If your child was too fat, what would you do?
This isn't a trick question. I want you to seriously ask yourself, if your child was obese, how would you address it? Would you address it?
Let's talk about it.
The American Academy of Pediatrics (AAP) just released their 2023 Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity.
It has garnered a lot of attention and controversy, and not without good reason.
The AAP defines obesity as a chronic disease that requires treatment with intensive and long-term care strategies. Whatever your thoughts about this, their primary recommendation is behavior and diet modification for kids of all ages. Cool.
Where the controversy comes into play is that the AAP also recommends treating children over 12 years old (and as young as 8 years in special situations) with pharmaceuticals and treating children 13 years or older who have morbid obesity with bariatric surgery.
Our position is rather simple: The AAP completely misses the mark.
Children do not become obese because of genetics (99.99% of the time) or their own choices, they become obese because of their upbringings and environments.
Obesity in children is very much a symptom of something, and we should be asking why a child is obese before jumping to fix it with drugs and surgery.
Trauma—children that have endured physical and/or emotional abuse often use food to self-soothe their hurting soul.
Mood disorders—children with anxiety, depression, or other mood disorder may use food as a coping mechanism to help stabilize themselves.
Fattening home environment—children with boundless exposure to hyperpalatable foods are likely to overeat.
There are probably many more reasons than the three above, but I'd guess that these are the most common causes. If you give drugs or perform surgery, you're just managing symptoms (the obesity and overeating) rather than addressing the cause(s).
If a child has experienced trauma and uses food to help calm their nervous system when activated, it's not only illogical to rip that comfort food away from them, it's downright disgusting behavior.
What do you think will happen when that child can no longer self-soothe with food? They'll turn to other means, most commonly drugs and alcohol. If those aren't available, then other forms of control through food can be found, like binging and purging behaviors. Ripping food away from the hurting soul just causes an addiction transfer. They might lose weight, but at what cost?
If the child is depressed or anxious and they use food to help stabilize their mood, do you think taking that food away is going to make their life easier? Or, is it going to make their moods more erratic and insufferable to both themselves and those around them?
The only situation in which such interventions make sense is when the child lives in an obesogenic environment. But even then, it doesn't address the cause, which is you.
Children don’t have the cognitive ability to make rational decisions about what they eat. That’s the job of the parent. If anything, behavioral interventions should focus on the parents of obese children rather than the children themselves. It's up to you to provide a food environment that supplies ample nutrition without excessive energy.
Humans and especially children do not become excessively fat for no reason. Obesity is a symptom of a bigger problem. Children do not need to be fixed with weight loss, they need to be evaluated for their causes of overeating.