"I'm also thinking about all the kids out there whose parents aren't listening to this podcast or reading this newsletter, who simply don't know to resist a doctor's recommendation, or who have doubts, but don't feel safe questioning the authority of a medical professional. These new guidelines will disproportionately harm the most vulnerable kids, kids of color, kids with fat parents, kids living in poverty, kids whose parents are immigrants, and so many other marginalized identities."
Thank you for this. I love that in addition to all the other points, this discussion raised the issue of the further eroding of trust in scientific institutions because I absolutely have been thinking about that. I feel like - come ON! after the three years we are coming out of, do we REALLY need to go actively creating legitimate reasons to be suspicious of the very institutions that we are supposed to be able to trust with the health and well-being of our selves and our kids?
I was just reviewing the note from my last visit to my PCP's PA. In the vital signs section in place of weight it says "Patient refuses to step on scale". I own it, I am that non-compliant patient.
When the article came out, I was just blown away that it seemed completely opposite the prevailing medical guidelines for weight loss surgery/drugs for adults from just a few years ago, ie use with caution after other methods have been tried. WTF!?!?
This episode is so important and the topic so troubling. One thing that I wonder about is why pediatricians (and this definitely seems systemic, given every person's experience shared on the podcast) seem to believe that BMI is THE primary indicator for health. I have one child who had a high BMI, had a growth spurt, and now has a BMI in a normal range. The pediatrician had chastised me about my child's BMI in the earlier appointment and then expressed concerned that my child had grown but not gained weight (to clarify: I've never done anything to limit or restrict my child's food intake - as someone with a history of an eating disorder, I feed my kids in a fairly food-neutral way, as in, please eat the dinner or breakfast I cooked or take a bagel, just don't go hungry). Back to the pediatrician -- I basically said: we obviously can't win with the battle against this chart. First you're disappointed her BMI is high but then concerned her weight didn't increase enough?
Feeling like I'm only going to go in for vaccines and sick visits from now on...
Pediatric nurse practitioner and mom of an 18 year old trying to recover from anorexia here.
I can’t tell you how engrained the culture of wellness and thin is in the medical field. The blinders many practitioners wear will take years and years of fight to change. I honestly believe that some of it lies in the fact that many MDs/researchers/providers are driven people themselves who tend toward disordered eating in order to keep their thin ideal or cope with health anxiety. This is only part of the multi factorial issue, but the more I speak out to my colleagues, the more I realize how cemented this culture is.
We recently had a patient who had an 8 hour surgery followed by a 2 day ICU stay after having an intestinal blockage. The teen had lost 50 pounds in ten weeks and then had eaten a whole pizza (after likely starving himself for weeks). Not one person mentioned eating disorder, a nutritional consult or psych consult. He had been “praised for his weight loss and was asking for help to lose more”.
My daughter as well was overlooked when she began to lose weight, I sounded alarm bells and was constantly reminded that she was within normal weight.
It’s frustrating, so sad and unbelievable. I will continue to fight and am grateful for the resources I have found here too.
Thank you for this episode, truly a beautiful gift, though a bittersweet one that brought me to tears. My 13-year-old daughter and 15-year-old son are both in the obese category of the BMI.
At their last wellness exams, scheduled back to back, the pediatrician sat down with the three of us and talked about BMI with a very concerned look and tone. She is a gentle and sensitive doctor, and as such would not come out and say "I am concerned and you both need to lose weight," but instead danced around it with knitted brows and a "let's solve this problem" approach without ever coming straight out and saying she wants them to lose weight. Lots of questions about sugar and processed food and snacks, implying that there must be an obvious solution to getting them into a "normal" weight range. I left feeling panicked and anxious, demoralized and depressed. Am I putting my kids' mental and physical health and jeopardy by "allowing" them to have gained so much weight? This is something I seriously questioned after their checkup, and it was followed less than a week later by the new AAP guidelines.
I could write pages about the confusion and self-doubt I've experienced as the parent of overweight children, always feeling that whatever I'm doing at the moment is the wrong thing. It's excruciating and isolating, particularly where we live, a part of the country where "health and fitness" (code for thinness) is the norm. My children stand out painfully in a sea of thin children. I want to protect them from it all: shame, insecurity, health complications and eating disorders. Reading the new AAP guidelines has sort of pushed me over the edge. I am wondering: is there a Burnt Toast forum or community of parents of overweight children? If I could just connect with others experiencing the same thing I think I would feel so much better and be able to navigate this situation with (hopefully) more peace and grace. Virginia, THANK YOU for all you do!!!
