AAP Guidelines — the Backlash Grows, Part 1

Rather than settling down, it appears that resistance against the guidelines recently issued by the American Academy of Pediatrics grows more vehement as time passes.

Of course, some individuals and groups had plenty to say before January even ended. The Academy for Eating Disorders (AED) warmed up by calling the document a “major shift in perspective,” although diligent readers of past AAP publications believe it was easy to see this coming. Their statement ended by asking the AAP to revise this last edition of the clinical practice guidelines for obesity, and to include input from “key stakeholders” such as eating disorder professionals and actual patients who have lived through these problems and processes.

The AED has three main objections, and one of them is that the Guideline does not have much to say about screening or treatment referral for people afflicted by eating disorders. There is “no clear course of action for healthcare providers to take if an eating disorder is suspected or identified.” This is especially important because it is exactly the type of problem that needs to spotted and derailed early on.


Another concern is that it does no good to recommend that clinicians approach the topic of weight in a sensitive manner, when they are offered no training on how to do that. Furthermore, there is a lack of long-term data on pharmacological and surgical interventions among the pediatric population. Rather than concentrating on individual-level changes like drugs and surgery, the group would much prefer to see more emphasis on structural reconstruction, like changes in food policy, the reduction of food insecurity in the population, and the reduction of stigmatizing attitudes in people’s minds.

Also criticized the lack of information on how “eating disorders can and do emerge after weight-loss surgery.” Another objection is, to put it delicately, “we wonder about the independence of the AAP recommendations given the financial reliance on pharmaceutical companies that is often required to investigate medication efficacy.”

The AED quotes the Hippocratic Oath, especially the part about “First, do no harm.” And mention of the oath leads into another ancient concept, iatrogenesis, derived from the Greek words for healer and causation. The AED feels that all the explicit focus on weight loss, in the ideas and practices being advocated, carries the potential for iatrogenic effects on some patients.

In the medical universe, that is a very scary word, partly because it has shades of meaning. In the most benign sense, it refers to problems that are not considered to be in the natural course of an injury or illness; harm that results from diagnostic procedures or medical treatment but without any intention. Charging a doctor with causing an infection would be a whole different level of an accusation than charging a hospital ward with causing one.

(To be continued…)

Your responses and feedback are welcome!

Source: “The Academy for Eating Disorders Releases a Statement,” Newswise.com, 01/26/23
Image by Johan Lange/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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