Guidelines, Quibbles and Quirks — Part 6

In the debates over the January news from the American Academy of Pediatrics, some serious points of contention exist. It is not enough that certain physical benchmarks be checked off the list to make major surgery permissible. Certain other factors need to be in place also, like the patient’s fully informed consent.

As things stand, a child who is bleeding out or drowning may be saved by anyone who is prepared to do it — even if neither parent is on the scene to sign a consent form. And certainly, the imperiled child is not offered a document and a pen. Water aspiration and rapid exsanguination are examples of life-threatening situations, where the response must be swift and decisive, so legal niceties can be put aside.

How is this different?

The argument is made that morbid obesity is also a life-threatening condition, only on a longer timescale. But does that make it acceptable for adults, even parents or legal guardians, to step in and authorize the almost-total removal of an irreplaceable major organ?

If a child is born with an orofacial cleft, parental permission is enough to proceed with reconstruction, and no one has a problem with that. Irreversible surgery on a minor child happens every day in the case of routine neonatal circumcision, for which there is much less justification than for what used to be called a harelip. However, surgery without the patient’s fully informed consent does raise some ethical questions.

Currently, law enforcement officers may capture and confine a person who intends and prepares to take their own life. Some individuals fear a nightmare scenario where the authorities could just take anyone into custody and remove most of their stomach for that person’s own good. Even among advocates of bariatric surgery for the young, many of those who theoretically approve would like to see more forethought exercised on a case-by-case basis.

How far is too far?

We mentioned Medical Students for Size Inclusivity, whose spokesperson Jessica Mui also wrote of the absurdity of expecting adolescents to “risk their lives and well-being in an attempt to make their bodies smaller”:

Weight loss surgeries take healthy, functioning organs and put them into a permanent disease state by reducing digestive hormone production, absorption of nutrients, and result in frequent complications. If we recommend these life-altering surgeries that come with a constellation of health risks for vulnerable youth as young as 13, we as medical providers are acting in direct opposition to our duty to “do no harm.”

(To be continued…)

Your responses and feedback are welcome!

Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Image by Photo by Jason Rosewell on Unsplash

Guidelines, Quibbles and Quirks — Part 5

Some things never change. There is very little likelihood that the United States will ever adopt the metric system for general use. Blue jeans will always be in style. And probably, the Body Mass Index will continue to be how the establishment decides whether or not a human is fat.

The BMI standard has always been controversial. Dr. Danielle P. Burton recently called it an antiquated system and explained,

BMI was never intended to be used as a measurement for health, and our current growth charts are based on data from the 1960s through the early 1990s. Are these outdated measurements truly the best measure of health?

A widely-held position is that obesity should not be determined by a lone data point, but by an array of them. Most things in life are on a spectrum, and ideal body weight is no exception. Gyms are full of living proof there is no exact cutoff point between fitness and the shame of being unacceptably big. A desperate need is felt for the culture to at least admit the possibility that size diversity and health could co-exist. When surgery is recommended, especially for kids, there is a hunger for evaluations that include the patient’s mental health status.

Stirring the pot

Meanwhile, policies uttered by the American Academy of Pediatrics at the beginning of this year focused intense attention on BMI once again. One expert who reacted is Dr. Kim Dennis, co-founder and medical officer at SunCloud Health, who says,

I think we do more harm than good when we […] say, ‘Based on the fact that your BMI is, you know, 28 or 30, you have a disease. By pushing people to get into this normal weight range, we’re only causing eating disorder behaviors.

It is no wonder that the recent news has been met with questions, concern, and outrage from practitioners and parents alike. Childhood Obesity News explored the concept of iatrogenesis. Many critics have mentioned ways in which the ideas could be dangerous for kids:

[T]he AAP released guidelines that recommend actions that are known top risk factors for eating disorders with almost no reference to how discussing weight and BMI can increase eating disorder risk. It is not helpful to reduce the number of children with obesity if they are driven toward the top risk factors for the second most deadly mental health illness.

