Weight Loss Surgery for Kids??? What is a "healthy kid"?

By now, many of you have seen the new guidelines from the American Academy of Pediatrics (AAP) recommending bariatric surgery and weight loss medications for adolescents and "lifestyle interventions" for toddlers. Pediatricians are now expected to make weight loss recommendations for children as young as two years old and for adolescents dangerous weight loss surgery will now be considered effective health care. There is no doubt that this will cause an alarming increase in eating disorders causing more children to suffer and even die because of these recommendations. 

In 2016 the American Academy of Pediatrics (AAP) advised against prescribing dieting and weight loss interventions for kids. They acknowledged that they could lead to eating disorders and other serious health issues. It should be noted that many of the authors of these new guidelines are primarily MDs who work in pediatric weight management and bariatric surgery. There was no input from eating disorder specialists. Also, worth mentioning that the majority of this “research” is funded by drug company Novo Nordisk and researchers who consult for these companies. This really begs the question, is this really about fat kids’ health or is it about money for the pharmaceutical and bariatric surgery industries? The AAP needs to consider how these recommendations will erode parents trust in their association, medical professionals and the field of medicine in general.

We don't know what the long-term consequences will be of putting teens, who are at critical stages in their growth, on weight loss medications and bariatric surgery where malnutrition is a well-known side effect, among many other awful and sometimes deadly consequences. My heart breaks for the kids who have fat phobic parents who will subject them to this life altering surgery. This could literally ruin a person's life permanently. 

What we have learned is that kids do not belong on weight loss diets and should not be pursuing intentional weight loss. In fact, the data indicates putting children on diets is actually counter-productive and dangerous. Both because it can damage to their physical health (with long term health issues such as osteoporosis, delayed menstruation, impaired muscle development, stunted growth, learning/attention issues among other, possibly irreversible, problems) and because of the detrimental effects it has on their mental health as well.

Restricting a child's calories or food increases the likelihood of sneak eating, bingeing behavior, eating disorders, low self-esteem, trauma, anxiety, depression, self-harm behaviors and suicidality. Research repeatedly shows that diets typically lead to weight cycling (yo-yo dieting) which has been proven to be even more detrimental to health than simply being "overweight" your whole life. Also, dieting has been shown to ultimately put individuals (kids included) at higher weights than those in bigger bodies who don’t diet.

A child who is put on a diet is five times more likely to develop an eating disorder. Eating disorders have the highest mortality rate of any mental illness. During the pandemic, there has been a sharp rise in eating disorders, particularly in teens. Inpatient treatment centers are at capacity and have tremendous waiting lists. Helplines have seen a 40% jump in volume since March 2020. The strongest predictor of an eating disorder? A history of dieting.

As parents, we want to teach our kids habits that support their health and well-being, but that is actually different from focusing on body size. Encouraging our children to lose weight sends them the message that there is something wrong with their bodies, that they are not good as they are, and that they need to change their body in order to be accepted, have confidence, be successful and healthy. This message is misguided and can set the stage for a lifelong struggle with body image and food.

Children are supposed to be growing, not shrinking. They are supposed to gain weight. During their puberty years it is normal and healthy for children to gain anywhere from 40- 60 pounds (sometimes more depending on their genetic makeup). When it comes to a child’s growth it is more important to look at trends in growth over time and that doesn’t always look linear either. Your child’s growth is unique to them and it’s important that you internalize this fact and tell them this. Some kids might be bigger and some may be smaller. Body diversity is a reality and there is no one right way for a body to look.

Humans are born knowing what our bodies need. As new parents, we allowed newborn cries to tell us if they were hungry, tired, or needed a new diaper. They let us know when they were full from a feeding by turning away (and good luck trying to get them to take more at that point, right?). They are born intuitive eaters. Somewhere along the way though kids are taught they can’t trust those inner cues anymore. The adults in their lives suddenly take over and know better.

“You had enough now.”

“One more bite, you didn’t eat enough”

“Finish what’s on your plate if you want dessert.”

“You don’t need that, you already had….”

They are taught that eating “too much” (there is no objective right amount. Every human body has different nutritional needs) is bad and that certain foods are “junk”, “toxic” or “unhealthy” and other foods are better and “healthier”. When our kids want those “bad” foods they feel guilt and shame and internalize the message that they are bad too. I often talk about boundaries and consent for our kids. Well, this is one of the earliest boundary violations a child can experience. These mostly well-intentioned actions give a child the message: “I’ll tell you what is good for your body, no matter how you feel. You can’t be trusted to know what you need”.

