The risks of 2023 AAP guidelines for weight loss in kids and what parents can do about it
Megan reached out to me after a disastrous doctor’s office visit with her eleven-year-old son, Carl. “I’m so upset, I could scream!” she said. “The doctor lectured Carl about his weight even though I called ahead and specifically asked her not to do that, and when I asked her to stop, she just kept going. She recommended that he start an intensive weight intervention …a diet.”
This news is upsetting but not uncommon. In 2023 the American Academy of Pediatrics (AAP) issued new guidelines regarding obesity* in children and teens. The guidelines recommend intensive weight loss interventions, drugs, and even surgery.
*Generally I don’t use the word “obesity” because it pathologizes higher-weight people based on the flawed, racist BMI scale. I’ve used it in this article sparingly in order to reflect the scientific data and guidelines accurately.
These guidelines are alarming for anyone who works with eating disorders. Because intentional weight loss of any type, for any reason, is identified as a major cause of eating disorders. The dubious claims in the guidelines rest on severe weight stigma, false assumptions about intentional weight loss, and poor evidence of the efficacy and safety of drugs and surgery on kids’ bodies.
Creating medical guidelines without considering that they will cause eating disorders is horrifying. Eating disorders are NOT RARE. They affect at least 9% of the population. That’s about 29 million Americans, and rates are rising exponentially. For comparison, about 6 million Americans have Alzheimer’s and about 23 million Americans have heart disease. Eating disorders are common, present a high level of risk to mortality and long-term health, and are heavily influenced by family, social, and medical beliefs about diet and weight.
Non-Diet/Health At Every Size® Fact Sheets, Guidelines, and Scripts
- Fact Sheets About Weight Stigma, Diet Culture, Kids and Diets, and More
- Non-Diet Parent Guidelines
- Non-Diet Parent Scripts About Responding to Fat Talk, Diet Talk, and More
- What to Say/Not Say When Talking About Bodies and Food
Should a child get an intensive weight intervention?
The suggestion that Carl should undergo intensive weight loss counseling is not based on evidence that such programs are effective. In fact, there is no evidence that any diet plan results in long-term weight loss and health benefits. For example, a large Medicare study was created to find the most effective weight loss program for obesity. It was cancelled due to poor outcomes, including counterproductive side effects on both weight and health.
In another attempt to prove the effectiveness of weight loss interventions, this time for schoolchildren, a large randomized controlled trial (the scientific gold standard) was published in 2016. However, it found that high-quality intensive health interventions that included weighing children, nutrition counseling, and an exercise program were not effective in reducing BMI or improving health behaviors.
But the fact that intensive weight interventions are ineffective is not the worst problem; it’s that intentional weight loss has the following reliable outcomes:
- Weight regain: The majority of individuals who lose weight are unlikely to maintain the reduced weight for an extended period of time.
- Additional weight gain: Intentional weight loss predicts accelerated weight gain and risk of overweight.
- Eating disorders: Intentional weight loss is the most important predictor of new eating disorders.
In other words, not only are intensive weight interventions ineffective, they have a high risk of harm. Even worse are the recommendations that children take weight-loss medications and undergo bariatric surgery, which have an extremely high risk of creating lifelong complications. And they’re being done despite evidence that fat itself is not deadly.
What to do to improve kids’ health without weight intervention
While we have a lot of evidence that intentional weight loss and weight interventions cause harm, that doesn’t mean you can’t support your child’s health. There are a number of excellent non-weight-based ways that parents can positively impact kids’ health, including:
1. Develop and nurture a secure attachment with your child.
“There is substantial evidence that children with secure attachments in childhood develop more positive social–emotional competence, cognitive functioning, physical health and mental health, whereas children with insecure attachments are more at risk for negative outcomes in these domains.” —Early Childhood Development and Care, 2008
🔎 Read more about building a secure attachment
2. Share family meals at least three times per week.
“The frequency of shared family meals is significantly related to nutritional health in children and adolescents. Children and adolescents who share family meals 3 or more times per week are more likely to be in a [non-obese] weight range and have healthier dietary and eating patterns than those who share fewer than 3 family meals together. In addition, they are less likely to engage in disordered eating.” —Journal of the American Academy of Pediatrics, 2011
🔎 Read more about creating family meals
3. Ensure your child has a healthy sleep pattern.
“Short sleep duration is associated with a wide range of negative physical, social, emotional, and cognitive outcomes including poor concentration, impaired academic achievement, an increased risk of obesity, depression, suicide ideation, and injuries.” —Sleep Research Society, 2013
🔎 Read more about optimizing sleep
4. Support your child in developing social skills.
“The influence of social relationships on the risk of death are comparable with well-established risk factors for mortality such as smoking and alcohol consumption and exceed the influence of other risk factors such as physical inactivity and obesity.” —PLOS Medicine, 2010
These four interventions are all well-documented and will improve your child’s health. And the effects are long-lasting and have no negative consequences. This cannot be said for weight interventions (almost all intentional weight loss leads to weight cycling).
