Recently, the American Academy of Pediatrics released new guidelines and recommendations regarding treatment of childhood obesity. The report contained something that I found quite shocking, and I experienced a complex emotional reaction.
Inquisitive to find out more, Dr. Sandra Hassink is the director of AAP Institute for Healthy Childhood Weight. She also wrote the guideline. “The guidelines are important in reframing obesity as a complex chronic disease. Evidence-based treatment for obesity exists and is safe and effective,” she told me, adding, “Comprehensive obesity treatment may also include pharmacotherapy for obesity and metabolic surgery as indicated.”
It may seem quite straightforward in theory. As someone with more experience in the medical system, I have some concerns.
My childhood experience of being fat was one that would define my entire life. I can recall being 8 years old and watching the socks of Catholic school girls slide down my calves. As I swung my legs from the pediatrician’s office, I was terrified of getting weighed. I looked at the scale as if it were the bullies who teasingly teased my corpulent body. My size was a factor in how my peers viewed me. In the 1990s, magazines and TV showed us how to get waifish Kate Moss frames. Slimfast was in my refrigerator, waiting for my grandmother and mother. It was everywhere that the message was clear: Fat is bad.
My weight was the one thing that stood out to the pediatrician when he reviewed my physical results. I remember looking that doctor in the eye and asking him (much to my mother’s surprise) what I should do about it… if I, too, could sip some Slimfast or pop one of those diet pills I saw infomercials on. I remember he looked at me and said, “We don’t put kids on ‘diets.’ We focus on healthy eating, exercise, and making good choices.” I remember being disappointed that there was no magic-bullet fix. That was exactly what he said. I distinctly remember his advice was not to eat the soft pretzels at recess and that he’d see me next year.
Ever since, the number on the scale has been labeled as the culprit for every ailment I’ve ever had. These visits were a constant cycle of doctors sharing their concerns, me assuring that I tried every suggestion, and that every diet they recommended was successful. Everything was always attributed directly to my lifestyle. I didn’t have to run any lab tests. Fat was always the cause and not the problem. It wasn’t until I hit my early 30s and began experiencing secondary infertility that doctors finally ran enough tests to conclude I actually had polycystic ovarian syndrome, an immunocompromising disease with symptoms that make it hard for the body to lose weight. I also learned — thanks to TikTok, not a doctor — that the gallbladder I had removed actually impacted my weight gain and retention too.
No doctor Everyday, ever looked at the entire picture, and it’s cost me dearly.
So when I awoke to the news that the AAP’s new clinical practice guideline recommends weight loss drugs and even bariatric surgery for children 12 and older experiencing chronic obesity, my hackles were raised. I’ve seen firsthand the benefits of focusing on weight reduction over comprehensive care, and I instantly envisioned it happening for so many children.
Jen Trachtenberg is Assistant Clinical Professor at Icahn School Of Medicine, Mount Sinai, and partner at Carnegie Hill Pediatrics LLP. I reached out to her for more information. She and other pediatricians see it as a way to expand treatment options.
“The causes of obesity are not limited to just genetics, nutrition or physical activity,” Trachtenberg told me. Unjust food systems, toxic stress caused by racism, childhood neglect, or lack of safe play spaces, can all be part of the overall picture.
“It’s important for parents to understand that these guidelines are NOT saying ‘oh I see your child is overweight or gained 10 pounds, so here’s a prescription pill to take to lose weight,’” she explained, stressing the importance of comprehensive, ongoing care. “Our kids need the medical and emotional and emotional health support, understanding, and resources we can provide within a fully comprehensive treatment plan that involves the whole family.”
But the truth is, comprehensive care for bigger-bodied folks isn’t the norm. Scientific American reported that 24 percent of doctors said they were uncomfortable being friends with people with larger bodies and 18% felt disgusted at the thought of treating someone with a high BMI. There are long-lasting effects of weight bias. For instance, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), “People in larger bodies are half as likely as those at a ‘normal weight’ or ‘underweight’ to be diagnosed with an eating disorder.”
In my personal experience, so many care providers took “fat” as the ultimate enemy, the thing that needs to be eradicated before anything else can get better. Fat is not a one-size fits all issue. Anecdotal evidence shows that doctors push weight loss to the disadvantage of patients, causing them to adopt unhealthy eating habits and low self-esteem. There are many cases of medical fatphobia.
We truly need is our medical providers — Particularly pediatricians — to truly hear and consider their patients with their concerns. To be compassionate with obese children.
Hassik emphasizes that pediatricians should only consider this type of care if they are able to see the whole picture. “It is important to keep obesity treatment in the context of the whole child,” she reiterated.
It is difficult to live a full life with a plus size body, no matter how small it may seem like finding clothes or fatphobic doctors. However, it’s important to remember that healthcare and body justice need to coexist, especially when it comes to our kids. They require good habits at all sizes. We must not look at their bodies solely as the problem. Our patience, kindness, and the ability to remind them that their feelings are valid, as well as our kindness, is essential for our children. Doctors need to ensure they see our children as whole people and not rush through a parent’s concerns or hesitations with pharmacological solutions.
“When discussing weight, I recommend thinking of it not as numbers but rather as how can we make healthy choices together and how can we make it sustainable for the entire family long-term,” Dr. Nadia Sabri the Assistant Dean of Wellness of Graduate Medical Education, Director of Lifestyle Medicine, and Assistant Professor of Pediatrics at East Tennessee State University Quillen College of Medicine and founder of Mindful MD Mom advised. “This means really understanding the family culture, the attitudes around food and mealtime, making meals a time of connection and reduced stress, identifying parental and caregiver disordered thinking around food, minimizing and eliminating negative self-talk, and identifying triggers to emotional eating.”
Perhaps if 8-year-old me had heard This Without my support system, I would have a completely new relationship with my body. It’s something that a pill alone cannot address, and it’s absolutely vital.
Lauren Gordon For 15 years, she has been a writer and editor. She is also a mother for four years. Apart from her family, her passions are the intersection of art, plants, and angsty fantasy novels for YA. Although she has a toxic trait of believing she can make anything and is often angry, she is an honest author who isn’t afraid to tell the truth about motherhood.
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