“The guideline authors say this change was driven, at least in part, by recent data showing how American kids’ rate of weight gain increased during the first two years of the Covid-19 pandemic. They interpret this as evidence that “watchful waiting” has failed.”
You alluded to this but I just want to emphasize - even if we accept this is the real/only reason, it’s still bullshit. It fails basic research principles on its face!
During a random internet journey yesterday I coincidentally read about the only NYC homicide recorded on 9/11. The FBI doesn’t include the attacks in their 2001 crime statistics because “the number of deaths is so great that combining it with the traditional crime statistics will have an outlier effect that falsely skews all types of measurements in the Program’s analyses.” You’d think a bunch of supposed scientists would underhand that better than law enforcement, and yet here we are.
I keep coming back to the fact that we don’t know the long term effects of these drugs or the long-term results of bariatric surgery. Meaning, like, 40 years on. We don’t have data on that. And a child cannot consent to that. You are modifying an organ system and they are legally unable to consent. It’s infuriating.
My gen z child is larger bodied and SO FREAKING aware of anti-fat bias and they are PISSED off. The one thing that brings me hope is that the younger generation seems to see the scam behind it all, and they also recognize thinness is a white supremacist capitalistic ideal that harms nearly everyone (except those raking in the profits). That’s all I’ve got today, but it’s not nothing.
What is it about our special (dare I say "exceptional") American society that seems to predispose us to "solutions" where when they fail, the answer is not to say "Huh, maybe that wasn't the right solution and we should explore something else" or even "Huh, maybe we didn't even define the right problem and maybe we need to go back and reconsider that before we propose solutions."
Instead the answer is to just double and triple down on the bad ideas, believing that somehow if we just do the thing (that hasn't worked or has actually made things worse) just a little bit harder, it will somehow "work" this time? (See war on drugs, obesity epidemic, trickle down economics, good guys with guns, policing, etc etc etc...)
I think it’s so important that your piece appeared in the Times. While this is an amazing forum, there is a “preaching to the choir” element that makes me so glad that you are getting the word out to the masses -- through your book and the Times column. So your three weeks was time very well spent.
I’m still stuck on how their response to this defies basic logic…ALSO: I am glad you shared all of this because it matters a lot to have it spelled out like this.
Medicine's obsession with manipulating surrogate endpoint is honestly exhausting. We have a bunch of evidence that it doesn't help, or helps only in certain cases: lowering cholesterol only helps prevent heart attacks in those who've already had a heart attack and is otherwise useless, for example. And weight is a surrogate endpoint. Can high weight indicate that something is wrong? Of course, in the same way that low weight can. I have no doubt that those pediatricians do indeed see many fat kids who are very sick. But does it follow that manipulating weight will automatically solve the underlying issue? No. And does it follow that all people with high/low weight are automatically sick? No. Many people with high cholesterol will never have any issues with their hearts, and even for those that will, lowering their cholesterol will not prevent those issues.
The unwillingness or inability to investigate into what may actually be wrong with sick kids is maddening. I can't see how you can look at a sick kid and think "what s/he really needs is some amphetamines/a mangled stomach!"
Thank you for this. That's all I can really say. Just, thank you.
Some part of me truly cannot believe that apparently THIS is going to be, like, the only actual long-term change that we make to our healthcare system, as a result of the pandemic. THIS is the big takeaway we are going to pull from all of this?? The other part of me can definitely believe it. I'm not sure which part feels worse.
Things that drive me up the wall--I was like, hmm, if this is because of the risk of diabetes, why wouldn't they just screen for diabetes and then go from there. If this is because of health problems, why aren't they talking about screening for the health issues. My kids don't get blood tests, and they don't even qualify for the every three years diabetes screening currently recommended. Even then, will my kids have high blood sugar because they are fat or because 50% of our family, regardless of size, has higher blood sugar (which may or may not have health implications at 65-70ish.) I am not going to give my kids a new drug or get them surgery because they are living the experience of being biologically part of our family. Sorry they drew the short straw and aren't perfect humans, but at least they could look the part?
I see this completely bullshit approach to eradicating fatness as the beginning of the end for institutionalized fat phobia. It’s reached such a hysterical pitch that it’s unsustainable. I only hope I live long enough to see it collapse.
Oh, and I already have a child with an eating disorder (ARFID) and I cannot imagine voluntarily signing a child up for anything even vaguely resembling this. His isn't based in body image issues but the worry when your kid won't eat anything is really intense. The worry about their ultimate relationship with food is so hard.
Still feeling sick over these new guidelines, I was reading "How to Raise an Intuitive Eater" yesterday. They cite the OLD AAP guidelines and it was like a smack in the face remembering what the new ones are. It's so unethical and against the evidence. How is this the world we live in?
My aunt was put on diet pills as a 9-year-old child in the 1930s. She lost a lot of weight and never recovered her mental health. (And she gained the weight back, in part because she was still a growing child! And she also had a very large frame, much like her father and brother.)
These AAP guidelines are going to do damage, maybe not to all children affected by this, but each one who suffers devastating effects will never be the same.
These guidelines make it ok to judge a patient by how they look regardless of actual health information and will lead to greater discrimination of people who don’t fit the thin white ideal. It’s maddening! It also gives no recognition to how teenage bodies change during puberty. My husband is a normal size guy but he would have been considered an overweight kid as a teenager because a lot of teens gain weight during puberty. I did. I worry that interventions will increase to involve even more kids than are already harmed by our anti fat healthcare system, simply because they are doing what bodies are supposed to do at that age - grow and mature into adulthood
“The guideline authors say this change was driven, at least in part, by recent data showing how American kids’ rate of weight gain increased during the first two years of the Covid-19 pandemic. They interpret this as evidence that “watchful waiting” has failed.”
