The New AAP Childhood Obesity Guidelines are Appalling: What you can do to keep your children safe
According to new guidelines from the American Academy of Pediatrics (AAP), published in Pediatrics on January 9, pediatric healthcare providers are now advised to provide “immediate, intensive obesity treatment to each patient” as soon as they are diagnosed. The new AAP guidelines on childhood obesity, has updated its previous mandate from one of “watchful waiting,” or delaying treatment to see if the child outgrows obesity. The AAP is now advising pediatricians to “offer treatment options early and at the highest available intensity,” which includes medications and surgery for some young children. This is appalling for a few reasons, including the fact that these children are still growing and developing mentally, emotionally, and physically.
The interventions are requiring at least 26 hours of face-to-face counseling over three to 12 months of intensive behavior and lifestyle treatment, including coaching on nutrition, physical activity, and changes in behavior. This approach is for kids 6 years of age and older, and may be recommended for toddlers as young as 2. After intensive therapy, weight loss drugs are recommended for adolescents 12 years old and on, while those 13 and older with severe obesity should be evaluated for weight loss surgery.
Why I Do Not Support the New AAP Guidelines
I am tremendously worried about the repercussions and the long-term effects of these guidelines being put into practice. When individuals, including children, are put on restrictive diets, this often leads to severe eating disorders and body image issues. Further, when the AAP is talking about “intensive behavior and lifestyle treatment,” for children 6 years old and as young as 2, this is simply no more than a diet, which will entail restriction in some way shape or form. Just as dieting and restriction has negative mental, emotional, and physical consequences for adults, this will likely have similar consequences on children, however possibly worse as these children are still growing. We know through research that telling someone to lose weight based on their “BMI” has the opposite effect, which is weight gain. At least 90-97% of people who lose weight through dieting will regain the weight within two to five years. And two thirds of those people will regain more weight back than they lost. I would assume this to also be the case with children. Time will tell.
After intensive therapy, the AAP is recommending medications and surgery to treat “childhood obesity.” As for the recommendation to assess kids 12 years of age and older for weight loss drugs, when you give a child an appetite suppressant this is going to have major negative health effects on their growth and development. Children are not only still growing mentally and emotionally, but physically as well. They need a certain level of calories, macronutrients, and micronutrients to grow and develop properly. Also, some of these medications are upwards of $1500 a month; if these children will need to be taking these medications for the rest of their lives my question is, who is really benefiting off of this? And why would we put a child through surgery when they have a fully functional digestive system? We also know that bariatric surgery in adults is none other than a band aide, masking many other complex problems at the root.
This recommendation is saturated with fatphobia and weight stigma. These guidelines send the message to children that their body is wrong and needs to be changed. Take for example, many of the women I have coached. Many of my clients were put on their first diet at 8 years old. If I was to ask you what an 8-year-old should be doing, would you ever in your right mind guess dieting? Absolutely not! An 8-year-old child should be playing, getting dirty, using their imagination. But no, these 8-year-old children were dragged to weight loss meetings and told they couldn’t have certain foods their brothers and sisters could have because they were in larger bodies. These women are now adults, some in their 50s and 60s and still struggling with hating their bodies, and had to deal with lifelong issues of chronic dieting, fearing food, bingeing, restricting, and not feeling good enough. All because they were told at a very young age that they weren’t okay the way they were and that their body was not the “right size.”
What You Can Do as Parents and Caregivers if Your Child is Labeled as “Overweight” or “Obese”
Fear-mongering messages surrounding the purported “obesity epidemic” alerts parents of children living in larger bodies, that their children are at an increased risk for certain health conditions. However, there is no evidence to show causation for this. For example, for every 100,000 children in the US, there are only 12 cases of type 2 diabetes, compared to 2,009 cases of eating disorders. That means a child is 242 times more likely to develop an eating disorder than type 2 diabetes. This only reinforces weight stigma and increases the risk of eating disorders, rather than promoting health.
Once told that their child is “overweight,” parents will often restrict what and how much their child is allowed to have. Many studies show that parents using restrictive feeding practices turns out badly, causing their child to eat when they are not hungry and often leading to extensive overeating. It doesn’t matter what size the child is, restricting the amount of food a child is fed only creates feelings of deprivation and rebellion. This is the same deprivation and rebellion felt that is created from dieting.
It is important to point out here, that any focus on a child’s weight, whether by a parent or health professional, has a strong potential of sending very damaging messages to the child’s ears. Additionally, worrying about future health problems does not typically motivate behavior change and only sends fear-mongering messages, which tends to create more problems.
So, what can you do as parents and caregivers if you do not agree with the AAP guidelines? Here are some things you can do to keep your children safe with these recommendations coming out:
Educate yourself and turn inward in order to make sure your children have a healthy relationship with food and their body. Many adults struggle with their own food and body image issues, and they sincerely don’t want their children to suffer like they have. Support your kids in becoming intuitive eaters. The more that you work on your own relationship with food and body and lead by example, the more it will spread to those who are closest to you. This is not going to happen overnight. It will take some time so give yourself compassion and grace and just know that working on your own relationship with food and body will be the cornerstone for allowing your children to do the same. More on this below.