Speaking on behalf of the grassroots advocacy organization Medical Students for Size Inclusivity, Jessica Mui noted that by focusing on the “flawed tool” of BMI, the AAP guidelines “are based on science that grossly misrepresents the complex relationship between weight and health.” To insist that weight loss is the chief measure of health is to “further stigmatize the bodies of children whose environments are likely already rampant with weight bias.” Mui adds,

The evidence remains elusive as to whether increased BMI alone is causative of increased morbidity and mortality. This outdated tool does not consider genetic, ethnic, and epigenetic variation or significant factors like poverty, racism, trauma, environment, chronic stress, and weight stigma, all of which negatively affect health outcomes in and of themselves.

When surgery is considered, a high BMI is what is known in logic as a necessary condition, but not a sufficient condition. In other words, a big number signifies that a person is obese enough to be medically qualified for bariatric surgery, but that alone is not enough. In making the recommendation, weight is just one factor, and needs to be regarded in the context of total health.

Your responses and feedback are welcome!

Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Source: “Eating disorder specialists ‘horrified’ by child obesity guidelines,” ScrippsNews.com, 03/07/23
Source: “The AAP’s new childhood obesity guidelines are dangerous. Here’s what to do,” Inergency.com, 03/01/23
Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Image by Ambuj Saxena/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 10

The childhood obesity world is still feeling the repercussions of how the American Academy of Pediatrics greeted the new year by releasing new guidelines that inspired reactions like this one from Dr. Catherine Devlin:

I am horrified, alarmed and concerned… First of all, I think that these guidelines need to just be completely thrown out.

The founder of Birch Tree Psychotherapy is not the only expert whose feeling could be described as outrage. Among other specifics, Dr. Devlin points out that the regimen demanded after bariatric surgery (and for the remainder of life) is very difficult for adults, and for children and teens, strict adherence must be closer to “a nightmare.”

Journalist Meg Hilling also consulted eating disorder specialist Nooshin Kiankhooy, whom we have previously quoted on the matter of inadequate evaluations before recommending surgery. This is not the only potential damage, says the founder of Empowering You. Kiankhooy told the reporter,

I have had some clients that have been put on diets at very, very young ages. Then they come to my office 10, 15 years later because they are put on weight loss at the age of 12, or they went to some clinic at a local hospital where they were told that carbs were bad.

Some authorities are even rehashing earlier controversies, like when the American Medical Association, a decade ago, recognized obesity as a disease, or further back when the National Institutes of Health said, “Obesity is a complex multifactorial chronic disease.”

There are reasons, like eligibility for insurance coverage, why this is good. But on the other hand, points out Dr. Kim Davis, some kids are being made to feel as if they themselves are a disease, and this is massively counterproductive.

In an interview with Pharmacy Times, Sheldon Litwin, M.D., pointed out, as so many have, that there is not much data on the use of weight-loss drugs on children and adolescents, since “we’ve only been using them really for 5 to 10 years, and the high potency ones probably about 5 years or so.” On the other hand, incretin mimetic drugs appear to be safe because they are analogs of naturally occurring hormones.

“It’s not really something exogenous, it’s just giving you a pharmacologic type of effect as opposed to a physiologic dose.” On the third hand, the same could be said of cannabinoids, which are naturally produced by the human brain, and yet many people are serving time in penal institutions for using plant-derived versions of them.

Your responses and feedback are welcome!

Source: “Eating disorder specialists ‘horrified’ by child obesity guidelines,” ScrippsNews.com, 03/07/23
Source: “Regarding Obesity as a Disease: Evolving Policies and Their Implications,” NIH.gov, 09/01/17
Source: “Expert: Risks, Benefits Must be Considered When Using Potent Anti-Obesity Drugs in Youth,” PharmacyTimes.com, 03/10/23

AAP Guidelines — The Backlash Grows, Part 9

We left off by talking about Body Mass Index and the significance thereof. In 1972, BMI had been deemed the best measurement method. In 1985, the U.S. National Institutes of Health concurred, and in 1997 the World Health Organization did too. What could be wrong with any of that? Well, apparently, BMI measurement does not distinguish between fat and muscle, which are, after all, two very different substances. Also,

BMI can also underestimate the threat for people who are “skinny fat,” as some doctors call those who tend to be fit, but have big bellies. Studies show that this belly fat can be more dangerous for health than any other kind.

