Rethinking Child Health: A Holistic, Inclusive Approach to the AAP’s Obesity Guidelines

Rethinking Child Health: A Holistic, Inclusive Approach to the AAP’s Obesity Guidelines

Overview

In an era where the scales of children's health are tipping more than ever, the American Academy of Pediatrics (AAP) has introduced a seminal set of guidelines targeting childhood obesity, a condition that, according to 2017-2020 statistics from the Centers for Disease Control and Prevention, affects nearly one in five children and adolescents in the United States.

The shadow of the COVID-19 pandemic has only darkened this picture, with experts attributing the rise in obesity rates to factors like diminished physical activity, increased screen time, and a turn towards more processed foods. Even though research has suggested just how horrible processed foods really are for the human body- let alone a growing adolescent body.

This is not just a transient wave but a rising tide, with the rate of childhood obesity seeing an alarming 2% increase during the pandemic, marking a continued uptrend over the last four decades.

Disclaimer: 

*As we scrutinize these guidelines, it's crucial to do so through a lens of social justice, Health at Every Size (HAES), and body positivity to ensure we're truly nurturing our children's health without inadvertently perpetuating harmful biases or oversimplified solutions. We acknowledge our privilige of color, status, and gender- being female in the eating disorder recovery and treatment space. We cannot, and do not, claim to have all of the answers or solutions to these complex issues especially as it impacts families of color, LGBTQIA+ community, or any situation that we have not personally lived. We simply hope to be more empathetic and hold space for continuous learning, and encourage other perspectives, opportunities for learning, and are open to being corrected in areas that we are failing in (we know that we are human and have lots of room for growth). We hope that this space provides a sounding board for education and a place to openly discuss these issues and make room for the difficult conversations that need to be held surrounding social justice, eating disorder equity and holding space for every body impacted by eating disorders.*

Lighthouse in the Storm or the Map on Course for Disaster?

In response, the AAP's new guidelines, the first comprehensive update in nearly 15 years, are a being promoted as a lighthouse in the storm, guiding families and healthcare providers through these turbulent waters. 

Why? 

Because according to the current health industry "they signify a paradigm shift from the conventional 'eat less, move more' mantra', addressing obesity not just as a lifestyle choice or lifestyle issue but as an actual chronic condition akin to diabetes or high blood pressure, and acknowledging the complex interplay of genetics, environment, and behavior in its genesis.

The recommendations are (more) robust and multifaceted, advocating for early and intensive intervention strategies. For children as young as two, the guidelines propose a multi-layered approach, tailoring treatment intensity based on the child's specific needs, gauged through the prism of their BMI and growth chart. 

(While yes, we acknowledge that this is a step in a better direction- this is 2024, why are we still using the number on a scale in relation to the gravitational pull on a specific planet or object in space??)

Guidelines Explained

Children over the age of six, and in certain cases, those between two and five, are candidates for Intensive Health Behavior and Lifestyle Treatment (IHBLT). This isn't a one-size-fits-all solution but a tailored, holistic strategy encompassing nutrition, physical activity, and behavioral support, aimed at children who are overweight (≥ 85th percentile) or obese (≥ 95th percentile).

For adolescents aged 12 and above, the guidelines cautiously introduce the option of weight loss medication, alongside ongoing IHBLT, a consideration that becomes even more pronounced for those with severe obesity (≥ 120% of the 95th percentile) at 13, where bariatric surgery could be on the cards.

(Excuse our french* But at what point are we going to stop the weight loss industry from indoctrinating our future generations with the industrial complex that is Modern American Medicine? Why would we as a society, knowingly promote bariatric surgery to children?

*who are still growing, changing, and most likely in the midst of puberty or the initial onset of puberty*

When these children don't even have a fully developed brain (the Prefrontal Cortex AKA: part of the brain responsible for major decision making) that can comprehend the repercussions of the life altering surgery or possible complications?

The Health Industry claims that: "the positivity is emanating from these guidelines is palpable" and toss phrases like "The guidelines shine a light on the stigmatized and often oversimplified issue of obesity, offering a beacon of hope for comprehensive, inclusive community programs that address behavioral modification" emphasized by: Dr. Sissi Cossio, a noted pediatric endocrinologist.

Arising Scrutiny

We are posing this question: Are we addressing the symptom rather than the root cause, and at what cost?

While some of that may be vaguely true, these guidelines significantly underscore the importance of a holistic view of a child's life, that should include: encouraging pediatricians to take on the hat of a detective, helping families in piecing together the puzzle of each child's lifestyle, environment, and emotional landscape to tailor a treatment path that's as unique as the child itself.

Thankfully, we are not the only ones whose eyes nearly popped out of their sockets and did a double take while reading these guidelines. These guidelines have gained scrutiny and their critics.

The specter of weight loss drugs and surgery for children has understandably raised eyebrows and concerns. (Hallelujah)

The fear of spiraling into eating disorders, exacerbated by the weight-focused narrative, is very REAL and arguable more potent than the original issue, as echoed by Dr. Katherine Hill of Equip Health, who highlights the often-"overlooked prevalence of eating disorders in children with larger body sizes."