Instead of trying to shrink a child's body, we can teach them to trust their innate cues, honor their hunger and enjoy the pleasures of eating without guilt or shame. We can teach them the joy of movement and how it's a wonderful tool to enhance our physical AND mental health. We can teach them that health is multi-faceted and it is not something you can see. All bodies are good bodies. Healthy people come in all shapes and sizes. Also, we can lead by example. How we talk about food and our own bodies has a profound influence on how kids view food and their own bodies. Do you believe certain foods are good or bad? Do you believe that being in a bigger body is a result of moral choice? Do you believe thin bodies are better? More attractive? What do you say about people in bigger bodies? Did you struggle with weight as a child? How does dieting feel? What is your current relationship with your body, food and exercise? Do you think “fat” is a bad word?

I encourage parents to consider where you have gotten these ideas from. We live in a culture that is obsessed with thinness, often at any cost. There is a 75 billion dollar industry that profits from making us believe that fat is bad, thin is healthy, and more attractive, smarter, more employable and more worthy. We compliment weight loss, when it could be the result of grief, depression, illness, or an eating disorder. We assume weight gain is bad when it could be the result of a life saving medication, healing from illness, surviving a pandemic, recovering from disordered eating or an eating disorder.

it is important to understand that losing weight and improving health are not the same thing. Very often we give credit to weight loss for health improvements when in reality it is behaviors that you engage in that impact your health, among many other factors that are not within our control like genetics, chronic illness, a history of trauma, race etc.

If you are concerned about your child being treated differently for their size, you cannot solve this problem by treating them differently because of their size. You can teach them that regardless of size they are valuable and loved.

If your pediatrician prescribes weight loss or worse bariatric surgery, I strongly suggest telling them that you will not be discussing your child’s weight or weight loss in front of your child (if possible, you can hand them a card with this request written on it) and instead discuss any medical concerns without your child in the room. If there is a medical concern ask what they’d suggest for a child in a small body with the same issues (because there is no one medical issue that occurs exclusively in bigger bodies). If your doctor continues to push weight loss, please consider finding a new practitioner.

If speaking up scares you, I highly recommend keeping a few of these "Please don't talk about my child's weight" cards in your pocket.

Get it here.

Are there times when weight may be a concern? Yes, but the answer is not to prescribe weight loss. Instead, focusing on the behaviors that support general good health have far greater benefits in the long run. Increasing fruit and vegetable intake for your family (not just one child), incorporating more movement into your life as a family, getting better sleep, managing stress by teaching a variety of coping skills, stopping smoking and reducing alcohol consumption are all behaviors that improve health without focus on weight.

Health is so much more than what we eat and how we move. Those are just two behavioral factors. Health is also how we feel about ourselves and our overall mental health, whether or not we live in a safe home and neighborhood, how connected we are to community and spirituality, how stable we are financially, our access to quality medical care, the availability of food, access to education etc.

Instead of teaching kids that health is about their body size, instead we can:

Help them learn to trust their bodies regardless of size.

Help them find ways to move that they enjoy.

Create structure around meals and snacks when they are young (learn more about Division of responsibility by Ellyn Satter).

Offer a variety of foods in tastes and textures and consider their preferences.

Let them eat until they are truly satisfied without judgement.

Not label foods as good or bad. All foods have a time and a place.

Make “fat” a neutral word in your home (we don’t use it as an insult. Everyone has fat on their body. Some people have more and some people have less.)

Teach them that commenting on people’s bodies is never okay and that we are all so much more than our bodies.

Teach them about body diversity and the natural changes to expect during adolescence including the necessary weight gain.

What your child needs from you is love, support, and understanding that their worth is not connected to their body size because a lot of messaging out there is going to try to tell them otherwise. We all want to set our children up for success. The best way to do that is helping them have a healthy relationship with themselves, regardless of what their body looks like.

Some recommended reading on this topic (many of these are available at my curated section in Blue Door Books, FYI) are Intuitive Eating 4th Edition by Evelyn Tribole and Elyse Resch, Anti Diet by Christy Harrison, Food Is Not Medicine by Dr. Joshua Wolrich, Raising an Intuitive Eater by Amee Severson and Sumner Brooks and Body Happy Kids by Molly Forbes.