“My first reaction was shock” Cheri Levinson, PhDassociate professor of psychology at the University of Louisville and clinical director of the Louisville Center for Eating Disorders, says SELF. “One of the biggest triggers for eating disorders in children is when they go to a medical professional who tells them they’re overweight. They walk out of the office feeling like they need to do something to change their bodies, then months later they’re diagnosed with an eating disorder. Dr. Levinson acknowledges that not every teenager who is told to lose weight will develop an eating disorder, but, she says, she has seen this scenario play out countless times in practice.
“I am outraged by the directives” Elizabeth Davenport, RDN, a family nutrition dietitian and co-owner of Pinney Davenport Nutrition in Washington, DC, tells SELF. « Diet is one of the biggest predictors of developing an eating disorder in teens, and now doctors will encourage kids to diet, even if they’re not using that exact wording. »
Screening for eating disorders is mentioned in new AAP guidelines – pediatricians are urged to ask about « unhealthy weight loss practices, » inducing meal skipping, use of diet pills or laxatives, or inducing vomiting. But eating disorder providers say this is entirely insufficient to reduce the risk of an eating disorder, because telling a child or adolescent to lose weight could inherently increase their risk of disordered eating behaviors, body image distress and, potentially, an eating disorder.
“There is a popular belief that eating disorders are just a phase that a teenager or young adult will go through and then come out of, but they are incredibly deadly and life-changing illnesses” Nicole Cifra, MD, MPH, a pediatrician and adolescent medicine specialist at Children’s Hospital of Philadelphia and an assistant professor of clinical pediatrics at the University of Pennsylvania’s Perelman School of Medicine, says SELF. Although the associated risks depend on many factors, including the type and severity of the disorder, eating disorders are known to increase the risk of anxiety, depression, suicide, substance use disorders, premature death, and serious problems at work, school, and in relationships. They can also negatively impact heart, bone, brain, digestive, and hormonal health. « This should be taken very seriously in any dieting or weight guidelines or recommendations, » says Dr. Cifra.
The guidelines recommend interventions, including medications and surgery, based solely on weight.
Yes, the guidelines recommend screening for other health conditions using various diagnostic tests and tools. But they also tell pediatricians to recommend weight loss even in the absence of health problems. « That’s the part that just doesn’t sit well with me, » says Dr. Cifra.
« Weight is just one data point, in a whole bunch of data points, about a person’s health, and weight alone should not be the basis of an intervention. »
The AAP notes in its guidelines that a person’s health is affected by much more than their lifestyle choices, and that factors such as economic stability, access to education, neighborhood and environment, and social context play a huge role. « I was really excited about the AAP’s growing recognition of the social determinants of health as a key factor in body shape and body weight, especially among young people, » said Janna Gewirtz O’Brien, MD, MPH, certified pediatrician and teenager. medical doctor in Minneapolis, says SELF. « I also loved the acknowledgment of weight bias and the fact that healthcare providers are the perpetrators of weight stigma and weight-based oppression. »