Appreciate hearing all the perspectives here. I’m an adult clinical RD (working inpatient) but my whole team was really upset about the new guidelines. We actually had a journal club at work about weight stigma and weight neutral approaches the other week and it went really well. We’re working as a department to try and figure out how to educate providers on why weight loss consults aren’t appropriate, how to remove language around “obesity” and “overweight” from our documentation, and are coming to a consensus that diets don’t work. This is all well established in HAES communities but this is a large clinical nutrition department at a major hospital and it feels BIG that we’re having these conversations. Throwing this in to give some hope to anyone feeling demoralized! It’s bleak out there but I do see some movement in a good direction (not from the AAP though).
Thank you very much for this. The new AAP guidelines are truly disheartening.
I am a primary care pediatrician in the Northeast and have been trying my best to challenge my biases, diet culture, and obesity panic in medicine. Recently, I sent a teen with a severe eating disorder (lost 40 lbs) to a different nutritionist than usual, and the parent told me the nutritionist said her kid was now a healthy weight and just needed to maintain at 1800-2000 calories. I didn't know whether to cry or to punch someone (maybe the nutritionist).
Another small example: at a checkup, if a kid's BMI is calculated by the electronic medical record as "overweight," or Lord have mercy, "obese," the program automatically adds three different diagnosis codes for BMI, dietary counseling, and exercise counseling, with little blubs--"recommended changes"--to the visit. At the end of the day, I try to remember to unselect each of them, because parents will see those notes afterward. I think about how hard-wired these unscientific biases are; the scary thing is that even if the provider was not even thinking about "BMI problems," there it is in front of them.
All that said, I would love the opportunity to chat with you about how I can support your work, and how we might work together towards supporting wholly healthy kids. I've been in contact with Oona as well!
Thank you thank you. Also THIS really got me:
"I'm also thinking about all the kids out there whose parents aren't listening to this podcast or reading this newsletter, who simply don't know to resist a doctor's recommendation, or who have doubts, but don't feel safe questioning the authority of a medical professional. These new guidelines will disproportionately harm the most vulnerable kids, kids of color, kids with fat parents, kids living in poverty, kids whose parents are immigrants, and so many other marginalized identities."
Thank you for this. I love that in addition to all the other points, this discussion raised the issue of the further eroding of trust in scientific institutions because I absolutely have been thinking about that. I feel like - come ON! after the three years we are coming out of, do we REALLY need to go actively creating legitimate reasons to be suspicious of the very institutions that we are supposed to be able to trust with the health and well-being of our selves and our kids?
I was just reviewing the note from my last visit to my PCP's PA. In the vital signs section in place of weight it says "Patient refuses to step on scale". I own it, I am that non-compliant patient.
When the article came out, I was just blown away that it seemed completely opposite the prevailing medical guidelines for weight loss surgery/drugs for adults from just a few years ago, ie use with caution after other methods have been tried. WTF!?!?
Thank you yet again for doing this vital work!
This episode is so important and the topic so troubling. One thing that I wonder about is why pediatricians (and this definitely seems systemic, given every person's experience shared on the podcast) seem to believe that BMI is THE primary indicator for health. I have one child who had a high BMI, had a growth spurt, and now has a BMI in a normal range. The pediatrician had chastised me about my child's BMI in the earlier appointment and then expressed concerned that my child had grown but not gained weight (to clarify: I've never done anything to limit or restrict my child's food intake - as someone with a history of an eating disorder, I feed my kids in a fairly food-neutral way, as in, please eat the dinner or breakfast I cooked or take a bagel, just don't go hungry). Back to the pediatrician -- I basically said: we obviously can't win with the battle against this chart. First you're disappointed her BMI is high but then concerned her weight didn't increase enough?
Feeling like I'm only going to go in for vaccines and sick visits from now on...
Mayo Clinic is having a QandA on this and it would be great if some moms here asked questions...they are soliciting questions now! “ Online
Video Q&A: Busting myths about eating disorders in adolescents
Thu, Feb 23, 2023
11:00am to 11:30am CT”
https://connect.mayoclinic.org/event/video-qa-busting-myths-about-eating-disorders-in-adolescents/?fbclid=IwAR1-vJw25inKL4azSo5zXu52e__ePfXTp_rUG0KEqTsV-9jU11HmT7KL2bo&mibextid=Zxz2cZ
Pediatric nurse practitioner and mom of an 18 year old trying to recover from anorexia here.
