Dear Kids (especially higher weight kids),
The American Academy of Pediatrics (the organization where lots of doctors who treat kids belong) made a big oops! If you’re anything like my kids, you probably think it’s pretty funny when adults mess up or make mistakes. Well, this one is a huge mistake and sadly it’s not a funny one because this mistake will harm lots of kids like yourself. You might already know what a pediatrician is because you probably go to one at least once a year. They are the people who are supposed to make sure you have all your vaccines and listen to your heart and make sure your reflexes are working well. They are supposed to be people that you can trust to help you feel good about yourself and who will answer questions you have about your body and ways that it changes during childhood and adolescence.
Well, this group of lots of doctors did something so wrong that it will actually lead to kids really disliking themselves or developing eating disorders, which are illnesses many people die from. It will also lead to lots of kids dieting and taking dangerous medications or having dangerous surgeries just to try and lose weight. I’m not so sure if they will ever apologize for their harm, but as a psychologist (a kind of doctor who helps people with their feelings) who works with lots of kids and adolescents and lots of people with eating disorders, I am going to apologize to you. Sometimes we say we are sorry even when we aren’t the ones who did something wrong because we are sorry that people are going to be hurt. And in this case I am so sorry that they got it so wrong and that you might be harmed as a result.
Let me tell you a little about what these pediatricians did. I’m sure that you’ve heard from the grown ups in your life how people come in all different shapes and sizes and that each of us is unique and different and how that’s a really cool thing. Well, these pediatricians are saying that being in a bigger body is a disease, which if you think about it makes no sense. How can body size be a disease? That’s like saying foot size or how tall you are could be a disease. Once they say that being in a higher weight body is a disease, they tell us that we should use the BMI to see if someone falls into that higher weight range. Here’s the thing- they recommend using the BMI even though there are years of data that says the BMI is useless and racist. It’s actually a math equation. Not something that can diagnose a disease. These doctors even say that they use BMI because it’s easy to use and inexpensive. Have you ever gotten in trouble for taking the easy way out? Well, let’s just say that using the BMI is the easy way out- especially when they didn’t even tell the whole truth about it.
So anyway, these doctors wrote a very long paper (like 100 pages long!) about trying to make higher weight kids into lower weight kids and many times throughout the paper they talk about something called weight stigma. You may or may not have heard of it, but in case you haven’t, weight stigma is basically when people are unkind or treat you differently because you’re fat or because they are afraid you will become fat. The thing about weight stigma is that it is really hurtful to people. It not only hurts people’s feelings, but it puts them in danger of eating disorders and depression and spending a lot of time dieting. The American Academy of Pediatrics is doing something that is pretty tricky because they are trying to tell everyone that weight stigma is bad (which it is!) while also stigmatizing people about their weight. They want to fool us into thinking that they are trying to be nice to fat people, but really what they are trying to do is stop people from being fat. How can you be nice to someone that you’re trying to change so much?!? It makes no sense.
The other thing they are doing that’s very tricky is not telling the whole truth in their guidelines. I am sure that you’ve already been taught the difference between truth and lies, but have you ever had a grown up ask you a question and you told a little part of the story, but not the part that you knew was going to get you into the most trouble? That’s kind of what they are doing. They are telling a little bit of the story, but leaving out the details that would get them in the most trouble and they are hoping no one will notice, but we noticed. They are leaving out that lots of their members are making money from telling kids to use medications or have surgery to lose weight. They are also letting us know about some research, but leaving out lots of research that disagrees with the things they are trying to say. In fact, lots of times in their (long) paper they give a recommendation and then right after say that there’s no research to support it.
Ok, so what we know so far is that these pediatricians first said that body size is a disease, which makes no sense. Then they used an outdated and racist equation to decide which bodies meet the criteria for the supposed disease and then they pretend they are being nice to higher weight people when really they are trying to make higher weight bodies not exist anymore and then they are lying about the research. None of this sounds very trustworthy, does it? But they don’t stop there with their half truths and misinformation. They keep going and start talking about what makes some bodies bigger than others. It’s kind of a weird thing to talk about when you think about it. Of course some bodies are bigger than others just like some people are taller than others and some people have different color eyes than others. But they don’t care about that. If you look back on pictures of people from any generation- like even really old pictures from like 100 years ago you will see some bigger bodies and some smaller bodies. That’s because higher weight people always existed and they always will and thank goodness for that. It would be super boring if everyone was the same size and really sad if higher weight people didn’t exist.
