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This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!The American Academy of Pediatrics has put out a new Clinical Guideline for the care of higher-weight children. This document is 100 pages long including references and there are so many things that are concerning and dangerous in it that I had trouble deciding how to divide it up to write about it.

I began on Thursday with a piece about the undisclosed conflicts of interest. Ultimately for today, I decided to focus on what I think will do the most harm in the guidelines, which is the recommendations for body size manipulation of toddlers, children, and adolescents through intensive behavioral interventions, drugs, and surgeries.

A few things before we dive in.

First, this piece is long. Really long. I thought about breaking it up to make it easier to parse, but I also know that people are (rightly) very concerned about these guidelines and I didn’t want to trickle information/commentary out over days and weeks in case it might be helpful to someone now.

Also, know that this may be emotionally difficult to read, in particular for those who have been harmed by weight loss interventions foisted on them as children. That will likely be exacerbated by the gaslighting these guidelines do to erase the lived experience of harm and trauma from the “interventions” they are recommending, and from their co-option of anti-weight-stigma language to promote weight loss. So please take care of yourself, you can always take a break and come back.

Per my usual policy I will not link to studies that are based in weight bias and the weight loss paradigm, but will provide enough information for you to Google if you want to read them. I’ll also use an asterisk in “ob*sity” for the reasons I explain in the post footer.

Ok, big breath and let’s get into this.

In later newsletters, I’ll address other issues in depth, but for now here are some quick thoughts and links about overarching issues before I dig into the actual recommendation:

The claim that “ob*sity is a chronic disease—similar to asthma and diabetes”

No, it’s really not. And it’s this faulty premise (that having a body of a certain size is the same thing as having a health condition with actual identifiable symptomology) that underlies everything in these guidelines. The diagnosis of asthma requires documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (improvement in these signs or symptoms with asthma therapy) and no clinical suspicion of an alternative diagnosis. The diagnosis of diabetes requires a glycated hemoglobin (A1C) level of 6.5% or higher. But to diagnose “ob*sity” you just need a scale and a measuring tape. A group of people with this “diagnosis” don’t have to share any symptoms at all, they simply have to exist in their bodies. That is not the same as asthma or diabetes, though the weight loss industry (in particular pharmaceutical companies and weight loss surgery interests) have absolutely poured money into campaigns to try to convince us that it is. (Note that the argument that ob*sity is correlated with other health conditions and thus is a disease actually proves the fallacy since some kids/people who are “diagnosed” with “ob*sity” don’t have any of those health conditions and some kids/people who are thin do have them. It’s especially disingenuous as it ignores the confounding variables of weight stigma and, in particular, weight cycling both of which these guidelines, if adopted, are very likely to increase.) I wrote about this

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