The New Childhood Obesity Guidelines Are Appalling, Experts Say

“My initial reaction was shock,” Cheri Levinson, PhD, an associate professor of psychology at the University of Louisville and the clinical director of the Louisville Center for Eating Disorders, tells SELF. “One of the major precipitators for eating disorders in children is that they go to a medical professional who says that they’re overweight. They walk out of the office feeling like they need to do something to change their body, and then, months later, they’re diagnosed with an eating disorder.” Dr. Levinson acknowledges that not all adolescents who are told to lose weight will go on to develop an eating disorder—but still, she says, she’s seen this scenario play out countless times in practice.

“I’m outraged by the guidelines,” Elizabeth Davenport, RDN, a dietitian who specializes in family feeding and the co-owner of Pinney Davenport Nutrition in Washington, DC, tells SELF. “Dieting is one of the biggest predictors of developing an eating disorder for teenagers, and now doctors will be encouraging kids to diet, even if they don’t use that exact wording.” 

Eating disorder screening is mentioned in the AAP’s new guidelines—pediatricians are told to ask about “unhealthy practices to lose weight,” inducing meal skipping, using diet pills or laxatives, or inducing vomiting. But eating disorder providers say this is totally inadequate in reducing eating disorder risk, since telling a kid or teenager to lose weight could inherently increase their risk of disordered eating behaviors, body image distress, and, potentially, an eating disorder. 

“There’s a popular belief that eating disorders are just a phase that a teen or young adult will go through and then grow out of, but they are incredibly life-threatening and life-altering diseases” Nicole Cifra, MD, MPH, a pediatrician and adolescent medicine specialist at the Children’s Hospital of Philadelphia and an assistant professor of clinical pediatrics at the Perelman School of Medicine at the University of Pennsylvania, tells SELF. Although the associated risks depend on many factors, including the type and severity of the disorder, eating disorders are known to increase the risk of anxiety, depression, suicidality, substance use disorders, premature death, and serious issues at work, school, and in relationships. They can also have a negative impact on heart, bone, brain, digestive, and hormone health. “This should be taken very seriously in any guidelines or recommendations about dieting or weight,” Dr. Cifra says.

The guidelines recommend interventions—including medications and surgery—based solely on weight.

Yes, the guidelines recommend screening for other health conditions using various tests and diagnostic tools. But they also tell pediatricians to recommend weight loss even when no health problems are present. “That’s the piece of it that just doesn’t line up for me,” Dr. Cifra says.

“Weight is just one data point, in a whole bunch of data points, on someone’s health, and weight alone shouldn’t be the basis of an intervention.”

The AAP does note in its guidelines that a person’s health is impacted by far more than just their lifestyle choices, and that factors like economic stability, access to education, neighborhood and environment, and social context play a huge role. “I was really excited about the AAP’s increasing recognition of the social determinants of health as a key driver of body shape and weight, especially among young people,” Janna Gewirtz O’Brien, MD, MPH, a board-certified pediatrician and an adolescent medicine physician in Minneapolis, tells SELF. “I also loved the acknowledgement of weight bias, and that health care providers are perpetrators of weight stigma and weight-based oppression.”