By Sharlene Kerelejza
Earlier this year, just as the diet and fitness industries are at their height of appeal, capitalizing on our resolutions for a "New Year, New You," the American Academy of Pediatrics released new guidance that not only condones but recommends "intensive health behavior and lifestyle treatment,” medication, and even surgical intervention for children and youth in bodies with larger than average weight/Body Mass Index (BMI). By the policy’s own statement, “individuals with overweight and obesity experience weight stigma, victimization, teasing, and bullying, which contribute to binge eating, social isolation, avoidance of health care services, and decreased physical activity. Importantly, internalized weight bias has been associated with a negative impact on mental health” (American Academy of Pediatrics Guidelines, January 2023).
So, let's wrap our heads around this a bit. We are recommending intensive intervention for children as young as 2 in larger bodies, including weight-loss surgery for children and youth in developing, perhaps pubescent, bodies, in part to help protect them from being stigmatized, discriminated against, marginalized, and isolated by a society that condemns fatness. For those familiar with other types of bullying behaviors based on gender, race, sexual orientation, etc., this is another form of blaming the victim and holding them responsible for protecting themselves from their victimization, all under the premise of promoting health.
This is definitely a situation of "buyer beware.” Yet, these are children. Children and youth are going to be subjected to these interventions at a time when their informed consent is impossible and when self-consciousness about one's body is rampant. Adolescents are supposed to gain a significant amount of weight during puberty, yet are already being told by the media, diet culture, society, and the medical establishment that thinness is the ultimate aspiration. According to the National Institute of Health, the average onset of eating disorders is before the age of 18. The American Academy of Pediatrics new guidelines reinforce all the ways we prescribe eating-disordered behaviors, such as restricting food intake, strict exercise regimes, and more, at a time when children and youth are already dabbling in these high-risk behaviors.
Additionally, using the Body Mass Index to measure and define the problem of “obesity” disproportionately affects those in Black, Brown, disabled, and non-binary bodies.
It's time to get grounded in some truth, and to know that it is OK for parents and caregivers to question these recommendations and to disagree with healthcare professionals on their prescribed solutions. It is OK for parents to wait and see what a child's body naturally does to sort out its own weight throughout its development and puberty before high stakes interventions. It is also important to get more information before you make a decision on behalf of (and hopefully with) your child and to know the long-term consequences of such decisions.
A couple of potential resources to broaden your lens may include the Association for Size Diversity and Health, "Health at Every Size" principles (asdah.org), and the Center for Body Trust (centerforbodytrust.com). If you are concerned about your child's health and if they show signs of disordered eating, please go further than a quick assessment from a pediatrician. Consult those who are well-versed in eating disorder assessment and treatment. If you have difficulty accessing care due to insurance limitations, Project Heal is a great resource.
Please remember that bodies have always come in all shapes and sizes, and weight in and of itself is not an indicator of health. Perhaps the lens of intervention needs to shift to be less about how we can make our children smaller and more about how to grow a society that stops shaming and bullying people because of their size and other characteristics and celebrates a wider lens of health, strength, and beauty. Our children internalize our voices. Let them hear us celebrate their diversity, strength, moral courage, and trust in their own bodies, exactly as they are.
Meriden resident Sharlene Kerelejza is a social worker who works as a clinical assistant faculty member at the Sacred Heart University School of Social Work. She is a member of the city's Democratic Town Committe e.