In their very long list of what makes some people bigger than others, they talk about these things called social determinants of health. Social determinants of health are things like if we have access to enough food, if we live in a place that’s safe and can go outside and play, if we have grocery stores with all different foods available, if we can get to the doctor regularly, if we are being oppressed or marginalized (which ironically is what the pediatricians are doing to higher weight people), if we have enough money to buy things that we need, if our schools are safe. Really important things, right? And things that have a pretty big impact on our health and well-being. Most of you reading this are probably thinking that this would be the time these pediatricians would stop talking about making bigger bodies smaller and start talking about how to end poverty and make sure schools are safe and that kids can see them for a check- up every year because if these doctors put time and thought into that they could really improve the health of kids. Instead they just keep going on with their weight stigma.
This is where things start to get even more upsetting because the pediatricians start talking about their ideas for how to make higher weight people smaller. What’s really confusing to me and maybe to you as well, is that there’s lots of research that tells us that almost everybody who loses weight gains it back (because bodies are super smart and don’t like to be malnourished) and that people who gain and lose weight a bunch of times are more likely to have health problems, and even these doctors tell us that as soon as people stop with the “treatment” they are receiving, they start to gain weight back. In their own words these doctors know that people are likely to lose weight and then gain it back and if they keep coming back for more treatment that’s going to happen over and over. And on top of that, the treatments they are offering are kind of scary and dangerous and put kids at risk for lots of yucky side effects that could make it really hard for kids to do kid things like play and go to school. So that’s why I get confused- these pediatricians say they are trying to help kids, but so far it seems like they are not doing a very good job at it.
I’m not going to go into too much detail about the ideas these pediatricians have because I think it’s pretty harmful for kids to even hear this stuff being talked about, but there’s a couple of things I think it’s important for you to know. When they share these ideas they let us know that they don’t really know how these ideas will impact kids’ mental health (mental health is kind of like physical health but about thoughts and feelings). I don’t know about you, but to me it seems pretty important to know how something is going to make kids feel before suggesting it to them. In their second idea, the pediatricians talk about some medications to give to kids. It was scary to learn that a lot of these medications aren’t even approved for kids to use to lose weight and many of them help with various other illnesses that kids get. It would be really awful if someone who actually needed the medication couldn’t get it because it was being wasted on trying to get kids to lose weight. It was also really scary to see that the pediatricians tell us that there’s no evidence for using these medications in this manner. It seems like they are trying so hard to find a reason to prescribe these medications. I’m a psychologist not a detective, but I wonder if we went looking if we might find some of these doctors make money from these medication companies.
The other thing these doctors recommend is a surgery that basically takes a perfectly functioning organ (the stomach) and removes part of it. This is kind of like doing surgery on an arm that’s not broken- it not only makes no sense, but we would really question what a surgeon was thinking doing that operation. We have to wonder the same thing here. Why would doctors want to mess with a perfectly functioning organ in kids? And especially with a surgery that has a lot of risks (including death) and no evidence that it leads to weight loss long term. Some kids who have this surgery might have to have another one a few years later and some kids might not be able to get enough vitamins for their body to run properly. Again, I’m a psychologist not a detective, but I wonder if some investigating would discover that some of these doctors make money from these surgeries. I think there’s a pretty good possibility that’s the case.
You might feel like you just read a book, but remember these doctors wrote like 100 pages, so this is kind of like cliff notes (I think those might be things that only old people like me remember, so if you don’t know what they are, look them up). All of the information in this letter to you is why I am here saying that I’m sorry. And it’s not just me that is here saying that it’s wrong- there are thousands of us working really hard (including lots of awesome pediatricians!) to try and get these guidelines tossed out and to let kids and adults know how harmful they are. No kid should have to be subjected to these things no matter what size their body is and it’s not ok that the American Academy of Pediatrics let you down so much.
Here’s what’s super important for you to know: your body is just fine exactly as it is. You don’t need to lose weight. In fact, childhood and adolescence is a time when people should be growing and gaining weight. You have so many more important things to do in your lifetime than spend time trying to make your body smaller. It’s super dangerous and doesn’t work anyway. And it’s totally unnecessary. And in case no one told you (because a lot of these doctors and some other grown ups sometimes keep this a secret), it is totally possible to live a really wonderful and awesome life in a fat body. There are so many kids and grown ups doing just that right now! Your body is on your side. No need to fight it.
Sending you love and hope for a future where all kids feel free in their body,
Dr. Rachel Millner