From the Vault: Examining the Harmful Implications of the AAP's Guidelines on Weight Loss Medication and Surgery for Children with Jessica Setnick, MS, RD, CEDRD-S [Episode 72]

Understanding Disordered Eating: Eating Disorder Recovery and Body Image Healing

We're continuing our summer throwback series with a powerful episode that's simply too important to leave behind. While we're taking a short break this summer, we'll be resurfacing some of our most impactful conversations — the ones that made us think, challenged the status quo, and sparked meaningful dialogue. Today's rerun is one of those episodes.

Originally aired as Episode 72, this conversation with Jessica Setnick dives headfirst into the controversial 2023 guidelines issued by the American Academy of Pediatrics (AAP). These guidelines made headlines — and not in a good way. Recommending behavioral interventions and even weight loss medications and surgery for children as young as 2, 12, and 13, respectively, the AAP ignited a firestorm of concern within the eating disorder treatment community.

Jessica, a fierce advocate and long-time voice in the eating disorder field, joins me to unpack what these guidelines really say, why they're so troubling, and how they reflect a deeper cultural problem rooted in weight stigma. We question authority, untangle complex motivations (hello, pharma profits), and explore what weight-inclusive, ethical pediatric care should actually look like.

In this episode, we're talking about:

• Why the AAP's new guidelines on pediatric weight management are sparking outrage in the eating disorder community.

• The alarming recommendations to introduce weight loss medications by age 12 and surgery by 13.

• The pervasive weight stigma built into these guidelines, including the problematic use of BMI as a screening tool.

• How profit motives, particularly from big pharma, may be influencing the creation of these "medical" guidelines.

• The real consequences of these interventions: malnutrition, stunted growth, cognitive impacts, and the risk of lifelong eating disorders.

• The false logic that shrinking a child's body will reduce weight stigma and why that belief is not just wrong, but dangerous.

• The importance of separating weight from health, and why any medical concerns should be treated based on symptoms, not size.

• How weight changes can be relevant when viewed contextually, but should never be the sole focus of medical intervention.

• Why trusting your gut and challenging medical advice is not only okay, but it might be necessary for protecting your child's wellbeing.

• Where to find weight-inclusive providers and what to ask when choosing a new pediatrician.

Tweetable Quotes

"Anyone who works in the eating disorder field at all – and probably many humans – knows multiple people, if not themselves, who have had failed weight loss interventions when they were children that then resulted in bigger problems." – Jessica Setnick

"The key is not to just single out the big kids. Any kid with an eating disorder should be evaluated. Any kid with a medical condition should be evaluated." – Jessica Setnick

"Shrinking children does not change their medical conditions." – Jessica Setnick

"'Does my child have a medical condition, or are you saying my child is too big? Because if it's a medical condition, we'd like to get treatment independent of his size. But if you're saying his size is a problem, that's not a conversation I'm willing to have.'" – Jessica Setnick

Resources

AAP Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity

News release for the AAP new guidelines

Understanding Disordered Eating, Ep. 30: Eating Disorders are the Solution Not the Problem with Jessica Setnick, MS, RD, CEDRD-S

Jessica on Facebook

Jessica on Instagram

Jessica Setnick: Understanding Nutrition

Jessica's Website

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