March is here and the first signs of spring are popping up that reveal the hope of new life. Concurrent with this transition to a new month is National Eating Disorder Awareness Week, which this year was from February 27 – March 5. Because preventing and treating eating disorders is something that we’re passionate about at Nurtured Soul, we’d be remiss to not do our part in raising awareness, even if a bit belated in posting this blog.

NEDA (National Eating Disorders Association) leads the campaign and states, “#EDAW 2023 is an opportunity to center on lived experiences and eating disorder education, which are the essential catalysts for awareness and change.”1 This focus is very timely and applicable given a controversial guideline that the American Academy of Pediatrics (AAP) released in January entitled “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity.”2 The eating disorder community is concerned that some of their recommendations have the potential to cause harm, and therefore, are advocating for change. I will summarize some of the AAP’s points and recommendations, and follow each one with some concerns from experts in the eating disorder community along with my own thoughts.

  1. Obesity is defined as a chronic disease, measured by BMI.

This point involves two controversial definitions for the terms obesity and disease. The World Health Organization defines obesity as “abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese.”3 Those numbers are for adults. For children and adolescents, overweight is defined as a BMI between the 85th percentile and 94th percentile for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. What is problematic is that BMI is being used to measure an individual’s body fat and health risk- 2 things it was never intended to measure. BMI is a calculation of weight in kilograms divided by height in meters squared. It does NOT take into account body composition, race or sex. To read more about the problematic use of BMI and it’s racist roots, see here4. So if we’re using an invalid measurement to define obesity, then that invalid measurement also causes problems in defining obesity as a chronic disease. In 2013, the American Medical Association (AMA) House of Delegates members voted to define obesity as a disease. The decision was somewhat controversial because it went against the recommendations of the AMA’s Council on Science and Public Health who had researched the topic and did not recommend that the delegates define obesity as a disease. However, the delegates made their recommendations because there aren’t reliable and conclusive ways to measure obesity.5

  1. Intensive, long-term behavioral interventions are recommended

One section heading related to this point caught my attention: Evidence-based Pediatric Obesity Treatment Reduces Risks for Disordered Eating. A leading expert helped me to take a closer and more critical look. Jessica Setnick, MS, RD, CEDRD-S trains and supervises dietitians who treat eating disorders. I had the privilege of attending one of her trainings in 2020 a few weeks before COVID hit. Just last week I received a mass email from her expressing her frustration with AAP’s claim that the structure and underlying principles of their [weight loss] programs share many similarities with eating disorder programs. When she looked at the citation, the article referenced was from the Journal of the Academy of Nutrition and Dietetics written by dietitians who are affiliated with Weight Watchers. The treatment that they promoted, CBT-E, is one of the least effective approaches to treating ED’s and assigns sessions based on BMI. Jessica had this to say, “[CBT-E] doesn’t deserve a footnote in our journal, much less glorification. As disgusted as I am, I almost admire the authors… it’s evil genius, really. Cherry-picking the one eating disorder treatment that actually IS a weight loss program and banking on the fact that no one will care.” Furthermore, this type of treatment may be inaccessible to many families with marginal short-term weight loss and no proven long-term benefit.

  1. Advocates for weight loss pharmacology as a method of treatment for children as young as 8 

Weight loss medications typically decrease appetite so when they are prescribed, the covert message is, “You can’t trust your body to do what it is made to do.” In just about every case of disordered eating I have worked with over the past 15 years, there’s some element of having lost trust in one’s body. That’s why the Intuitive Eating principles developed by Evelyn Tribole and Elyse Resch are so foundational in healing one’s relationship with food AND they’re evidence-based. It’s hard enough for adults to relearn how to honor their bodies. To think that children and adolescents receive the message at such a young age that they need to rely on a drug instead of their own intuition is HIGHLY troubling to me!

  1. Recommends bariatric surgery for some adolescents as young as 13

Yes, you read that right- 13 years old!! What?! A permanent change to one’s digestive system that is known to cause vitamin and mineral deficiencies, could be recommended for young teens whose bodies and brains are still developing. As if adolescents don’t already struggle enough with other insecurities, imagine how shameful it would feel to be told that your body is so flawed that surgery is required to “fix” it. Furthermore, there is evidence that eating disorders can and do emerge after weight loss surgery.6

It is also worth noting that the AAP guidelines include minimal directives for screening for ED’s and referring to treatment, increasing the likelihood of harmful and unnecessary surgical options being presented to families of children and adolescents with disordered eating. The Academy for Eating Disorders has released a statement on these guidelines, emphasizing that the new AAP guidelines conflict with the Hippocratic oath, first, do no harm. Their full statement can be found here. The guidelines reference weight stigma, which directly intersects with social justice considerations that impact marginalized communities. Medical approaches that shame individuals in larger bodies, especially those in marginalized communities, worsen trauma and other mental health symptoms.

I will close by sharing that dieting is the #1 behavioral risk factor for the development of an eating disorder, and eating disorders are among the deadliest mental illnesses, second only to opioid overdose. These recommendations have the potential to put our children at risk of becoming a statistic and they deserve better. So. Much. Better.



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