An Intuitive Eating Dietitian’s Thoughts on the New AAP Guidelines
Today’s post comes from Kelsey Chadwick, MS RDN
I’m not sure where to start on this one. I have so many thoughts and emotions towards this week's topic: the new American Academy of Pediatrics (AAP) guidelines for treatment of children and adolescents with “obesity.”
These new guidelines, “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity” were published online at the beginning of January. After reading through them, I couldn’t help but feel disheartened. These guidelines were published for ages two and older. Yes, you read that right, age two! As someone who works closely with individuals with disordered eating and eating disorders, I can’t help but think of the harm these new recommendations will do for years to come.
I first want to start with pointing out some of the main takeaways and recommendations from the guidelines:
Naming “obesity” as a threat to “children’s current and future health” and defining it as a “complex chronic disease.”
Offering BMI as “a validated proxy measure of underlying adiposity that is replicable and can track weight status in children and adolescents.”
Suggesting the use of weight loss medication and bariatric surgery in the treatment of “obesity.”
We have known for some time now that weight does not equal health and living in a larger body does not indicate poor health. These guidelines are rooted in weight bias, weight stigma and victimization. These guidelines further entrench the healthcare world into diet culture, something I work so hard to take down every day. We also know that dieting is one of the strongest predictors of developing an eating disorder. Furthermore, I’d like to share some statistics on eating disorders and adolescents:
81% of 10 year old children are afraid of being fat (1)
35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives (2)
46% of 9-11 year-olds are “sometimes” or “very often” on diets (3)
42% of 1st-3rd grade girls want to be thinner (4)
These statistics are quite alarming and my fear is with these new guidelines these numbers will only increase. It is also important to note that research shows “people in larger bodies are half as likely as those at a ‘normal weight’ or ‘underweight’ to be diagnosed with an eating disorder.” You can not simply look at an individual and know if they have an eating disorder. You do not have to be at a certain weight or size to be worthy of treatment.
Now, I cannot write this post without briefly mentioning the flaws and harm the BMI scale has done and continues to do. The BMI was invented in the 19th century by a Belgian scientist, Lambert Adolphe Jacques Quetelet. Quetelet was by no means a physician and did not study medicine. He created this formula as a quick way of quantifying a population's weight. The population he chose to base his formula off of is (surprise, surprise) white Western Europeans, specifically French and Scottish men. When he was creating this formula, he even specifically noted that it should and could not be used on an individual basis. More to come on this topic in a future blog post!
These guidelines do not respect the natural diversity of body sizes. It uses language including “obesity” and “overweight,” which is rooted in anti-fat bias. As I write this, I can only think of the harm these recommendations have already done in the month or so of being published. These guidelines fuel my fire and passion for helping individuals create a positive and peaceful relationship with their body and food—something these guidelines will only prevent. If you have experienced anti-fat bias and weight stigma please know there are Health At Every Size and Intuitive Eating aligned medical practitioners out there. And if you feel you need professional support to explore your relationship with food while navigating diet culture, you are welcome to reach out to us here.
McNutt, S. W., Hu, Y., Schreiber, G. B., Crawford, P. B., Obarzanek, E., & Mellin, L. (1997). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: the NHLBI Growth and Health Study. The Journal of Adolescent Health, 20(1), 27–37.
Boutelle, K., Neumark-Sztainer, D., Story, M., & Resnick, M. (2002). Weight control behaviors among obese, overweight, and nonoverweight adolescents. Journal of Pediatric Psychology, 27(6), 531–540.
Gustafson-Larson, A. M., & Terry, R. D. (1992). Weight-related behaviors and concerns of fourth-grade children. Journal of the American Dietetic Association, 92(7), 818–822.
Collins, M., H.S.D., M.P.H. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10(2), 199-208.