I can’t tell you how engrained the culture of wellness and thin is in the medical field. The blinders many practitioners wear will take years and years of fight to change. I honestly believe that some of it lies in the fact that many MDs/researchers/providers are driven people themselves who tend toward disordered eating in order to keep their thin ideal or cope with health anxiety. This is only part of the multi factorial issue, but the more I speak out to my colleagues, the more I realize how cemented this culture is.
We recently had a patient who had an 8 hour surgery followed by a 2 day ICU stay after having an intestinal blockage. The teen had lost 50 pounds in ten weeks and then had eaten a whole pizza (after likely starving himself for weeks). Not one person mentioned eating disorder, a nutritional consult or psych consult. He had been “praised for his weight loss and was asking for help to lose more”.
My daughter as well was overlooked when she began to lose weight, I sounded alarm bells and was constantly reminded that she was within normal weight.
It’s frustrating, so sad and unbelievable. I will continue to fight and am grateful for the resources I have found here too.
Thank you for this episode, truly a beautiful gift, though a bittersweet one that brought me to tears. My 13-year-old daughter and 15-year-old son are both in the obese category of the BMI.
At their last wellness exams, scheduled back to back, the pediatrician sat down with the three of us and talked about BMI with a very concerned look and tone. She is a gentle and sensitive doctor, and as such would not come out and say "I am concerned and you both need to lose weight," but instead danced around it with knitted brows and a "let's solve this problem" approach without ever coming straight out and saying she wants them to lose weight. Lots of questions about sugar and processed food and snacks, implying that there must be an obvious solution to getting them into a "normal" weight range. I left feeling panicked and anxious, demoralized and depressed. Am I putting my kids' mental and physical health and jeopardy by "allowing" them to have gained so much weight? This is something I seriously questioned after their checkup, and it was followed less than a week later by the new AAP guidelines.
I could write pages about the confusion and self-doubt I've experienced as the parent of overweight children, always feeling that whatever I'm doing at the moment is the wrong thing. It's excruciating and isolating, particularly where we live, a part of the country where "health and fitness" (code for thinness) is the norm. My children stand out painfully in a sea of thin children. I want to protect them from it all: shame, insecurity, health complications and eating disorders. Reading the new AAP guidelines has sort of pushed me over the edge. I am wondering: is there a Burnt Toast forum or community of parents of overweight children? If I could just connect with others experiencing the same thing I think I would feel so much better and be able to navigate this situation with (hopefully) more peace and grace. Virginia, THANK YOU for all you do!!!
Appreciate hearing all the perspectives here. I’m an adult clinical RD (working inpatient) but my whole team was really upset about the new guidelines. We actually had a journal club at work about weight stigma and weight neutral approaches the other week and it went really well. We’re working as a department to try and figure out how to educate providers on why weight loss consults aren’t appropriate, how to remove language around “obesity” and “overweight” from our documentation, and are coming to a consensus that diets don’t work. This is all well established in HAES communities but this is a large clinical nutrition department at a major hospital and it feels BIG that we’re having these conversations. Throwing this in to give some hope to anyone feeling demoralized! It’s bleak out there but I do see some movement in a good direction (not from the AAP though).
Thank you very much for this. The new AAP guidelines are truly disheartening.
I am a primary care pediatrician in the Northeast and have been trying my best to challenge my biases, diet culture, and obesity panic in medicine. Recently, I sent a teen with a severe eating disorder (lost 40 lbs) to a different nutritionist than usual, and the parent told me the nutritionist said her kid was now a healthy weight and just needed to maintain at 1800-2000 calories. I didn't know whether to cry or to punch someone (maybe the nutritionist).
Another small example: at a checkup, if a kid's BMI is calculated by the electronic medical record as "overweight," or Lord have mercy, "obese," the program automatically adds three different diagnosis codes for BMI, dietary counseling, and exercise counseling, with little blubs--"recommended changes"--to the visit. At the end of the day, I try to remember to unselect each of them, because parents will see those notes afterward. I think about how hard-wired these unscientific biases are; the scary thing is that even if the provider was not even thinking about "BMI problems," there it is in front of them.
All that said, I would love the opportunity to chat with you about how I can support your work, and how we might work together towards supporting wholly healthy kids. I've been in contact with Oona as well!