American Academy of Pediatrics’ New Guideline on Childhood Obesity has Dangerous Recommendations
Updated: May 30
On January 9th, 2023, the American Academy of Pediatrics (AAP) released a publication for the first time in 15 years recommending that children and adolescents should be put on medication or undergo surgery to treat obesity, based on their BMI.
The publication release comes just 17 days after the FDA approved the use of Wegovy, a weekly weight loss drug used to treat diabetes, in kids aged 12 and up.
Although obesity can lead to health complications depending on each individual case, the recommendations being made in the new AAP guideline are “quick fixes” and are in no way sustainable or ideal for the treatment of obesity.
Not only that, they are promoting treatments and beliefs that increase the chances of children developing disordered eating behaviors as well as other mental and physical complications.
Encouraging dieting, surgery, and medication to promote weight loss blames children for being overweight rather than solving the actual problem of why it’s happening. Some examples of long-term solutions to preventing and treating childhood obesity include:
Increasing access to healthy, good-quality food in food deserts,
Creating safer neighborhoods with areas to exercise,
Reducing the amount of processed foods and the chemicals within them,
Educating children and parents about intuitive eating and how to make your body healthy for the sake of health, not body size,
Making efforts to fight back against weight stigma and the idea that you have to be small to be healthy and happy, which is untrue.
Recommending that children need to change their body size with such drastic and dangerous measures does nothing but further stigmatize children with large bodies. This will cause harm to those children through trauma, bullying, and supporting weight-phobic ways of thinking.
The AAP is also encouraging behavior that leads to the development of eating disorders. Here is a breakdown of what they are recommending and how it can lead to disordered eating behaviors:
Dieting
Dieting involves restricting food types or entire food groups, counting calories, and labeling foods as “good” or “bad”. Restriction, fixating on numbers for weight loss, and moralizing foods are eating disorder behaviors. Restricting foods viewed as “bad” creates negative relationships with food and can lead to binging episodes, which is another eating disorder behavior.
Dieting can also involve counting calories, commonly seen in those suffering from eating disorders because it becomes an obsession. Dieting fails 95% of the time, meaning, the weight loss is very unlikely to stay off. Regaining weight, or weight cycling, is actually worse for your health than maintaining a stable weight, regardless of your body size.
Adolescence: phase of life with the highest risk of developing eating disorders
While kids are developing during adolescence, this time of their life is when they have the highest risk for developing an eating disorder. One major reason for this is that they are going through a lot of major changes during this phase of life, and eating disorders are often used as a way to control what is happening in their life.
It’s also when they are trying to figure out who they are as a person while being exposed to what they “should” look like by the media, their friends, and sometimes their family. If parents have fixated on their weight, dieting, or had a negative body image around their child as they were raised, it would have a major impact on how they view themselves during adolescence, and likely long before.
Having a negative body image, regardless of how it was caused, has a high chance of developing into an eating disorder in order to fit into whatever is believed “should” be. Doctors promoting this idea further by placing the blame on the child for their weight reinforces this whole problem.
Closely monitored weight and diet
Wanting to change your body for the sake of health is not a problem. However, encouraging children to change their bodies simply because of their size, is. Doctor visits, conversations with parents, or anything else that makes a child believe they are fat, can lead to body dissatisfaction.
If a child has a negative body image, it can cause low self-esteem and depression, which leads to disordered eating behaviors to try to correct what they believe is wrong with them. Alternatively, if a child has a positive body image, they are more likely to feel confident and practice healthy behaviors, making them less likely to develop an eating disorder.
It is clearly stated throughout the guideline that the treatments proposed are not effective unless they are done over a minimum of 3-12 months. If the child receiving treatment feels bad about themselves, it’s not likely that they will stick to this type of treatment for that long.
Being fixated on a child's weight and diet, especially for that long of a time period, is going to result in the child doing the same: fixating. This will cause the child to continue to practice those disordered eating patterns throughout their life.
Whether or not a child sticks to what the AAP is recommending, none of it is a long-term solution:
95% of people who diet regain the weight within three years,
It’s unknown what the effects of weight loss drugs do to kids,
Regaining some amount of weight after bariatric surgery is expected based on the effect it has on adults,
Developing disordered eating behaviors in the process of this "treatment" will cause either weight gain from behaviors like binging, or unhealthy weight loss from behaviors like restriction or purging.
All the while, the attitudes promoting weight stigma are being reinforced.