The BMI measurements used for children are weighted for age, but when boys go through puberty, they add muscle at a rapid rate; girls add fat. BMI tends to miss these nuances.

And this is no small matter: More accurate methods are too costly for general use.

Jessica Mui reports that the grassroots advocacy organization Medical Students for Size Inclusivity believed that…

The AAP guidelines intensify the focus on BMI and weight loss as measures of overall health and further stigmatize the bodies of children whose environments are likely already rampant with weight bias. As a result of these guidelines, children will learn that their bodies are a pathology… The new AAP guidelines are based on science that grossly misrepresents the complex relationship between weight and health.

Mui pointed out that dieting and a poor self-image are known risk factors in the eating disorder realm, and labeled BMI measurement a “flawed tool.” Not only that, but nobody was absolutely positive that BMI alone causes greater morbidity and mortality. Furthermore,

This outdated tool does not consider genetic, ethnic, and epigenetic variation or significant factors like poverty, racism, trauma, environment, chronic stress, and weight stigma, all of which negatively affect health outcomes in and of themselves.

When surgery is considered, a high BMI is what is known in logic as a necessary condition, but not a sufficient condition. In other words, a big number signifies that a person is obese enough to be medically qualified for bariatric surgery, but that alone is not enough. This year, the recently issued guidelines were met with questions, concern, and outrage by practitioners and parents alike. We have spoken here of iatrogenesis, and this article brings up two reasons why the guidelines are dangerous for children:

The AAP released guidelines that recommend actions that are known top risk factors for eating disorders with almost no reference to how discussing weight and BMI can increase eating disorder risk. It is not helpful to reduce the number of children with obesity if they are driven toward the top risk factors for the second most deadly mental health illness.

Another source confirmed that BMI was never intended to be used as a measurement for health. Weight can be a helpful data point, but it needs to be evaluated in the context of overall health.

Your responses and feedback are welcome!

Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Source: “The AAP’s new childhood obesity guidelines are dangerous. Here’s what to do,” Inergency.com, 03/01/23
Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Image by A Quiverful of Fotos/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 8

Body Mass Index measurement has been a bone of contention in many debates. More than 10 years ago, a study of nearly 15,000 young people led the British publication mirror.co.uk to print,

Health experts said yesterday that using Body Mass Index to calculate whether youngsters are obese is unreliable, especially for girls.

A 2013 article revealed this nugget:

Investigators […] analyzed data on people whose BMI and waist-to-height ratio were measured during the 1980s, looking at death rates a generation later… [T]hey found waist-to-height ratio was a better predictor of life expectancy.

In 2014, blogger Rodney Steadman wrote,

The BMI has become a big problem for some researchers… BMI does not accurately measure body fat in individuals with a high level of lean body mass (body weight minus the fat) and some ethnic groups. Furthermore, the BMI can be difficult to calculate in field settings when body weight cannot be accurately measured.

Meanwhile, parents who just did not like the whole idea argued with schools, and some questioned the ultimate usefulness of BMI information. As TorontoSun.com described in 2015, cultural factors were involved:

[…] BMI information alone may not be enough to help parents in high poverty areas where fresh produce and safe playgrounds to encourage exercise may not be available.

Around the same time, a study found that BMI measurement failed to identify “as many as 25% of children, age 4 to 18 years, who have excess body fat.” The Mayo Clinic’s director of preventive cardiology, Francisco Lopez-Jimenez, said, “BMI is not capturing everybody who needs to be labeled as obese.”

He also said, “That’s because it does have real limitations.”

Your responses and feedback are welcome!