You alluded to this but I just want to emphasize - even if we accept this is the real/only reason, it’s still bullshit. It fails basic research principles on its face!
During a random internet journey yesterday I coincidentally read about the only NYC homicide recorded on 9/11. The FBI doesn’t include the attacks in their 2001 crime statistics because “the number of deaths is so great that combining it with the traditional crime statistics will have an outlier effect that falsely skews all types of measurements in the Program’s analyses.” You’d think a bunch of supposed scientists would underhand that better than law enforcement, and yet here we are.
I keep coming back to the fact that we don’t know the long term effects of these drugs or the long-term results of bariatric surgery. Meaning, like, 40 years on. We don’t have data on that. And a child cannot consent to that. You are modifying an organ system and they are legally unable to consent. It’s infuriating.
My gen z child is larger bodied and SO FREAKING aware of anti-fat bias and they are PISSED off. The one thing that brings me hope is that the younger generation seems to see the scam behind it all, and they also recognize thinness is a white supremacist capitalistic ideal that harms nearly everyone (except those raking in the profits). That’s all I’ve got today, but it’s not nothing.
What is it about our special (dare I say "exceptional") American society that seems to predispose us to "solutions" where when they fail, the answer is not to say "Huh, maybe that wasn't the right solution and we should explore something else" or even "Huh, maybe we didn't even define the right problem and maybe we need to go back and reconsider that before we propose solutions."
Instead the answer is to just double and triple down on the bad ideas, believing that somehow if we just do the thing (that hasn't worked or has actually made things worse) just a little bit harder, it will somehow "work" this time? (See war on drugs, obesity epidemic, trickle down economics, good guys with guns, policing, etc etc etc...)
I think it’s so important that your piece appeared in the Times. While this is an amazing forum, there is a “preaching to the choir” element that makes me so glad that you are getting the word out to the masses -- through your book and the Times column. So your three weeks was time very well spent.
I’m still stuck on how their response to this defies basic logic…ALSO: I am glad you shared all of this because it matters a lot to have it spelled out like this.
Medicine's obsession with manipulating surrogate endpoint is honestly exhausting. We have a bunch of evidence that it doesn't help, or helps only in certain cases: lowering cholesterol only helps prevent heart attacks in those who've already had a heart attack and is otherwise useless, for example. And weight is a surrogate endpoint. Can high weight indicate that something is wrong? Of course, in the same way that low weight can. I have no doubt that those pediatricians do indeed see many fat kids who are very sick. But does it follow that manipulating weight will automatically solve the underlying issue? No. And does it follow that all people with high/low weight are automatically sick? No. Many people with high cholesterol will never have any issues with their hearts, and even for those that will, lowering their cholesterol will not prevent those issues.
The unwillingness or inability to investigate into what may actually be wrong with sick kids is maddening. I can't see how you can look at a sick kid and think "what s/he really needs is some amphetamines/a mangled stomach!"
Thank you for this. That's all I can really say. Just, thank you.
Some part of me truly cannot believe that apparently THIS is going to be, like, the only actual long-term change that we make to our healthcare system, as a result of the pandemic. THIS is the big takeaway we are going to pull from all of this?? The other part of me can definitely believe it. I'm not sure which part feels worse.
Things that drive me up the wall--I was like, hmm, if this is because of the risk of diabetes, why wouldn't they just screen for diabetes and then go from there. If this is because of health problems, why aren't they talking about screening for the health issues. My kids don't get blood tests, and they don't even qualify for the every three years diabetes screening currently recommended. Even then, will my kids have high blood sugar because they are fat or because 50% of our family, regardless of size, has higher blood sugar (which may or may not have health implications at 65-70ish.) I am not going to give my kids a new drug or get them surgery because they are living the experience of being biologically part of our family. Sorry they drew the short straw and aren't perfect humans, but at least they could look the part?
I see this completely bullshit approach to eradicating fatness as the beginning of the end for institutionalized fat phobia. It’s reached such a hysterical pitch that it’s unsustainable. I only hope I live long enough to see it collapse.
<insert primal scream>
Oh, and I already have a child with an eating disorder (ARFID) and I cannot imagine voluntarily signing a child up for anything even vaguely resembling this. His isn't based in body image issues but the worry when your kid won't eat anything is really intense. The worry about their ultimate relationship with food is so hard.
Still feeling sick over these new guidelines, I was reading "How to Raise an Intuitive Eater" yesterday. They cite the OLD AAP guidelines and it was like a smack in the face remembering what the new ones are. It's so unethical and against the evidence. How is this the world we live in?
My aunt was put on diet pills as a 9-year-old child in the 1930s. She lost a lot of weight and never recovered her mental health. (And she gained the weight back, in part because she was still a growing child! And she also had a very large frame, much like her father and brother.)
These AAP guidelines are going to do damage, maybe not to all children affected by this, but each one who suffers devastating effects will never be the same.
These guidelines make it ok to judge a patient by how they look regardless of actual health information and will lead to greater discrimination of people who don’t fit the thin white ideal. It’s maddening! It also gives no recognition to how teenage bodies change during puberty. My husband is a normal size guy but he would have been considered an overweight kid as a teenager because a lot of teens gain weight during puberty. I did. I worry that interventions will increase to involve even more kids than are already harmed by our anti fat healthcare system, simply because they are doing what bodies are supposed to do at that age - grow and mature into adulthood