Health

New guidelines highlight the complexity of childhood obesity

New guidelines highlight the complexity of childhood obesity

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“Physicians are not immune to the societal biases about weight that are prevalent in our culture,” said Rebecca Poole, professor and deputy director of the Rudd Center for Food Policy and Health at the University of Connecticut. “Weight bias is rarely, if ever, addressed in medical school education.”

On a related note, the AAP’s continued reliance on BMI is troubling to some, as it can be a poor indicator of individual metabolic health and can be stigmatizing.

“I wish AAP had not used BMI as a marker,” Dr Amin said. “BMI does not take into account the child’s health. It’s just looking at the numbers.” Dr. Amin has many patients with relatively high BMIs who “track beautifully” in their growth percentiles, she said, by eating a varied diet and getting enough exercise. They just have bigger bodies.

Dr. Jason Nagata, an adolescent medicine specialist at UCSF Benioff Children’s Hospital in San Francisco, said it’s important to remember how sensitive doctor-patient discussions around weight and bodies can be. He also expressed concern that practices such as using language first, while important, are not enough.

“As an eating disorder specialist, I now get so many referrals with the same story: A teenager who was previously overweight or obese was recommended by their pediatrician or parents to lose weight, and they took it to an extreme.” Dr. Nagata I said. He has worked on studies that show this disordered eating behavior such as fasting or vomiting are common in obese children. Even if parents and doctors are careful to use language first and focus discussions on health rather than weight, a child may only hear, “You’re telling me I’m too fat, I need to lose weight,” he warned.

Dr. Miller echoed that assessment, saying that “weight talk” can set children up for poor eating. “I am concerned that we are offering treatment strategies that are expensive, not readily available and most often unsuccessful, even under the best of circumstances,” she said. “At the same time, we’re setting kids up for a challenging relationship with their bodies and increasing their risks for other serious medical conditions.”

Experts say it may take time for the AAP’s recommendations to change the way pediatricians provide care every day.


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