Be a safe space for your child. This is done in various ways, such as through affirmations like, “you are beautiful,” “you are strong,” “you are intelligent,” and “I am proud of you.” They need to hear that they are enough, and they need to hear it from you. Also, children are naturally impulsive, and they want what is convenient and what is comfortable. They don’t necessarily think through the logic of “meal time” or “snack time,” what a balanced meal entails, or what foods will make them feel the most satisfied. Therefore, it is the parents’ or caregivers’ job to set them up in order for them to have the ability to tune into their bodies. For example, give them space to tune into their bodies, such as calling them in for lunch and having them sit at a table so that they can tune in and listen to their bodies.
Set boundaries in medical settings. When you have doctor’s appointments with the pediatrician, call ahead of time and ask that the healthcare team not discuss or bring up weight during the appointment when your child is present. Be adamant that you will not talk about weight. Another idea is to hand the pediatrician a note saying “do not mention weight in this appointment with my child.”
If necessary, find a new doctor. Doctor’s work for you. If their practice is not in line with your goals and values, that is your sign to find one who is. There are plenty of doctors out there that are informed on eating disorders, which is a good place to start.
If your child regularly eats past fullness, follow the specific guidelines listed below.
Lead By Example: Less Talk, More Walk
What we know is that kids naturally eat intuitively right off the bat, as long as they have access to a variety of foods. That is where we come in as adults, in providing that structure and support.
I spoke about this above already, but it’s that important. Parents are typically the primary role models for their kids in terms of eating. Therefore, it is important to set an example of eating when hungry, stopping when comfortably full, and enjoying a range of satisfying foods. However, there are some parents who intend to help their children with intuitive eating but don’t actually practice it themselves. When parents talk about food in a certain manner, such as making judgements about the amount their child eats, this increases the risk for that child to rebel against the parent or “authority” figure. This is why less talk and more role modeling is important, so that the child is more likely to try new foods, find nutritious foods like veggies interesting, and have more balance and enjoyment in the eating experience.
Steps to Take When Your Child Regularly Eats Past Fullness
Discuss what hunger feels like to your child. Explain the various sensations that might be felt that will tell them they are hungry, such as an emptiness in the stomach, a growling sensation, even a little achiness in the belly, etc.
Teach your child to tell an adult when they are hungry (if too young to get food on their own).
Discuss with them, what fullness feels like. When we tell a child that they’ve had enough to eat because we think they have, we are teaching them not to trust themselves. Using terms like “full” and “fullness” are useful terms because they are clear in what they mean. Ask your child, “Does your belly feel full? Do you feel like you have any more room for food?” They know how their body feels, but this can take some time to set in as your child becomes more verbal in articulating how their body is feeling.
Have a discussion about what satisfaction means and that satisfying hunger with just the right amount of food will proved energy to go play and run. Tell them that too much food might make them feel uncomfortable, and possibly sick. You can explain to them that it is like feeding a campfire wood. The wood is fuel for the fire and their body also needs fuel to blaze like a fire, but if the fire is fed too much wood/fuel, there’s no more room in the campfire for the extra wood.
Remind your child that there will always be enough food. Some kids get worried that their favorite foods will be gone for good, and it’s that scarcity mindset that can cause them to eat beyond fullness.
Once your child feels comfortably full, ask them if their body needs more food. If their answer is no, ask them if they need anything else. When they say that they don’t know, talk to them about how sometimes people eat too much food when they are feeling certain emotions like boredom or if they are scared or sad. Encourage them to express their feelings to you when these emotions come up. Assist your child in coming up with different ways to cope with their feelings rather than eating.
Don’t weigh your child. In fact, it’s best not to even have a scale in the house. And never criticize them about their weight.
Ask your child if he or she would like certain foods in the house, foods that have previously been forbidden. Reassure him or her that these foods will be readily available in the home.
Tell your child that you will not be telling them what to eat, what not to eat, or how much to eat. Explain to them that you will be providing a variety of foods including foods that are more nutritious, and some play foods that they enjoy, and that it will be up to them to choose what they want in a meal and how much they need to feel comfortably full.
Assure them that you trust that they will listen to their body and inform them that their body knows what it needs through its’ internal signals about hunger, fullness, and food preferences. This is important because the more your child is reassured that you trust their body’s internal signals, the more they will continue to stay attuned to their body’s signals, instead of reacting to you.
The new AAP guidelines for treating “childhood obesity” is underway and will surely be implemented by our pediatric healthcare professionals. Simply put, I don’t see this as being an effective way solve “the problem” that they want to fix for all the reasons I listed above. In short, these children are still growing and developing and need a certain level of nutrients to thrive. Putting them on diets will likely backfire, just as it does when an adult goes on a diet. Putting them on appetite suppressants and putting them under the knife will also likely backfire. The way I see it, using weight loss drugs or bariatric surgery to treat “obesity” is like putting a band aid over a wound that needs stitches. Regardless, the effectiveness of these interventions will be told with time. Until then, the best thing you can do as parents is lead by example, become intuitive eaters yourself, provide space and give your child structure so they can become intuitive eaters themselves, and above all, do not place focus on your child’s weight.
If you’re ready to become an intuitive eating so you can stop worrying about food and your body, and so you can lead by example for your kids, check out Freedom From Dieting group coaching.