Source: “What is Food Addiction?,” AnonymousOne.com
Source: “Hidden danger: UK’s childhood obesity could be worse than feared,” Mirror.co.uk, 06/18/12
Source: “Is BMI Outdated?,” MedicalDaily.com, 05/14/13
Source: “Absurd, but True?,” WordPress.com, 07/15/14
Source: “Screening teens for obesity may not help them lose weight,” TorontoSun.com, 07/03/15
Source: “Obesity Is Undercounted in Children, Study Finds,” WSJ, 06/23/14
Source: “Calling BS on BMI: How can we tell how fat we are?,” GantDaily.com, 08/16/17
Image by Todd Huffman/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 7

As Dr. Pretlow teaches, it is a lot better to treat the underlying cause of a problem than to treat the symptoms. One reason for this is, treating the symptoms is just not practical. Symptoms are rarely eliminated. They may hide, show up in disguise, or pull some other trick. But the smart money says, get rid of the basic reason for the problem. And that is a very strong incentive to back up and start at the source.

There is another quite convincing reason to work from the ground up. In the early stages, the preferred treatment for an eating disorder is on the behavioral level. Because all humans are fallible, mistakes may be made, but at least they don’t yet involve the routinization of drugs, or the amputation of body parts.

The best reason of all to take it slow is because these are minors. There is some legal stuff involved, to the point where healthcare professionals, administrators, institutions, and even parents might someday find themselves on the wrong side of a jury box. Some things cannot be done to an adult without fully informed consent. But parents can sign a form on their child’s behalf, and that is a mixed blessing that can be either a life-saver or a life-destroyer.

Upcoming professionals

Medical Students for Size Inclusivity is a grassroots advocacy group for which member Jessica Mui writes,

Weight loss surgeries take healthy, functioning organs and put them into a permanent disease state by reducing digestive hormone production, absorption of nutrients, and result in frequent complications. If we recommend these life-altering surgeries that come with a constellation of health risks for vulnerable youth as young as 13, we as medical providers are acting in direct opposition to our duty to “do no harm.” We cannot ask adolescents, who lack the ability to fully consent and manage their bodily autonomy, to risk their lives and well-being in an attempt to make their bodies smaller.

Some individuals fear a nightmare scenario where the authorities could capture a person and remove a big hunk of their stomach for that person’s own good — just as authorities can now capture and confine someone who is preparing to take their own life. In another, much more frequent example, a child who is bleeding out or drowning may be saved by anyone who is prepared to do it — even if neither parent is on the scene to sign a consent form. And certainly, the imperiled child is not offered a document and a pen.

Deep questions

Water inhalation and rapid exsanguination are life-threatening situations, where the response must be swift and decisive, so legal niceties can be put aside. Morbid obesity is a life-threatening condition, only on a longer timescale. Does that make it okay for adults, even parents or legal guardians, to step in and authorize the almost-total removal of a stomach? Some people say no, and many of those who theoretically approve would like to see more forethought exercised.

If a 13-year-old can consent to bariatric surgery, should they also be permitted to consent to other procedures, with or without parental consent?

Irreversible surgery on a minor child does seem to raise some ethical debate points, although it happens every day in the case of, for instance, routine neonatal circumcision. And if a child is born with a cleft lip or palate, parental permission is enough.

Dr. Danielle P. Burton writes of bariatric surgery,

Can a thirteen-year-old truly consent to the lifelong undernourishment caused by such a radical procedure? Can they consent to the increased risk of suicide? While it is great to minimize the risk of potential future disease, it cannot be at the cost of premature death. A key factor in helping our children grow into healthy adults is making sure they live long enough to become one.

Your responses and feedback are welcome!

Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Image by NIH Image Gallery/Public Domain

AAP Guidelines — The Backlash Grows, Part 6

Dr. Pretlow is by no means alone in preferring prevention over cure. Just as a random example, see Dr. Daisy & Co, where the file title “Resource Page for Harmful AAP Guidelines” kind of gives it away.

While not claiming to hold the only answer, the dietitians there treat not “obesity,” but eating problems. They remind us that “Safe, successful and evidenced-based nutrition interventions exist for pediatric eating concerns.” They reject aggressive treatment, restrictive diets, appetite suppression meds (beyond a certain point), or stomach surgery. Like so many others, they point to the lack of long-term research. And they call the American Academy of Pediatrics guidelines “a step backwards.”