Not only is all of this dangerous to children's body image and mental health, but it’s also dangerous to their physical health too.
Wegovy
Wegovy is a once-weekly injectable prescription medication that is used in adults to help them lose weight and treat diabetes. It has now been approved by the FDA to be used in adolescents aged 12 and older, and is now being recommended by the AAP to use on children considered to be obese.
According to Wegovy’s website, here are the possible side effects:
Inflammation of the pancreas (pancreatitis)
Gallbladder problems
Increased risk of low blood sugar in patients with type 2 diabetes
Kidney problems (kidney failure)
Serious allergic reactions
Change in vision in patients with type 2 diabetes
Increased heart rate while at rest
Depression or thoughts of suicide
The most common side effects of Wegovy® may include: nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, and heartburn.
Adolescents with large bodies, who are already at a high risk for developing eating disorders and depression because they may have a negative body image as a result of the messages being fed to them that their bodies are “wrong”, are now recommended to take a weight loss medication that can cause serious health complications and depression?
This is yet again another example of how this guideline is in no way proposing a long-term solution for children with obesity, but rather a quick fix with dangerous consequences.
Bariatric Surgery
Bariatric surgery is also being recommended to adolescents, as young as 13 years old, which is a type of weight loss surgery that involves manipulating the digestive system to control how many calories are able to be consumed and absorbed (Cleveland Clinic).
In order to prepare for the surgery, you are required to follow a specific diet for a few weeks before the surgery takes place. This is problematic because, as stated previously, it’s not okay to encourage children or adolescents to diet.
According to the University of California San Francisco (UCSF) website, this is what you can expect during recovery from bariatric surgery:
“In the early days and weeks after surgery, it's normal to experience fatigue, nausea and vomiting, difficulty sleeping, postsurgical pain, weakness, light-headedness, loss of appetite, flatulence and gas pain, loose stools, and emotional ups and downs”
Once released from the hospital, you’re required to follow specific diet and activity instructions. For 3-6 weeks, you’re expected to avoid strenuous activity (UCSF).
How do you think a 13-year-old would feel after this surgery? How would it impact them socially and educationally in school? What kind of effects would all of this have on them mentally?
According to the National Child Traumatic Stress Network (NCTSN) up to 80% of children and their families experience traumatic stress after a painful medical procedure. These stress reactions “impair daily functioning and affect treatment adherence and recovery” (NCTSN).
All of these issues aside, it’s important to remember why this idea even being brought up to an adolescent is such an issue. It’s sending a message that their body is wrong, it’s their fault, and therefore needs to be changed with drastic measures.
Imagine the impact that will have on the children and adolescents that will experience this now as a result of these new recommended guidelines. It’s a recipe for a major increase in the development of disordered eating behaviors and full-blown eating disorders. Not to mention depression, PTSD, anxiety, etc.
We can’t predict how children’s bodies are going to change over time, and it’s ridiculous to suggest such drastic and dangerous measures at such young ages.
Overall, this guideline of recommendations by the American Academy of Pediatrics promotes the exact ideologies that cause weight stigma and negative body image in children and adolescents that cause eating disorders, recommends incredibly dangerous short-term “solutions” for childhood obesity that does more damage than good, is taking the easy way out by putting the blame on children rather than the food and diet industry, and is setting an example that they care more about the gains of big pharmaceutical companies than the wellbeing of our children.
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Sources:
American Academy of Pediatrics. (2023, January 9). American Academy of Pediatrics issues its first comprehensive guideline on evaluating, treating children and adolescents with obesity. Home. Retrieved January 15, 2023, from 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/
Cleveland Clinic. (n.d.). Bariatric (weight loss) surgery: Types & requirements. Bariatric Surgery. Retrieved January 15, 2023, from https://my.clevelandclinic.org/health/treatments/17285-bariatric-obesity-surgery
Indication and important safety information. Wegovy® Side Effects | Wegovy® (semaglutide) Injection 2.4 mg. (n.d.). Retrieved January 15, 2023, from https://www.wegovy.com/taking-wegovy/side-effects.html
The National Child Traumatic Stress Network. (2018, March 19). Effects. The National Child Traumatic Stress Network. Retrieved January 15, 2023, from https://www.nctsn.org/what-is-child-trauma/trauma-types/medical-trauma/effects
University of California San Francisco. (2022, October 12). Recovering from bariatric surgery.UCSF Health. Retrieved January 15, 2023, from https://www.ucsfhealth.org/education/recovering-from-bariatric-surgery