The American Academy of Pediatrics released their first clinical practice guideline for the evaluation and treatment of children and adolescents with obesity.
Lemond Nutrition opposes guidelines that will negatively impact body image and self-esteem. We believe these guidelines will be harmful.
We could call out all the things we take issue to in these guidelines -- the outdated BMI, the ethics of prescribing weight loss medications or bariatric surgery for children -- but we stop at what triggers doctors into the treatment guideline. The child's body weight and size.
At Lemond Nutrition, we have been helping families live healthy lifestyles since 2009. Our practice employs many registered dietitian nutritionists and our services span across multiple states. Our ongoing monitoring on this topic is large. You should know, we have admittedly had to do our own work on how we approach weight management referrals from our physician partners. We always emphasized healthy lifestyle and minimized weight focus, but we still did weigh kids each visit. We do not do this anymore and have not for many years. We encourage every health professional to do their own work in this area because there is a huge piece of the puzzle that they are not considering, and this speaks even louder in the pediatrics field. What the conventional medical community does not fully appreciate is the powerfully negative impact they have when they tell a child or adolescent that their body shape is wrong.
Nobody likes to hear their bodies are wrong, but that is what our children are hearing. Children are not little adults. Their brains are not mature enough to take a doctor’s comments about their “obesity” in the context it was intended. Children are emotionally vulnerable during a time when their bodies are rapidly growing and changing. Recall for just a moment what you remember when you were, say, 12 years old. Growing pains, acne, hormone changes, and growth at times being so rapid that one feels like a fawn that collapses under their legs. Now, imagine that you have the highest level of medical professional, your doctor, telling you that your body is growing wrong. This pulverizes a child’s body image.
Doctors, we know you don’t intend harm with this guidance, you are merely following treatment protocols. As dietitians, we have had to take issue with some of our own professional organizations that are often led by many researchers that have not had boots on the ground seeing the wreckage of these protocols. So here we are, doctors (and dietitians) following the general protocols of their organization, telling their pediatric patients that they are fat (obese).
Unfortunately, we are watching this play out time and time again. A parent is told by their child’s doctor about the need to get control of this rapidly increasing weight. Mom and Dad are indeed concerned. The doctor warned them! They will do whatever it takes to get this problem under control. Fear becomes the driver and behaviors occur that in turn reinforce to the child that their body is wrong.
The parents go home and vow to make changes. Many say that the whole family needs to change, but the child “growing wrong” starts being watched closer in the safe space that the child had previously called home. Out of good intentions, Dad may tell this child there are no more second helpings or Mom may question if the child truly is hungry when a desire for food is expressed. The child is sent to bed hungry and feeling that their parents do not trust their own body cues, so that leaves them questioning if they should as well.
The focus remains on the child. However, in our experience, we find that parents often don’t know how to approach food in their own lives. The media tells them that they need to go on diets, deny their own hunger, or that many foods are killing them. Now, they are trying to navigate this guidance for the sake of being a good parent and taking care of their child.
This approach is not helpful, and the damage ensues. In fact, a pediatric weight management program at a local pediatric hospital here in Dallas found that intervention focusing around the child's obesity gained more weight instead of losing weight. This type of pressure of weight checks and a hyper focus on the child causes anxiety, food insecurity and abnormal parental responses that make the problem worse.
We fully acknowledge that health issues like high cholesterol, pre-diabetes and blood pressure need proper treatment. That need can be met with a non-weight focused approach. The hyper focus on weight is causing all kinds of behavioral and psychological problems, particularly in children and adolescents.
Teach All Families Wellness
America must get better at preventing illness. Until we realize that wellness includes the consideration of behavioral ramifications of the guidance we provide as clinicians, disordered eating and eating disorders will continue to climb. Mental health is health.
A child that feels overly controlled regarding a basic human need to eat will likely develop food insecurity. I always say, “over control leads to out of control.” We know that food insecurity and obesity are correlated in low socioeconomic environments. It is not hard to imagine this same thing happening in homes around the country of parents wanting their children to lose weight like their doctor recommended.
It does not matter what size or shape a person is – they should pursue many of the same healthy lifestyle behaviors. We should get adequate sleep, attend our medical well checks, find physical activity that is enjoyable and tune in to our emotional and spiritual well-being. When it comes to food, we want to enjoy eating styles like the Mediterranean or flexitarian way of eating. It should be gentle, flexible, and eating should bring people together.
Body weight should not be the focus. A healthy and purposeful lifestyle is one that we should all live regardless of the number on the scale.
Do no harm, American Academy of Pediatrics. Live by your Hippocratic oath. Remove weight-centered treatments out of this guideline or you will be making the problem you want to fix worse. We call those unintended consequences, and we see it every day in our practice. Include experts in pediatric mental health, child feeding psychologists that are on the front lines to be on your panels in the future.
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