Two key words: forethought and evaluation

Psychiatrist Kimberly Dennis, who specializes in treating addictions, eating disorders, and co-occurring disorders, says:

As for referring certain kids 13 years or older for bariatric surgery, my main concern is that there is little data on the long-term physical and mental health effects of this drastic and expensive procedure when performed on young people.

A Swedish study followed up 81 severely obese teens for five post-op years and:

[…] 20 test subjects (25 percent) ended up requiring follow-up surgery because of complications from the original procedure, and 58 subjects (72 percent) showed some type of nutritional deficiency at the five-year follow-up. No mental health screens were listed as having been done.

That last part, about the absence of mental health screening, disturbs not only Dr. Dennis, but Dr. Pretlow and plenty of others. Let’s hear from Dr. Mélanie Henderson, a pediatric endocrinologist and researcher in Canada (which is also developing new obesity treatment guidelines). In that country, at present, a teen may be considered eligible for weight-loss surgery after two years of behavioral intervention.

Dr. Henderson cites the “alarming” rise in obesity that “has led to a greater need for surgery for teens whose mental and physical suffering typically worsens into adulthood.” According to this point of view, there should be more emphasis on not only mental health but on other quality-of-life issues and interventions about which, incidentally, “We don’t have a lot of data.” The report continues,

[A] review of studies over the last decade suggests evaluations of anxiety and depression, for example, are lacking even though those issues are addressed in various intervention programs… Obese children are at three times the risk of depression compared with their non-obese peers due to the stigma and shame…

Medical writer Virginia Sole-Smith makes a strong argument for improvement at the forethought stage, rather than just measuring a child’s BMI and jumping to the conclusion that surgery must be scheduled. She writes,

The step that a lot of people are skipping is the evaluation component… The guidelines talk about an extensive physical laboratory evaluation, evaluation for eating disorders, evaluation for mental health problems. And based upon that evaluation, then we have an individualized treatment plan for that individual.

Nooshin Kiankhooy is an eating disorder specialist and founder of a therapy practice, who spoke with the popular program All Things Considered about clinicians who make evaluations under the current rules:

[W]hat I understand is these evaluations are very short, maybe an hour long, and they’re kind of put on a timeline by the physician or even by the insurance company, right? And that is not at all an amount of time, I think, that can allow for a proper evaluation.

Your responses and feedback are welcome!

Source: “New AAP Guidelines for Childhood and Adolescent treatment of ‘obesity’ Resource Page,” DrDaisy.com, undated
Source: “A Critical Look at New Guidelines for Kids With Higher BMIs,” PsychologyToday.com, 02/11/23
Source: “Ahead of new childhood obesity guidelines, doctors say surgery is an important option,” CoastReporter.net, 02/17/23
Source: “Why the New Obesity Guidelines for Kids Terrify Me,” NYTimes.com, 01/26/23
Source: “This eating disorder expert is worried by new guidelines to treat childhood obesity,” WVIA.org, 02/17/23
Image by michellereyntjens/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 5

Yesterday we mentioned Dr. Danielle P. Burton, who has more to say about the recently revised guidelines of the American Academy of Pediatrics. The document grants only “sparse discussion” to eating disorders, and Dr. Burton continues:

[The guidelines] do not mention the medical complications of eating disorders, which are numerous and far exceed the medical complications of obesity… Eating disorders represent a lethality that far outweighs that of obesity, and at a much younger age.

Does this sound crazy? Perhaps, but she cites research showing that people with anorexia are 18 times more likely to die by suicide, and those with bulimia are seven times more likely to die by suicide than other individuals of the same age and gender.

And, she says, the guidelines “fail to mention that the risk factors for developing an eating disorder are closely related to those for developing obesity.” Which in both cases seems to advance the argument for doing something more than just treating the symptoms. Whether a patient is obese or has an eating disorder or both, it’s all part of the same problem that does not appear to be handled very effectively at present.

