On The Weight List – How the American Academy of Pediatrics Failed our Kids and How good dietitians can prepare for what’s next (March 2023 )

Over the last month the guidelines put out by the American Academy of Pediatrics has caused all providers in my field to have an uproar. Because the guidelines are unethical, do harm and make children feel that there is something wrong with their bodies, my colleague Jessica Setnick, MS, RD, CEDRD-S graciously allowed me to repost her write up on this important topic. This article is reprinted with permission from Jessica Setnick, MS, RD- CEDRD-S

To calm the chaos of my thoughts about the recent AAP guidelines, I corralled them into a hall of shame: 10 reasons they’re harmful to children, scientifically unsound, and based on bad medicine:

#1: The whole point of the guidelines is that big kids need to shrink.

#2: The guidelines assume shrinking a child’s body will improve their health.

#3: The guidelines ignore that there is no lasting, effective body-shrinking method for children besides starvation.

#4: All of the mentioned body-shrinking methods assume that bigness is caused by calories in/calories out.

#5: The guidelines use BMI to determine who should be shrunk.

#6: The full report mentions social determinants of health & referring to dietitians. Yet this is ignored in the summaries and Key Points documents.

#7: The guidelines suggest making body-shrinking recommendations without a nutrition assessment.

#8: They reference studies a) with terrible outcomes b) funded by industry.

#9: Practicing pediatricians weren’t consulted. The authors are researchers who have conflicts of financial interest.

#10: The guidelines prioritize malnourished smaller kids over bigger, healthy kids.

If anyone asks you why there’s such a big uproar about the guidelines, feel free to pick your least favorite of the above, share the whole list, or offer them one of these links:

Listen:

Therapist Rachelle Heinemann and I discuss why the guidelines got us hopping mad on her Understanding Disordered Eating podcast

Read:

Response from IFEDD, the International Federation of Eating Disorder Dietitians

Response from Lemond Nutrition, a pediatric nutrition counseling practice

NY Times article by Virginia Sole-Smith

Deep Dive:

Ragen Chastain’s thoroughly researched rebuttal

In summary there will be more conversations about this topic, how you as a provider, parent or loved one can respond to weight stigma and learning what to say when a patient’s parent tells you someone else said the child needs to lose weight.

As always, thank you for all you’re doing to make the world a better place.

– Jessica Setnick, MS, RD, CEDRD-S