Parent Resource: Navigating Pediatric Care in Light of the New American Academy of Pediatrics (AAP) Guidelines

Parent Resource: Navigating Pediatric Care

We teamed up with Carolina Resource Center for Eating Disorders to create this parent resource. The resource is designed for parents and caregivers who are concerned about pediatric care in light of the new AAP Guidelines for the Assessment and Treatment of Children and Adolescents with “Obesity” (AAP Guidelines). It is meant to be supportive by providing language, resources, and ideas on how best to pursue weight-inclusive medical care for children and adolescents.

You may not feel comfortable with some or all of these suggestions, depending on your identity, beliefs, and comfort level. Our medical system needs to do better for ALL children and families, of all identities. The change shouldn’t rest on your shoulders. However, here we are. The new AAP Guidelines have immense potential for harm.

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Below are a few ideas of what you can do NOW and BEFORE, DURING, and AFTER your child’s doctor’s visit.

NOW: What you can do today.

Express your concerns about the AAP Guidelines and how they will impact pediatric care.

Here are some examples:

The new AAP Guidelines for the Treatment of Children and Adolescents with “Obesity” do not meet the basic standard of health care to “Do No Harm.”
The recommendations are based entirely on using BMI as a diagnostic tool, which has racist origins and was never intended to be used for the diagnosis of individuals.
The research cited in the recommendations is not robust and does not show long-term outcomes.
The recommendations are individual-level “solutions” to environmental-level problems. Reducing health disparities cannot be solved on the individual level.
The recommendations made in the guidelines perpetuate weight stigma, which research unequivocally shows causes negative physical and psychological health outcomes.
The recommendations for ”Intensive Health Behavior and Lifestyle Treatment," weight loss medications, and bariatric surgery for children are not backed by any long-term data about the potential harmful side effects.
Dieting and experiencing weight stigma are significant risk factors for eating disorders.

Share, via email or portal message, statements from organizations that are concerned about the guidelines:

BEFORE: What you could do before your child’s doctor’s appointment.

Send an email or portal message: Send an email to your child’s doctor prior to your child’s appointment. Explain in your message that your child has an upcoming appointment and how/if you'd like growth discussed. You might use this letter as a template or send the letter as is. A Letter to Your Child's Doctor

Schedule an appointment to meet with your doctor: We know healthcare providers are extremely busy. You might schedule a parent appointment prior to your child’s next appointment to discuss your concerns about the new AAP Guidelines. Express how you would like your child’s healthcare to be approached.

DURING: What you could do at your child’s doctor’s visit if the medical provider expresses concerns about your child’s weight.

Bring in the above letter (printed) or a card asking clinic staff and the medical provider not to discuss weight in front of your child. You could also write a handwritten note “Please do not discuss my child’s weight in front of my child.” Check out these great cards from Morelove.org.

Possible statements if an MD or other medical provider brings up weight in the visit:

“You do not have my permission to discuss my child’s growth charts during this visit. If you have concerns we can schedule a separate visit.”
“The AAP Guidelines in the Treatment of "Obesity" state that the doctor must ask for consent to discuss weight during the visit. You do not have my consent to discuss weight.”
“Weight is not a measurement of health. We’re happy to discuss other vitals and health-promoting behaviors.”
“We do not believe body size is a disease.”
“We are not interested in any referral with the goal of only reducing body size. If you have concerns about my child’s nutrition, I would like to be referred to a Registered Dietitian who is weight-inclusive and understands the risks of dieting and eating disorders.”

Possible questions to ask:

“Research does not show causation between BMI and health concerns. Is your only concern for my child’s health their weight?”
“Are there other health parameters, besides weight, you are concerned about? What are they?”
“If my child had a smaller body and had this same health concern, what recommendations would you be giving?”

AFTER: What you can do if you're concerned about your child's doctor's appointment.

Follow up with an email or portal message with your concerns. Refer to the letter above and the concerns listed in the “Now” section of this resource.

Schedule a parent appointment to discuss how you want your child’s health care to be approached.

Talk with your child, depending on their age, about your family's values around weight and health. Assure your child that you love and support them.

If you do not feel heard or your doctor does not agree to approach your child’s care in a more weight-inclusive way, consider getting a new doctor, if possible.

We have this blog post formatted as a PDF that you can print out or share with others. Click here for the Parent Resource: Navigating Pediatric Care in Light of the New American Academy of Pediatrics (AAP) Guidelines

For more information

For resource and referral information, contact Carolina Resource Center for Eating Disorders. info@crcfored.com | 828.337.4685 | crcfored.com

For more diet-free parenting support

References

Hampl SE, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023.
Strings, S. (2019). Fearing the Black Body (1st ed.). New York University Press.
Chastain, R. (2022, January 14). Serious Issues with AAP Guidelines for Higher-Weight Children. Weight and Health Care. https://weightandhealthcare.substack.com/
Brown, A., Flint, S. W., & Batterham, R. L. (2022). Pervasiveness, impact, and implications of weight stigma. EClinicalMedicine, 47, 101408.
Neumark-Sztainer, D., Wall, M., Story, M., & Standish, A. R. (2012). Dieting and unhealthy weight control behaviors during adolescence: associations with 10-year changes in body mass index. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 50(1), 80–86.