What Is Wrong With The American Academy of Pediatrics?
The American Academy of Pediatrics recently release new guidelines for “Pediatric Obesity Management” saying that the providers who created these guidelines are saying they’re HAES aligned and equally recommending bariatric surgery for child and teens.
Let’s break this down before we get into a more nuanced argument.
Health At Every Size is NOT a weight-loss framework. In fact it specifically was created to de-center weight as a marker for health and stop weight stigma and implicit bias from impacting access to healthcare and from providers enforcing personal views onto patients.
According to the Association for Size Diversity & Health the Health at Every Size® Principles are:
WEIGHT INCLUSIVITY
Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
HEALTH ENHANCEMENT
Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional and other needs.
EATING FOR WELL-BEING
Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
RESPECTFUL CARE
Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
LIFE-ENHANCING MOVEMENT
Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose. (ASDAH, 2013)
If you read through these it becomes very clear that HAES does not support intentional weight-loss and for good reason. Many studies (that the AAP conveniently ignored) have show that long-term weight loss is not sustainable including bariatric surgery and leads to more weight gain in the future as well as eating disorder development and a myriad of other health issues.
So why would the AAP support a procedure that involves cutting off 1/2 of the stomach of a child; A child whose body doesn’t fully develop until 18–25 years of age and a brain and psyche that does not fully develop until 25? Many will say it’s because of health and does health mean we remove 1/2 of a healthy, fully functioning organ that hasn’t reached it’s full development? It sounds like instead we fear and hate what that body could grow into and would go to dangerous lengths to stop it from happening.
Even more so, how does a child consent to removing 1/2 their stomach? How does a parent make that kind of choice? What are the long term outcomes for children who can no longer absorb vitamins from food, will vomit and become ill when they eat one cracker too many, that are restricting food groups and being forces to do intense exercise, count calories, use a FitBit and MyFitnessPal? There is no quality longitudinal studies to help people make an informed choice. And the studies on restriction, forced intense exercise, the use of MyFitnessPal all show poor outcomes and long term eating disorder development/exacerbation.
As an eating disorder therapist I continue to question why no eating disorder providers have been part of the consultation of this new regulation. If the only people we ask are “Weight Management Specialists” we’re only going to get one answer. As my dad used to say, “To a hammer everything is a nail”. That’s why in the eating disorder world we promote working with multi-disciplinary teams. The more people with expertise in different parts of the topic the more dialogue we can have to ensure patients are guided appropriately rather than based on one idea.
I continue to highlight in this debate that we have no problem removing 1/2 a child’s stomach but we continue to debate puberty blockers and top surgery for both Gender Diverse adolescents and adults and have said it’s unnecessary surgery. So removing an external part of the body that has no bearing on long-term health functioning is wrong and dangerous and child abuse but removing 1/2 a fully Functioning organ a body needs to survive long-term is now “clinically approved”. Wether you hate Trans & Gender Diverse people or not the message to me is clear. We would rather have a dead child who is thin and presents as their assigned sex at birth than a fat child who is at home in their body and with their identity.