“To me, this new guidance looks very weight-focused,” Dr. Gewirtz O’Brien says. “I am very concerned about pathologizing kids’ bodies and weights, particularly when there are no associated health concerns, and especially when there are no studies looking at the long-term effects of new weight-loss drugs.” (The new drugs she’s referring to are semaglutide injections, including Wegovy—which is FDA-approved for weight loss—and Ozempic, a type-2 diabetes medication that some doctors are prescribing off-label for weight loss.) Plus, it’s well documented that both weight-loss drugs and weight-loss surgery come with side effects. Among the known side effects mentioned for the drugs named in the guidelines are elevated blood pressure, dizziness, tremor, headache, nausea, vomiting, fecal urgency, and gassiness. (These are just the potential short-term side effects; for many of the drugs, there’s a lack of research on long-term issues.)
And bariatric surgery is associated with even more potential complications, including acid reflux (which can become chronic and lead to gastroesophageal reflux disease), chronic nausea and vomiting, the inability to eat certain foods, weight gain or failure to lose weight, low blood sugar, malnutrition, ulcers, bowel obstruction, and hernias. The guidelines also state that between 13 and 25% of those who get bariatric surgery will need a follow-up procedure within five years.
These recommendations could pathologize normal growth and development.
To really grasp the extent to which these guidelines could hurt kids, it’s important to understand how pediatricians track healthy growth and development in children and teenagers.
“Every kid, if they’re being seen in primary care, will have their weight, height, and BMI tracked over time on a growth curve,” Dr. Gewirtz O’Brien says. These curves come from the CDC’s growth charts for individuals ages 2 to 19, and they allow pediatricians to plot each person’s weight, height, and BMI relative to the rest of the population. (Although they’re not based on the current population—they’re based on data collected on American children between 1963 and 1994.) “We’re not really looking at single weight or height measurements, we’re looking for trends over time. Most kids who are healthy and eating well will trend along a certain curve,” Dr. Gewirtz O’Brien says.
For example, some kids trend along the 50th percentile for their entire lives, while others might trend on the 10th percentile, and still others trend on the 95th percentile. “If I see that someone has always been on the 90th percentile curve, and they’re eating well and moving their body, then I’m happy to see that they’re still on that curve, because it means that they’re developing properly,” Dr. Gerwirtz O’Brien says. “It’s a red flag when someone rapidly goes down on the growth curve, or when someone rapidly goes up on the growth curve.”
But with these new guidelines, pediatricians are being told to recommend weight loss to anyone above the 85th percentile (and weight-loss drugs or surgery to those in higher percentiles)—even if they’ve been there their entire lives.
Parents can ask pediatricians not to talk to their child about weight—and many experts recommend speaking up.
Dr. Levinson—who points out that eating disorder-related emergency room visits have doubled among teen girls during the pandemic—says that now the impetus is on parents to try and minimize the harm (and increased eating disorder risk) that these guidelines could cause to children. The best way to do that, she says, is to ask the pediatrician to never talk about weight or BMI in front of their kid or make negative comments about their body. And if parents get pushback, it’s worth looking for a new pediatrician who understands their concerns and respects these boundaries, she adds.
This isn’t to say that parents should insist that their child not be weighed during doctor’s visits. Both Dr. Cifra and Dr. Gewirtz O’Brien say that tracking weight is important for ensuring proper development and screening for diseases or other health issues, including malnutrition. But if the doctor gives a weight-loss recommendation—be it through lifestyle intervention (a.k.a. dieting and increased exercise), weight-loss drugs, or bariatric surgery—it’s best not to relay this information to your child. As Davenport says: “Doctors telling kids to go on a diet interferes with their autonomy and their sense of who they are.”
If you’re struggling with an eating disorder, you can find support and resources from the National Eating Disorder Association (NEDA). If you are in a crisis, you can text “NEDA” to 741741 to be connected with a trained volunteer at Crisis Text Line for immediate support.