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Eating disorder specialists 'horrified' by child obesity guidelines

Eating disorder specialists say new childhood obesity treatment guidance could cause even more weight and self esteem issues in kids.
Posted at 8:57 PM, Mar 07, 2023
and last updated 2023-04-07 11:25:20-04

Recent health guidance has many Americans doing a double take.

In January, the American Academy of Pediatrics released new guidance on how to evaluate and address childhood obesity, sparking outrage among eating disorder specialists across the country.

"I am horrified, alarmed and concerned," said Dr. Catherine Devlin, an eating disorder specialist and founder of Birch Tree Psychotherapy.

Many say they're worried the guidance will lead to a rise in eating disorders among children and adolescents.

"First of all, I think that these guidelines need to just be completely thrown out," Devlin said.

In particular, specialists are taking issue with intervention measures outlined in the guidance that include weight loss medication and bariatric surgery for patients as young as 12 and 13 years old based on their BMI.

"This idea of surgically changing, you know, still a child's body or giving them weight loss medication has been very concerning to the eating disorder community — not from just an immediate consequence of what that could do to a child's body when it's still developing and growing and going through puberty, but also in the future, what that means for that person's relationship with food and with their body and what it's really communicating to them," said Nooshin Kiankhooy, an eating disorder specialist and founder of Empowering You.

For many specialists, these concerns stem from encounters they have had with patients.

"We know that for adults, following a post-bariatric regimen is difficult," Devlin said. "I think that compliance among kids is just going to be a nightmare."

"I have had some clients that have been put on diets at very, very young ages," Kiankhooy said. "Then they come to my office 10, 15 years later because they are put on weight loss at the age of 12, or they went to some clinic at a local hospital where they were told that carbs were bad."

This has prompted experts to call for an overhaul of how weight concerns are discussed.

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"I think there needs to be a whole lot more talk about, how do we help kids understand that they're not a disease because of the way their body looks?" said Dr. Kim Dennis, chief medical officer and co-founder of SunCloud Health.

Many think similarly about BMI measurements.

"I think we do more harm than good when we take one data point and say, 'Based on the fact that your BMI is, you know, 28 or 30, you have a disease,'" Dennis said.

"By pushing people to get into this normal weight range, we're only causing eating disorder behaviors," Devlin said.

To replace it, doctors want to look at everything more holistically, with mental health taking a more central role when it comes to diagnosing and treating concerns.

"Unless health is considered more broadly and inclusive of mental health and inclusive of size, diversity, we're going to continue to see worse health outcomes, and none of us wants that," Dennis said.

When it comes to pediatrician visits, many specialists recommend keeping weight conversations just between the parent and physician.

"I think it's incredibly important that you do not let a physician talk to your child about their weight, like full stop," Devlin said.

"I've told parents, you know, write a note, give it to the nurse, give it to the doctor, right before saying, 'I don't want to talk about my child's weight,'" Kiankhooy said. "If that's something you want to talk about, we can find a different time, whether it's over the phone or the kid can be in the waiting room or whatever. So, I think it's not only advocating in those moments with your team, but also seeking other consultation as well."

Eating disorders aren't always the easiest to detect, so specialists say it's important to be observant.

"Keeping an eye on, like, how do they feel about their body changing?" Dennis said. "If kids are not eating with the family and wanting to eat in their room, that can be an indicator. If you're noticing any weight changes, that could be something to kind of look for. And it can be in either direction."

If you are concerned that your child has an eating disorder, Dennis has some advice.

"I generally tell people, as a parent or as a loved one, to use as simple language as possible," Dennis said. "You know, 'I've seen this behavior or change. It makes me think...' whatever the parent is thinking. Like, 'It makes me worry that you're depressed or maybe are struggling with food or are struggling with an eating disorder, and I'm concerned.'"

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