The knife

In the field of juvenile bariatric surgery, it seems that the potential for iatrogenic or healer-caused harm is very present. Online forums supply plenty of examples, and complete articles from experienced patients sometimes appear, like the eloquently titled “I Had Weight-Loss Surgery at 17, and It Worked — but It Didn’t Address My Real Problem,” published by Slate.com. Headlines are sometimes awkward, and it is likely that the young woman’s other problems were also real. What we seem to be talking about here are basic, first-cause situations.

The author’s story

Amy Scheiner was diagnosed as obese at age eight, and by 16 was pre-diabetic. At 17, she underwent bariatric laparoscopic banding, or lap-band surgery. It was not a magic bullet. She writes,

[B]y the time I was 23, I had begun having side effects from the surgery, such as frequent vomiting, heartburn, and inability to eat. After an upper endoscopy, I found out I had gastritis, esophagitis, and gastroesophageal reflux disease… It was then I realized that the surgery that was supposed to cure my obesity problem had done a poor job of addressing the underlying issue, which comprised a tangle of mental health and environmental challenges.

Amongst all the doctors and diet experts the author met with, none had ever asked “what was wrong in my family, in my mind, or in the culture… My weight was a symptom of the dysfunction around me.” Consequently, she started therapy, but then bounced from binge-eating disorder to hyper-vigilance, excessive exercising, extreme calorie restriction, and purging. This went on until she was dangerously dehydrated and vomiting blood, and still in semi-denial. “I knew I was sick, but at least I was thin.”

As an adult, Scheiner describes how her entire young life was defined by her physical size, leading to an unhealthy obsession with weight. Although the doctors promised her that having surgery at 17 would make her happier, it did not — but only left her with “more problems to untangle as an adult.” She goes on to say,

I worry for the children who will have permanent bariatric surgeries before they really understand their relationship with food, and self-worth.

Your responses and feedback are welcome!

Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” Psychology Today, 03/04/23
Source: “I Had Weight-Loss Surgery at 17, and It Worked—but It Didn’t Address My Real Problem,” Slate.com, 02/01/23
Image by Wonder woman073/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 4

Last time, this page explored more deeply the concept of iatrogenesis as it relates to the newest American Academy of Pediatrics guidelines. Not surprisingly, in the realm of long-lasting trauma, there is more to say. A lot of it is said by a pediatrician and psychiatrist Dr. Danielle P. Burton, who is herself in recovery from an eating disorder:

Including weight loss pharmacology and bariatric surgery in the AAP obesity guidelines is premature, irresponsible, and dangerous. The dangers of these guidelines increasing suicidality and perpetuating eating disorders are much greater than the risks associated with being overweight or obese.

Dr. Burton is not happy with the AAP’s “sparse discussion of eating disorders” and goes on to say that among teens, suicide is one of the three leading causes of death, the others being accident and homicide. She wrote:

The potential of these guidelines to increase suicide risk is multifactorial. The first is a direct cause: One study, published in January of this year, found that bariatric surgery increases the risk of suicide, especially in the youngest patients.

The second cause is indirect. By promoting fatphobia, these guidelines are likely to increase the risk of adolescents developing eating disorders.

Jessica Mui reports that the organization Medical Students for Size Inclusivity has requested that the AAP rescind the guidelines and re-examine its premises. This grassroots advocacy group of medical students is also worried about potential harm because “children will learn that their bodies are a pathology rather than a variation on the normal spectrum of body shapes and sizes.” The concern here is that kids will regard normal weight gain as a personal failure, which may irrevocably harm their sense of self-worth.

And yet, it would be enormously better to concentrate on eating disorders and do everything possible to cure them early, than to decree, “This this person is obese, let’s bring out the pills or the scalpel.”

Would it not be more beneficial to get the person un-obese in some way that doesn’t pile on additional trauma? Wouldn’t it be preferable to help him or her to unlearn the false coping skills that created obesity in the first place? And incidentally, how can we find in this person’s experience a way to help little kids not ever have to go there?

Your responses and feedback are welcome!

Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Image by Simone Lovati/CC BY-SA 2.0

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