“Physicians are not immune to societal weight bias that is prevalent in our culture,” said Rebecca Puhl, a professor and the 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 training.”
Related to this, the A.A.P.’s continued reliance on B.M.I. is troubling to some, as it can be a poor predictor of individual metabolic health and may be stigmatizing.
“I wish the A.A.P. had not used B.M.I. as a marker,” Dr. Amin said. “B.M.I. does not take into consideration the health of a child. It only is looking at numbers.” Dr. Amin has many patients with relatively high B.M.I.s who are “tracking beautifully” on their growth percentiles, she said, eating a varied diet and getting sufficient physical activity. They simply have bigger bodies.
Dr. Jason Nagata, an adolescent medicine specialist with the UCSF Benioff Children’s Hospital San Francisco, said it was important to remember how sensitive doctor-patient discussions around weight and bodies could be. He also expressed concern that practices like using person-first language, while important, are not enough.
“As an eating disorder specialist, I get so many referrals now with the same story: A teenager who was previously overweight or obese got a recommendation from their pediatrician or parents to lose weight, and they took it to the extreme,” Dr. Nagata said. He has worked on studies showing that disordered eating behaviors like fasting or vomiting are common in children with obesity. Even if parents and doctors are careful to use person-first language and focus discussions on health, not weight, a child may only hear “you’re telling me I’m too fat, I need to lose weight,” he cautioned.
Dr. Miller echoed that assessment, saying “weight talk” can set children up for disordered eating. “What I fear is that we are proposing 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 are setting kids up for a challenging relationship with their bodies and increasing their risks of other serious medical conditions.”
What the new guidelines mean for your next pediatrician visit
Experts say it can take time for A.A.P. recommendations to change how pediatricians provide care day to day.
