On January 9, 2023, the American Academy of Pediatrics (AAP) published a statement regarding their guidance for treating children in higher-weight bodies, where they recommended the clinical use of pharmacotherapy medications to assist in weight loss for children as young as 12 years old in addition to bariatric and metabolic surgery for children as young as 13 years old. As an organization of Eating Disorder experts with over 100 years of combined professional experience, we voice our profound opposition and concern regarding this statement, and we feel that it is our ethical duty to share our outrage and fear on behalf of the clients and families whom we serve. Prosperity Eating Disorders and Wellness Center operates from a weight-inclusive model, where we believe that weight is not a disease, nor a predictor of health and that health can be pursued in any sized body. We also believe that words such as “obesity” and “overweight” are stigmatizing and pathologizing and that they cause further harm to children in developing bodies. We fear that the recommendations put forth by the AAP will lead to an increase in Eating Disorders in children and adolescents, as children and adolescents are at an increased risk of developing Eating Disorders when they are exposed to discussions around weight, dieting, weight loss, and body judgment. Currently, there is no clinically significant evidence for long-term sustained weight loss as a result of the pursuit of weight loss; rather, evidence points to chronic dieting and intentional weight loss as risk factors for additional weight gain and for the development of Eating Disorders with a 95% failure rate for long term weight control. As an organization, we seek to teach our clients that their bodies are not a problem to be solved and health includes more than weight alone. We implore the AAP to allow children and adolescents to be just that: developing children and adolescents, whose bodies are still growing and whose relationships with their bodies are still developing. We fear that these medical guidelines will make life more difficult for children in all sized bodies, as these guidelines will continue to perpetuate medical fatphobia and weight stigma not just for children in larger bodies, but in children of all sizes. It also places children at risk of the complications of bariatric surgery, which include malabsorption, particularly of concern in growing bodies as well as weight cycling with comes with associated osteopathic and cardiac risks. We are so grateful for the solidarity and collaboration among pediatricians and medical practitioners who are also working towards promoting body acceptance, normalization of all shapes and sizes of bodies, and rejection of dieting and weight loss surgery as an effective treatment for health conditions. As we are committed to creating a world without Eating Disorders, we strongly request that the AAP rethink the guidelines put forth in their statement and seek the insight and counsel of Eating Disorders professionals in creating future guidance for weight-neutral and body-affirming care.  

 Written by Allison Gasko-Backman, LCSW and Mary Dye, MPH, RD, CEDS-RD

References:

Emmer, C., Bosnjak, M., & Mata, J. (2019). The association between weight stigma and mental health: A meta‐analysis. Obesity Reviews, 21(1). doi:10.1111/obr.12935

Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019–1028. https://doi.org/10.2105/AJPH.2009.159491

Weight Stigma. (2019, June 27). Retrieved September 23, 2020, from https://www.nationaleatingdisorders.org/weight-stigma

Families play such a vital role in eating disorder recovery.  Your loved one(s) can benefit greatly from your support and involvement in their journey to recovery.  Below are some communication tips for families to keep in mind as they embark on the road to healthily recovering from an eating disorder.

Avoid making any comments (positive or negative) about physical appearance and weight.

There are comments that we say like “You look really good today” – from the mind of someone with an ED – they might think – I must have gained/lost weight. ‘You look thin” can mean to the ED that they are doing a great job and to keep it up. It is best to not make any comments that relate to how they look. 

Be an empathetic listener.

“I can hear that this is really scary and overwhelming for you.”

Have conversations that do not include talk about diets, calories, or exercise. 

It is always best to have a strong support system of people that you can trust and be open with about your feelings and struggles while in eating disorder recovery. You can rely on your support system, whether it may be a friend, family member, or even your therapist to be there for you in times that feel stressful. Your support system of trustworthy allies can help you breathe through stressful situations, help you redirect your focus, and be there for you when you need them most. Whether they be the people you call on the phone to discuss your thoughts and emotions or be the people that you ask to attend an event with you so that they can assist you in engaging in conversation that isn’t revolving around diet talk, they will be there for you when you need someone to lean on for support when you need it.

Express that you understand how eating disorders are very complicated. Recovery is hard work.

Eating disorders can change the brain. The altered brain from an eating disorder can suffer from anxiety, depression, adverse effects on emotions, weakened response in reward circuitry, shrinkage in overall size, as well as difficulty thinking and switching tasks. The mending process of the brain can’t happen overnight, but by making recovery a priority, the brain will heal over time. Eating disorders also tend to get in the way of personal values, making your loved one believe that the values of the eating disorder are their own. The eating disorder values food choices, weight, and appearance and will set goals related to these values. These values are not your loved one’s values. Eating disorders are incredibly complex mental illnesses. 

Remember that your child is not going through a phase and that this will pass.

We see our children constantly changing and having many successes and setbacks. Seeing your child depressed, anxious, feeling worthless, or not good enough is heartbreaking for us to watch. We never want to blame them or tell them all the things that they could be doing differently. It is our job to really listen, validate and let them know you are there for them. When they hear “you just need to…” they might be hearing that they aren’t good enough. 

One thing that I have heard a lot from children is that they have been suffering for a while and it wasn’t until they got really sick did their parents notice. I am not sure if this is accurate. I think what often happens as parents is that we feel helpless, confused, and at a loss for how to connect. So the best thing we can do is not assume that their emotions, thoughts, and behaviors are just phases. Take this time when you notice, to truly connect and give loving-kindness.

Very importantly, being a parent of someone going through an ED is so extremely hard. You are not alone. There are resources for you.

Prosperity invites you to come join our virtual Parent Support Group that meets on Monday nights at 6 PM. This is a safe and open space where we will answer any and all of your questions about eating disorders and mental health while providing you with an open forum to make validating supportive connections with others who are sharing this experience.

To register, please email information@prosperityedwell.com