Center for Body Trust Opposes the New Guidelines from the American Academy of Pediatricians

Content Warning: O words

In January 2023, the American Academy of Pediatricians released guidelines recommending intentional weight loss for higher-weight children via “Intensive Health Behavior and Lifestyle Training” starting as early as age two with intensive behavioral approaches and drugs and surgeries starting as early as age 13. Here’s the news release, and below are the key action statements we want to highlight:

• Comprehensive o*esity treatment may include nutrition support, physical activity treatment, behavioral therapy, pharmacotherapy, and metabolic and bariatric surgery.
• Intensive health behavior and lifestyle treatment (IHBLT), while challenging to deliver and not universally available, is the most effective known behavioral treatment for child o*esity.
• Physicians should offer adolescents ages 12 years and older with o*esity weight loss pharmacotherapy as an adjunct to health behavior and lifestyle treatment.
• Teens age 13 and older with severe o*esity (according to BMI for age) should be evaluated for metabolic and bariatric surgery.

Diet culture and weight loss recommendations aggressively bypass the boundaries and sovereignty of kids and parents. Kids are severely psychologically harmed when they are told that their bodies are wrong. They are their bodies. There is no way to focus on a child’s fatness without othering them and other fat children.

We struggle, as a society, to understand the role discrimination, stigma and oppression play in the emotional and physical well-being of people with marginalized identities. We fail to see how our conversations about well-being often bypassed the social determinants of health (poverty, trauma, environmental racism, genetics, etc). We over-rely on personal responsibility and bootstrapping rhetoric (i.e. If you are fat, it’s because you aren’t living a “healthy lifestyle”). We reinforce a hierarchy of bodies that is upheld across systems and institutions without questioning the validity of our knowing. Individual’s worthiness is born from this, as well as the coping mechanisms which allow people to survive in a culture that doesn’t truly value them.

The Center for Body Trust unequivocally believes:

1. Fatness (o*esity) is not a disease.
2. The body mass index (BMI) is a tool of white body supremacy. The AAP guidelines will disproportionately impact Black and Brown bodies.
3. Anti-fatness, weight stigma and body shame lead to self neglect and self harm.
4. It’s not okay to talk to children about their weight/size.
5. We cannot address anti-fat bias and weight stigma with a weight-loss intervention.
6. It’s never ok to put a child on a diet (restrict their food) for weight loss.
7. Fat kids should not be singled out when it comes to health promotion and public health campaigns.
8. There’s no such thing as lifestyle intervention when it comes to weight loss. It’s always a diet regardless of what people are calling it.
9. Parenting from an anti-diet, weight inclusive framework is not dangerous for children.
10. We can trust children’s bodies.
11. We can trust children’s ever growing and evolving relationship with food.
12. Weight loss research is short-sighted and biased. Most weight loss research is short-term and fails to adequately address the commonplace weight regain that happens after ALL weight loss methodologies, choosing to blame the behavior of the individuals for weight regain instead of acknowledging that weight loss methods are iatrogenic.
13. The co-option of anti-fat bias statements (as well as anti-racist sentiments) by o*besity medicine is a manipulation. They say, “of course stigma is bad” and “diets don’t work” and what they do with that is up the ante on invasive interventions instead of helping fat people live big, beautiful FAT lives. This includes children.
14. The health risks of weight cycling are documented (and very consistent with the health risks that get blamed on higher-weight bodies). Setting people up for weight cycling starting as toddlers is harmful and unethical.
15. Our collective focus should be on addressing the social determinants of health by fighting for things like racial justice, access to a living wage, nutritious food, clean air and water, stable housing, childcare, reproductive justice, and non-stigmatizing healthcare.

The Center for Body Trust is asking the AAP to withdraw their guidelines and go back to the drawing board. The AAP must include fat people, body liberationists and weight-inclusive eating disorder expertise in the revisioning of guidelines. And physicians, researchers, and academics should receive mandatory comprehensive training regarding anti-fat bias and eating disorders, especially if they are involved in the writing of any kind of evidence based treatment guidelines.

In the video below, we share our conversation with Sirius Bonner about why the AAP’s new guidelines are problematic.

We want kids to feel free and connected to their bodies. The role of parents, teachers, pediatricians and other caregivers should be to help steer kids away from diet culture, anti-fat bias, and body blame. The Association for Size Diversity and Health (ASDAH) has created a petition you can sign. We encourage you to read their statement and join us in opposing these guidelines.

Weight-inclusive care should be the norm. We can and must do better.

Recommended Reading & Resources

ASDAH’s statement: Sign the petition!

Serious Issues with the AAP Guidelines

Letter to Parents and Caregivers

Letter to a Pediatrician

Dear Kids, The AAP Got It Wrong