Just like adults, children can feel nervous about upcoming doctor appointments, especially when visits revolve around body size and weight. With the new American Academy of Pediatrics (AAP) guidelines for managing childhood overweight and obesity, we anticipate more pediatricians will discuss weight and body at well-child visits.
The new AAP recommendations outline how pediatricians can recommend diets and weight loss medications in children under 12 years of age, as well as weight loss surgery in teens. Children ages 3-7 years of age in a higher BMI percentile can be treated with behavior programs a.k.a. diets. Children ages 8-12 years with higher body weights can be prescribed weight loss medications. Children with higher body weights and over 12 years of age can be recommended for weight loss surgery.
As eating disorder dietitians, we recognize that weight loss tactics in adolescents and teens significantly increase the risk of eating disorders and negatively impact mental health. We see negative physical effects in promoting weight loss as well. Weight cycling (repeatedly gaining and losing weight) causes increased inflammation, increased cardiovascular risk, and poor diet quality. Weight loss medications disrupt the GI system and can cause nausea, vomiting, acute pancreatitis, and overall GI distress. Weight loss surgery permanently alters the GI system and forever changes eating habits. Lifelong supplementation is required after weight loss surgery. Negative implications of using diets, medications, and surgery as a treatment for high body weight in children include concerns for bone density, muscle wasting, and overall growth. These AAP recommendations are more weight conscious instead of health-conscious.
We know, and the AAP recognizes, that children’s body weight is determined by genetics, socioeconomic status, environmental factors, and healthcare access. We also know that weight does not determine health. We can absolutely promote healthy behaviors without focusing on weight and body size.
In order to avoid weight talk at the pediatrician’s office, it is acceptable to contact the doctor ahead of time and let them know they are not to discuss your child’s weight in front of the child. We can add this information to the paperwork we complete prior to the appointment. As parents, we can add this information to our child’s medical chart so all doctors seeing our child are aware of our preference. If the doctor does have a concern, let them know they can speak to you, the parent, away from the child. Ask if the doctor has a medical concern regarding your child’s weight to recommend additional testing (lab tests for cholesterol or A1C for early signs of diabetes) and to not use weight as a determinant of your child’s health. If our preferences are disregarded, it is acceptable to find a different pediatrician that will be mindful of our concerns and not weight biased in their practice.
Instead of having a discussion about weight, we can ask our pediatrician how best to promote healthy behaviors with our child such as family dinners, enjoyable movement, and consuming a variety of foods. They may have a variety of ideas or resources to help incorporate these behaviors in a manageable way. Pediatricians can be wonderfully effective in educating children and families, especially when given guidance about what education is needed.
In our culture, there is already an intense focus on children’s weight in the media, at school, and among peers. Advocating for weight-neutral care at the pediatrician’s office can have a dramatic impact on our children’s self-esteem and future self-worth.
If your family needs more support for your child, give us a call. We can be a positive force on your child’s treatment team and advocate for weight-neutral care at your pediatrician.
Written by: Andrea Cox, RDN, LD