So, where does that leave parents?

We feel that, while yes the current situation may seem bleak, it does put parents in a position of informed empowerment. These guidelines are not "ALL FAX. NO PRINT" or the end all be all, but more like guidelines, providing option, and the ability to take back the power and lead our children into a "Fat-Positive", "HAES", and ultimately a more accepting and inclusive future filled with body neutrality and maybe even acceptance.

A Parental Summon

Parents, we are summoning you! We are encouraging you to engage in open, informed dialogues with your pediatricians, and asking you to pose questions, Be your child's advocate. Stand up for your child's body in a way that past generations have failed. Participate in shaping the conversation around your child's health in a way that's supportive, inclusive, values drive, and wholeheartedly centered around making the best choices for your child's mental, physical, and overall emotional health.

Scrutiny from Experts

Dr. Rebekah Diamond aptly encapsulates this sentiment, emphasizing the need for a nuanced understanding of pediatric obesity, not as a standalone issue but as an integral part of a larger family health mosaic.

In fostering a healthy home environment, it's crucial to remember that the focus should not be on the scales but on nurturing healthy, sustainable, and maybe even enjoyable behaviors for your child and family as whole. 

The AAP's guidelines, while centered on treatment, and sadly posing fat and obese children as a problem to be fixed, also set the stage for (improvement) forthcoming preventative guidelines.

Until then, we call parents to be the architects of their children's health, requesting that they remain steadfast in crafting an environment where "DIET" isn't a dirty word but part of a balanced narrative, where physical activity is a joy, not a chore, and where a child's worth is measured in smiles and laughter, not just numbers on a scale.

In this complex conundrum of health, we are taking the metaphor that "health is mosaic" and every child is a unique piece, with these new guidelines, the AAP is providing the frame, within which each family can create a masterpiece of health, happiness, and holistic well-being, whatever that means for you and your family. Take the guidelines, and use them to your family's benefit. Call out your pediatrician and ask them "why" certain recommendations are being made, and if they do not align with your family values, then request a different approach.

Reimagining the path to child health is a long term investment, and it's important to weave together a tapestry that's rich in diversity, empathy, and inclusivity. The AAP's guidelines offer a simple framework, but it's up to us – healthcare professionals, parents, and ultimately society as whole – to fill the gaps within this framework with the colors that represent every child's right to health, happiness, and self-acceptance. 

Summing All Parents Again Because it's That Important

Parents! Again, we are calling you to action. We are asking you to commit to rewriting history and changing the narrative. We hope to create a story where every child is valued, not for the numbers on a scale, but for their inherent worth as individuals.

In a society where weight discrimination is as prevalent as racial discrimination, these guidelines, though well-intentioned, risk reinforcing the notion that health is synonymous with thinness. This perspective can be detrimental, especially when research indicates that weight stigma can lead to patients avoiding medical care, harboring mistrust towards doctors, and showing low adherence to treatment plans. Moreover, this stigma contributes to mental health struggles, including anxiety, depression, and low self-esteem, further complicating an already intricate issue.

How

So, how can healthcare providers and parents navigate these guidelines with a perspective that honors every child's uniqueness and promotes health without focusing solely on weight? 

Resource

While that is a conversation that requires continual maintenance, revision, and improvement, we have compiled a list for parents and providers in need of tangible targets. This list is a meant solely to serve as a starting point for providers and parents to check in with their child's healthcare team and make sure that they are making choices based off of their values and the overall wellbeing of the child.

Advocate for Inclusivity:

Recognize and challenge the biases in healthcare settings. Providers should be mindful of their language and approach, ensuring they're fostering an environment where children of all sizes feel respected and heard.

Promote HAES Principles:

Encourage behaviors that prioritize health and well-being over weight loss. This includes nurturing a positive relationship with food and encouraging physical activities that children enjoy, rather than those solely focused on burning calories.

Focus on Mental Well-being:

Understand that a child's health is not just physical. Mental health plays a crucial role, and any approach to addressing obesity should include support for the emotional and psychological well-being of children.

Empowering Parents: (Providers*)

Equip parents with the knowledge and tools to advocate for their children's health in a holistic manner. This includes having open, informed dialogues with healthcare providers and creating a home environment that celebrates health, joy, and body diversity.

Tailor the Approach:

Every child's journey is unique. Healthcare providers and parents alike should work together to create personalized health plans that consider the child's physical, emotional, and social health, moving beyond a narrow focus on weight.

In reimagining the path to child health, it's vital to weave together a tapestry that's rich in diversity, empathy, and inclusivity. The AAP's guidelines offer a framework, but it's up to us – healthcare professionals, parents, and ultimately society as whole – to fill the gaps within this framework with the colors that represent every child's right to health, happiness, and self-acceptance. 

We are committed to a narrative where every child is valued, not for the numbers on a scale, but for their inherent worth as individuals. Are you? What steps would you like us to include in this quick start checklist? We want to hear your thoughts and opinions on how to improve this list!