More Angles on the Guidelines

In yesterday’s post, we mentioned how eating disorder dietician Christine Byrne, as a matter of principle, does not use the terms “overweight” or “obese.” The words were used in her article only for clarity, because they are employed in the new AAP guidelines.

Today we look at a couple of the ways in which seemingly straightforward thoughts and principles can branch off into disagreements about more particular and specialized ideas. Among other topics, there are fierce debates about whether doctors should mention the advisability of weight loss to juveniles, or even weigh them.

Weight-loss surgery for 13-year-olds has not been advised before, so the author points out that the new recommendations “go against the AAP’s own 2016 guidelines” — which is not, in and of itself, a valid criticism. The concept may be wrong for other reasons, but because it contradicts the group’s previous standard is not one of them. As science marches on, it is quite normal for new discoveries and novel theories to overtake and displace older rules.

The perpetual disagreement continues over whether dieting, “defined as calorie restriction with the goal of weight loss,” is good or bad. Byrne quotes Cheri Levinson Ph.D., clinical director of the Louisville Center for Eating Disorders, who is wary of telling adolescents that they are too heavy, because of the danger of developing an eating disorder. Dietician Elizabeth Davenport agrees, saying,

Dieting is one of the biggest predictors of developing an eating disorder for teenagers, and now doctors will be encouraging kids to diet, even if they don’t use that exact wording.

Doctors are advised to ask young patients whether they skip meals, take diet pills or laxatives, or make themselves throw up. The usefulness of this approach would need to be grounded in a certainty that kids always tell grownups the truth about what they are up to, which is not invariably the case.

Also, it is important for parents and doctors alike to realize that an eating disorder is not “just a phase,” but can be life-altering and even life-threatening. Byrne wrote about the psychological risks of such disorders, as well as the many threats to “heart, bone, brain, digestive, and hormone health.” Speaking of the various bodily systems, but in an opposite direction, there is ongoing resistance against the notion of labeling someone obese if they are not experiencing any actual disease processes.

As for measurements using the Body Mass Index standard,

These curves come from the CDC’s growth charts for individuals ages 2 to 19, and they allow pediatricians to plot each person’s weight, height, and BMI relative to the rest of the population. (Although they’re not based on the current population — they’re based on data collected on American children between 1963 and 1994.)

The standards of normalcy have changed in recent decades, and this detail is a sticking point for many healthcare professionals who are uneasy about the definition of normalcy. Dr. Gewirtz O’Brien is quoted saying:

If I see that someone has always been on the 90th percentile curve, and they’re eating well and moving their body, then I’m happy to see that they’re still on that curve, because it means that they’re developing properly. It’s a red flag when someone rapidly goes down on the growth curve, or when someone rapidly goes up on the growth curve.

Despite this endorsement of allowing leeway, Byrne explains…

[W]ith these new guidelines, pediatricians are being told to recommend weight loss to anyone above the 85th percentile (and weight-loss drugs or surgery to those in higher percentiles) — even if they’ve been there their entire lives.

Your responses and feedback are welcome!

Source: “The New Obesity Guidelines for Kids Are Appalling,”, 02/02/23
Image by Willy Ochaya/CC BY 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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