New AAP Guidelines Worry Eating Disorder Specialists

According to the CDC, 14.7 million children and adolescents are currently affected by obesity. The AAP updated their guidelines for the first time in 15 years but some folks aren't too happy.

With childhood obesity continuing to rise in the United States, the American Academy of Pediatrics (AAP) has released updated guidelines for health care providers to address the issue.

The study published in the January 2023 edition of Pediatrics provides insight into the cause of rising obesity and steps to treat the condition in children. Children or adolescents who classify as obese maintain a body mass index (BMI) at or above the 95th percentile for their respective age group and sex. The guidelines classify obesity as a disease or condition — like cancer — where eating disorder specialists worry that classifying it as a disease will prevent patients from seeking care.

Who is impacted?

The AAP notes different contributing factors to children who become obese. For example, children who grow up in homes that are less fortunate financially are more likely to suffer from obesity due to the inability to consistently purchase nutritious foods.

The CDC says the obesity prevalence was 18.9% among children and adolescents aged 2-19 years in the lowest socioeconomic class, while the number was 19.9% for middle-class children and adolescents. Children and adolescents in the highest socioeconomic class were significantly less likely to be obese, with only 10.9% classified as obese.

Other contributing causes to childhood obesity include policy factors such as the marketing of unhealthy foods, under-resourced communities, and food insecurity. Also, certain home factors, individual health choices, or certain diagnosed conditions can increase the chances of obesity.

In an AAP news release, Sarah Hampl, M.D., chair of the Clinical Practice Guideline Subcommittee on Obesity and author of the new guidelines, emphasizes the need to treat obese children as soon as possible.

However, eating disorders among children, as well as adults, increased during the pandemic. The Lancet found that eating disorders increased by 15.3% in 2020 and are still increasing in women and young girls.

Moreover, eating disorders are worldwide. Priory Group, a mental health and addiction treatment facility in the United Kingdom found a 61% increase of folks inquiring about treatment for anorexia and a 26% increase of those seeking help for bulimia.

Since many medical professionals aren't trained on how to identify eating disorders, many patients may not be recognized as someone with disordered eating.

What the guidelines say

The AAP lists behavioral strategies for children and adolescents battling obesity that have been researched and proven to be true. It is recommended to lower the intake of sugar-sweetened beverages, including popular sports drinks along with fruit juice.

The guidelines advise 60 minutes of play per day in order to reduce a sedentary lifestyle. With more forms of entertainment through different streaming services and video games, it is important children and adolescents maintain healthy levels of activity.

Another key to reducing obesity lies in a healthy plate of food. The U.S. The Department of Agriculture suggests a nutrient-dense diet low in added sugar and concentrated fat that includes balanced protein and carbohydrates.

The AAP highlights that intensive health behavior and lifestyle treatment (IHBLT) as the most effective treatment for childhood obesity. Meaning, it is vital for parents and family members to discuss positive steps for the child to overcome their case with obesity.

As far as treatments for obesity, the AAP lists a plethora of solutions based on the severity of obesity in the child. In instances of severe obesity for children 13 or older, the AAP says those teenagers should be evaluated for metabolic and bariatric surgery.

Concerns for those with eating disorders

Not everyone is in agreement with the AAP guidelines. In a press release, Jim Mangia, president and CEO of St. John’s Community Health states the guidelines are not seeking real solutions to the childhood obesity epidemic.

The guidelines suggest that pediatricians and child health care providers should pay close attention to body mass index (BMI), a mathematical formula calculating a person’s weight in pounds divided by the square of height in feet. In December 2022, the CDC adjusted its BMI due to increased obesity prevalence in children. Previously the BMI scale was charted as high as 37 for children, which now reaches 60.

However, BMI has been called a deeply flawed method created in the early 1830s by a mathematician an astronomer — not a physician. It does not factor in bone, muscle, and fat density. It also doesn't measure the waist, a huge indicator of obesity and type 2 diabetes. Overall, it promotes thinness with inaccurate calculations.

Mangia believes the guidelines are too focused on body image, which can lead children to believe there is something wrong with their bodies.

The Collaborative of Eating Disorder Organizations (CEDO) released a public statement to AAP addressing their concerns in a letter. The Alaska Eating Disorder Alliance, Body Equity Alliance, Stay Strong Virginia, Project Heal, Recognize Your Beauty, and many more organizations explained the harm this type of rhetoric could have on young people during a vulnerable time. Misinformation, shame, and stigma are the main focuses of the letter where they write that they question the AAP's concern for weight bias and the intensity of these new guidelines.

Mangiia concluded, "If the AAP is so concerned about weight gain in children, they should be presenting guidelines to schools about integrating much more recreational activity into their curriculums, offering nutritious meals to their students, and providing comprehensive education around health for the entire school."