AAP Guidelines — The Backlash Grows, Part 3

Since the beginning of the year, when the American Academy of Pediatrics issued new advice, emotions have been stirred up, and Childhood Obesity News has been looking at some of the repercussions. Many of the interested parties refer to the guidelines as “aggressive.” Some mean it as a compliment; others, not so much. Personalities who see everything as a battle say that the chronic illness of obesity must be treated like an enemy, with aggressive intervention. This can be mistaken for an attack on obese people.

The culture on the whole seems to prefer to let problems fester, and then attack them vigorously. It is surprising that we have not yet been asked to enlist in a full-scale War on Obesity. (Oops, it seems that we were, back in 2006. But that is a topic for another day.)

Conversely, many practitioners and influencers believe in loving attentiveness, followed if necessary by an intervention that is timely, gentle, and persistent.

Emotionally loaded

We have touched on the concept of insensitivity, along with the shocking lack of training that leaves some medical professionals saying too much, saying the wrong things, or not saying anything at all, when a different response would be more appropriate and useful. We have also explored what happens when the concept of iatrogenic, or healer-caused harm, enters the picture.

Virginia Sole-Smith has a new book coming out, titled Fat Talk: Parenting in the Age of Diet Culture. In a recent New York Times op-ed she wrote,

[W]e cannot solve anti-fat bias by making fat kids thin. Our current approach only teaches them that trusted adults believe the bullies are right, that a fat body is just a problem to solve.

In other words, this is supposed to be about reducing bias and stigma. Sole-Smith points out that we don’t blame kids for having asthma or other chronic conditions, and that blaming them for their weight is counterproductive, to say the least.

Practitioners and parents feel outrage, or something close to it, when contemplating the possible dangers to children, including “irreparable harm.” An uncredited author described two major criticisms of the guidelines:

1. They do not mention or caution pediatricians around eating disorders and disordered eating
2. Focusing on weight does not lead to health. It leads to shame and unhealthy behaviors

Many kids are highly likely to feel shame or self-doubt when they sense an adult is judging or criticizing their weight or food relationship, especially someone in a professional capacity. It is staggering the number of individuals I encounter who… can link the beginning of their disordered eating behaviors to a conversation with a doctor who negatively talked about their weight.

Your responses and feedback are welcome!

Source: “Why the New Obesity Guidelines for Kids Terrify Me,” NYTimes.com, 01/26/23
Source: “The AAP’s new childhood obesity guidelines are dangerous. Here’s what to do,” Inergency.com, 03/01/23
Image by Scott Maxwell/CC BY-SA 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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