🔎 Read more about preventing loneliness
Handling pediatrician visits with 2023 AAP guidelines
The 2023 AAP guidelines put kids at risk, since intentional weight loss is a major cause of eating disorders. But what can you do if your child’s pediatrician is committed to the 2023 AAP guidelines for weight-based interventions? Well, it may be time to consider finding a new pediatrician! These guidelines are suggestions for physicians, not requirements. But if that’s not possible, keep asking questions and seeking answers about the most likely outcomes and risks of weight-based interventions.
To help her navigate this distressing situation with her son, I recommended that Megan download the free guide provided by CRC for ED and Sunny Side Up Nutrition called “Navigating Pediatric Care in Light of the New AAP Guidelines.”
“We created this resource because we have concerns of the harmful impact the AAP guidelines are having on young people, particularly those with marginalized identities,” said Anna M. Lutz, MPH, RD/LDN, CEDS-S. “After the guidelines were released we heard from parents who were scared and worried about taking their child to the pediatrician. We hope parents can use this resource and feel more supported in navigating their child’s medical care.”
I also have some cards that you can use at the doctor’s office and an eBook, Non-Diet/Health At Every Size® Fact Sheets, Guidelines, and Scripts.
About the 2023 American Academy of Pediatrics guidelines
In January 2023 the American Academy of Pediatrics (AAP) issued updated guidelines on obesity evaluation and treatment in children and teens. It’s been deeply discredited by the eating disorder professional community.
For example, the Collaborative of Eating Disorders Organizations (CEDO) and the Eating Recovery Center say the recommendations put children at risk for developing eating disorders, disordered eating, and other mental and physical health issues.
The new AAP guidelines stray far from those released in 2016, which very carefully linked a focus on weight reduction to increased risks of eating disorders and recommended that physicians not recommend weight control to children and teens. It said:
- “There are concerns that obesity prevention efforts may lead to the development of [an eating disorder].”
- “Dieting, defined as caloric restriction with the goal of weight loss, is a risk factor for both obesity and [eating disorders].”
- “The focus should be on a healthy lifestyle rather than on weight.”
Sadly, the 2023 AAP guidelines ignore the 2016 findings and suggest that physicians recommend weight loss using intensive behavioral interventions starting at age 2, weight-loss drugs as young as 12, and bariatric surgery as early as 13.
The new guidelines recommend intentional weight loss, despite evidence that it is 1) ineffective, 2) counterproductive, and 2) a major cause of eating disorders.
🔎 Regan Chastain has provided several deep dives into the problematic nature of the new recommendations, including a review of the conflicts of interest the guidelines failed to disclose and faulty presentations of the effectiveness and risks of bariatric surgery in kids.
Pushback against the new AAP guidelines
The Collaborative of Eating Disorders Organizations (CEDO) issued a letter saying “The statements made throughout these guidelines are problematic at best, and at worst, put American children and adolescents at serious risk for developing eating disorders, disordered eating, and other mental and physical health issues.”
The Eating Recovery Center in Denver, Colorado, launched a petition to change the guidelines saying “[W]e expect these guidelines will cause harm and put young people at risk of developing or worsening eating disorders, disordered eating, and other mental and physical health issues as well as perpetuate harmful weight stigma and move us further away from achieving universal weight-inclusive care.”
The Academy for Eating Disorders (AED) had three main concerns with the report, which it detailed in a press release saying “In line with the Hippocratic oath of first, do no harm, the AED urges the AAP to revise their Guideline with input from key stakeholders including eating disorder professionals and individuals/families with lived experience in higher-weight bodies.”
Non-Diet/Health At Every Size® Fact Sheets, Guidelines, and Scripts
- Fact Sheets About Weight Stigma, Diet Culture, Kids and Diets, and More
- Non-Diet Parent Guidelines
- Non-Diet Parent Scripts About Responding to Fat Talk, Diet Talk, and More
- What to Say/Not Say When Talking About Bodies and Food
Ginny Jones is on a mission to change the conversation about eating disorders and empower people to recover. She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents supercharge their kid’s eating disorder recovery.
Ginny has been researching and writing about eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.
Ginny’s most recent project is Recovery, a newsletter for deeply feeling people in recovery from diet culture, negative body image, and eating disorders.