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
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