“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.
The most offensive part of using the pandemic as a reason for this is, as a nation, we have done absolutely nothing to address the many things that impacted kids during those two years - namely, their caretakers dying and becoming sick at horrific rates. And now we’re showing those kids that the adults do not care about their grief and suffering, just what they weigh. The trauma of all of this is really heavy to even contemplate. If as a group, this generation of kids just says “fuck them adults” when we’re all old and need their help, they’ll be justified 10x over.
For sure, the weight statistics are *potentially* a useful signal about the stress children are experiencing (just because weight changes are a symptom of stress). And that connection has both a logical basis AND ample evidence from about a zillion other datasets. We could use this information to actually help children and families, but no.
I had my first child in 2020 so wasn’t really tracking the 2016 recommendation. I imagine that felt like such an important step in the right direction, making this about-face all the more heartbreaking.
The way that sentence had me SCREAMING. Literally, screaming aloud at my desk. WHAT THE FUCK. I have nothing sensible to add to the conversation at this point, just screams.
Right? I'm a public health researcher, and I was trained to be VERY SKEPTICAL of interventions based on an increase in rate. Reporting a change this way can artificially inflate it (basically make it seem like a bigger problem than it is) which is then used as a way to generate moral panic about something that is not actually necessarily a health problem. Or at least not for the reasons they are trying to claim it is. Ugh.
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.
Yes. I suspect the thing that may help finally change the tide on this will be someone gathering key follow-up data on the impact of these surgeries on kids 10, 15 years out. But we have to wait for that and in the meantime... kids are getting these surgeries.
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.
Thank you for sharing this, it gives me hope too. I can't wait to see Gen Z come into their power and hopefully dismantle some of these toxic ideas. Stay angry, young people!
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.
Oh agreed and thank you. It's why I do still write for mainstream outlets, even though Burnt Toast is now my full-time job. We do important work here, but we need the conversation happening out there too.
Same. The other coverage I've seen of these changes in NY Times and the Washington Post has been not good at all. Just total acceptance of the new guidelines and not at all taking seriously the risk of disordered eating.
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.
I wonder if this stems from the fact that being overweight is considered to be a co-morbidity of COVID? I’m not saying it’s right, but I’ve had a family member (a nurse!) blame the pandemic on “the obesity epidemic” so I feel like they do see this as a reasonable response because of this?
I am a cranky old person and this point and just feel so tired that it's hard for me to put on my Most Generous Interpretation hat for this kind of systemic fat-shaming, but that is an interesting point to raise. I tend to think that people get kind of covertly gleeful whenever weight increases a risk factor for x, because it's another reason to justify anti-fat bias and dress it up as concern, but that is not very compassionate of me!
Oh, if I came off as being at all charitable in my comment regarding my interpretation that was a failure of tone. I think the obesity as a comorbidity is lazy. Because thin people have also had bad COVID outcomes. I think they are using it as a justification to push these clearly biased, not based on anything but aesthetic guidelines through.
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.
The most offensive part of using the pandemic as a reason for this is, as a nation, we have done absolutely nothing to address the many things that impacted kids during those two years - namely, their caretakers dying and becoming sick at horrific rates. And now we’re showing those kids that the adults do not care about their grief and suffering, just what they weigh. The trauma of all of this is really heavy to even contemplate. If as a group, this generation of kids just says “fuck them adults” when we’re all old and need their help, they’ll be justified 10x over.
For sure, the weight statistics are *potentially* a useful signal about the stress children are experiencing (just because weight changes are a symptom of stress). And that connection has both a logical basis AND ample evidence from about a zillion other datasets. We could use this information to actually help children and families, but no.
THIS.
AND YET HERE WE ARE. Thank you for emphasizing that.
I had my first child in 2020 so wasn’t really tracking the 2016 recommendation. I imagine that felt like such an important step in the right direction, making this about-face all the more heartbreaking.
The way that sentence had me SCREAMING. Literally, screaming aloud at my desk. WHAT THE FUCK. I have nothing sensible to add to the conversation at this point, just screams.
Right? I'm a public health researcher, and I was trained to be VERY SKEPTICAL of interventions based on an increase in rate. Reporting a change this way can artificially inflate it (basically make it seem like a bigger problem than it is) which is then used as a way to generate moral panic about something that is not actually necessarily a health problem. Or at least not for the reasons they are trying to claim it is. Ugh.
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.
Yes. I suspect the thing that may help finally change the tide on this will be someone gathering key follow-up data on the impact of these surgeries on kids 10, 15 years out. But we have to wait for that and in the meantime... kids are getting these surgeries.
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.
A lot of kids I interviewed for the book gave me this same hope. We need this hope. It's absolutely not nothing.
Thank you for sharing this, it gives me hope too. I can't wait to see Gen Z come into their power and hopefully dismantle some of these toxic ideas. Stay angry, young people!
I love this and I think it's so hope-affirming.
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...)
"What if we keep doing the same thing, but MORE?!"
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.
Oh agreed and thank you. It's why I do still write for mainstream outlets, even though Burnt Toast is now my full-time job. We do important work here, but we need the conversation happening out there too.
Same. The other coverage I've seen of these changes in NY Times and the Washington Post has been not good at all. Just total acceptance of the new guidelines and not at all taking seriously the risk of disordered eating.
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.
Yes the defies basic logic part is really A LOT.
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.
I wonder if this stems from the fact that being overweight is considered to be a co-morbidity of COVID? I’m not saying it’s right, but I’ve had a family member (a nurse!) blame the pandemic on “the obesity epidemic” so I feel like they do see this as a reasonable response because of this?
I am a cranky old person and this point and just feel so tired that it's hard for me to put on my Most Generous Interpretation hat for this kind of systemic fat-shaming, but that is an interesting point to raise. I tend to think that people get kind of covertly gleeful whenever weight increases a risk factor for x, because it's another reason to justify anti-fat bias and dress it up as concern, but that is not very compassionate of me!
Oh, if I came off as being at all charitable in my comment regarding my interpretation that was a failure of tone. I think the obesity as a comorbidity is lazy. Because thin people have also had bad COVID outcomes. I think they are using it as a justification to push these clearly biased, not based on anything but aesthetic guidelines through.
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