to the point where it needs drugs to disrupt a normal body function or surgery to mutilate a perfectly healthy organ. (4)
We are all helpers and caregivers. We have our children’s best interests and well-being at heart. We want to do no harm. But our experience tells us what will happen if these guidelines for medical care are enacted. And it’s not good.
Learn more about unsubstantiated claims, dangerous side effects, unsafe outcomes, and conflicts of interest in the AAP’s new guidelines and what the IAEDP taskforce proposes the AAP do in Fighting fatphobia in healthcare—Part 2: IAEDP asks AAP to revise harmful guidelines for childhood “obesity.”
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
