The new guidelines highlight the complexity of childhood obesity

The new guidelines highlight the complexity of childhood obesity

“Physicians are not immune to the societal weight bias that is prevalent in our culture,” said Rebecca Puhl, a professor and associate director of the Rudd Center for Food Policy and Health at the University of Connecticut. “Weight bias is rarely, if ever, discussed in medical school training.”

On that note, the AAP’s continued reliance on BMI is troubling to some, as it can be a poor predictor of an individual’s metabolic health and can be stigmatizing.

“I wish the AAP didn’t use BMI as a marker,” Dr. Amin said. “BMI does not take into account the health of the child. We only look at the numbers.” dr. Amin has many patients with relatively high BMIs who are “keeping up nicely” with their growth percentile, she said, by eating a varied diet and getting enough physical activity. They just have bigger bodies.

dr. Jason Nagata, an adolescent medicine specialist at UCSF Benioff Children’s Hospital San Francisco, said it’s important to remember how sensitive doctor-patient discussions about weight and body can be. He also expressed concern that practices such as using language first, while important, are not enough.

“As an eating disorder specialist, I now get so many referrals with the same story: A teenager who was previously overweight or obese was recommended by their pediatrician or parent to lose weight, and they took it to the extreme,” Dr. Nagata said. . He has worked on studies that show this disordered eating behavior such as fasting or vomiting they are common in children with obesity. Even if parents and doctors are careful to use personal speech and focus discussions on health rather than weight, a child might only hear “you’re telling me I’m too fat, I need to lose weight,” he warned.

dr. Miller echoed that assessment, saying that “weight talk” can set kids up for disordered eating. “I’m afraid we’re proposing treatment strategies that are expensive, unavailable, and often unsuccessful, even under the best of circumstances,” she said. “At the same time, we’re setting kids up for a challenging relationship with their bodies and increasing their risk of other serious health conditions.”

Experts say it may be a while before the AAP’s recommendations change the way pediatricians provide care every day.

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