Episode Details

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!

I think that one of the more dangerous and disingenuous parts of the new American Academy of Pediatrics guidelines is their claims about eating disorders. These are claims that I am hearing echoed in other spaces as well, so I wanted to write about them in depth. In terms of the guidelines themselves, I wrote a deep dive about their three main recommendations around “Intensive Health Behavior and Lifestyle Treatment (IHBLT), weight loss drugs, and weight loss surgeries here. I also looked into undisclosed conflicts of interest here.

When it comes to eating disorders they claim (in bold, title case) that “Evidence-based Pediatric Ob*sity* Treatment Reduces Risks for Disordered Eating.” Is this remotely true? Let’s get into it.

They begin by saying “concerns have been raised as to whether diagnosis and treatment of ob*sity [in the case of these guidelines starting at the age of two] may inadvertently place excess attention on eating habits, body shape, and body size and lead to disordered eating patterns as children grow into adulthood.”

Well, let’s examine the situation. They are “diagnosing” kids as having a “disease” based solely on their body size and shape, and then recommending “Intensive” interventions and dangerous drugs and surgeries that put significant focus on food and food restriction with the goal of changing the child’s body size and shape. There is nothing inadvertent about this, it’s about as advertent as it can get.

They go on to claim “Cardel et al refer to multiple studies that have demonstrated that, although ob*sity and self-guided dieting consistently place children at high risk for weight fluctuation and disordered eating patterns, participation in structured, supervised weight management programs decreases current and future eating disorder symptoms (including bulimic symptoms, emotional eating, binge eating, and drive for thinness) up to 6 years after treatment. “

I’ll get to the research they cite in a minute, but I want to point out that in their list of current and future eating disorder symptoms, they left a few out including (from the AAP’s OWN 2016 paper on eating disorders prevention in adolescents):“Severe dietary restriction, skipping of meals, prolonged periods of starvation, or the use of self-induced vomiting, diet pills, or laxatives”

Let’s remember that even if their “intensive” behavioral therapy recommendations don’t devolve into disordered eating and eating disorders (and they certainly could,) their recommendations around pharmacotherapy and weight loss surgery literally induce all of these symptoms, sometimes for the rest of the child’s life.

It’s pretty difficult to reduce eating disorders symptoms when you’ve created 100 pages of guidelines to literally recommend them. This reminds me of something the brilliant Deb Burgard says, which is that we prescribe to fat people what we diagnose and treat in thin people, and in this case the people are children.Now, I don’t know if those symptoms are left out accidentally because the authors are so ignorant about eating disorders and higher-weight kids that they assume higher-weight kids aren’t susceptible to these (potentially fatal) symptoms, or if they left them out on purpose because they know that being honest about this renders their claims of their “treatments” decreasing eating disorder symptoms not just false, but patently ridiculous. Either way, the fact that they don