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Our Children Deserve a Weight-Neutral Approach

You may or may not have heard that back in February 2023 the American Academy of Pediatrics (AAP) published their Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity. This Clinical Practice Guideline (CPG) is the first of it's kind and recommends intensive health behavior and lifestyle treatment (IHBLT). The goal of IHBLT is "achieve body mass reduction or the attenuation of excessive weight gain in children" through "healthier eating and physical activity habits." The CPG states that the "most effective IHBLT programs" are recommended for children 6 years and older. SIX YEARS OLD?! We're gonna have a problem here...

I remember learning in school that it's the expectation for children & adolescents to gain weight. I remember hearing that you never want a child or adolescent to lose weight but sometimes their rate of weight gain changes due to change in height and/or activity levels. That was 18 years what has changed? Well, in 2013, the American Medical Association (AMA) designated obesity as a disease. Around that time and since then, the focus of our medical system has heavily relied on "curing" this "disease". Let's not even get into the fact that the AMA recently released a statement that body mass index (BMI) should not be used as the only tool for measuring obesity.

The CPG also recommends the use of weight loss drugs for children ages 8-11. It also goes on to recommend pediatric metabolic & bariatric surgery.

I was a dietetic intern when I first learned about bariatric surgery. I shadowed a registered dietitian who worked full time in the bariatric center. I remember learning about the intensive pre-operative education, psychiatrist evaluation and medical examinations that these patients had to complete before having bariatric surgery. I worked in a hospital with a well-known bariatric surgeon during the increase in bariatric surgeries. I remember hearing this bariatric surgeon state that these operations were the "only" cure for obesity. I learned that the insurance companies decreased the requirement for body mass index (BMI) to allow more folks to have surgery. Later on, I saw patients come into the intensive care unit (ICU) where I worked as a nutrition support dietitian with complications from bariatric surgery. A few years later, I saw patients with malnutrition, nutrition deficiencies and eating disorders as a result from bariatric surgery.

The AAP boasts that bariatric surgery is "safe and effective" for pediatric patients. I promise you that no matter HOW much research has been done, it is never enough to truly know the long-term effects of this operation. I remember observing sessions with adult patients who were having bariatric surgery. These adult patients were told that bariatric surgery was "safe and effective" and I also know that we did not have enough research to know the long-term effects of this operation. I know this because I cared for these patients when they came back to the hospital. Some patient required more surgeries in an attempt to resolve complications of their bariatric surgery. Some patients developed eating disorders and continued to struggle with their relationship with food. Some patients developed malnutrition as a result of how extremely bariatric surgery alters the gastrointestinal (GI) tract. Most patients developed nutrient deficiencies because they couldn't afford to continue to purchase the bariatric vitamins that they were instructed to take for the rest of their life. One patient in particular had to come into the emergency room daily to receive intravenous nutrition because their GI tract would no longer absorb nutrients.

As a member of Weight Inclusive Nutrition and Dietetics (WIND), registered dietitian, and mom, I encourage you to visit the Advocacy Toolkit. It is an amazing resource that includes an extensive review of the references used in the CPG as well as relevant studies not included (RSNI). You can also view relevant articles and responses from other organizations. Lastly, you have the opportunity to read WIND's response to these guidelines which I had the honor of helping to write. WIND is inviting others to sign this letter in support.

Please consider signing this letter and sharing this amazing resource with your friends, family, and pediatrician. Let's do it for our children.

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