NEDA stands firm in recognizing that as written, and without changes before implementation, there is cause for concern about their impact on members of our community, some of whom may be deeply affected and potentially harmed.
The National Eating Disorders Association (NEDA) is the largest non-profit dedicated to supporting individuals and families affected by eating disorders. We work to ensure that individuals and families have information, resources and tools, a connection to and understanding of treatment options, and access to quality care as they navigate every step of an eating disorder diagnosis, treatment, and recovery. As advocates for individuals and families, we hold dearly our responsibility to work on their behalf to create education, awareness, and strategies to prevent eating disorders from taking hold in the lives of America’s youth.
We want to acknowledge the expertise, time, and resources the AAP committed in developing the new guideline published out of the Clinical Practice Guideline Subcommittee on Obesity. However, In the interest of the members of our community, some of whom have the potential to be deeply affected and harmed by the updated AAP guidelines, NEDA believes the singular focus on BMI as the critical metric for making recommendations for intensive health interventions and behavioral training is highly problematic and is likely to perpetuate the harmful effects of weight stigmatization. It is the opinion of clinicians and those with lived experience, that this is particularly powerful if that stigma is reinforced by a highly authoritative source, such as a child’s pediatrician.
As the AAP looks at national adoption and wide-scale implementation, it is critical that the implementation of the guidelines must emphasize the importance of individualized assessment of each child’s health parameters that may be associated with the child’s weight status. Further, we strongly recommend that in the implementation of the guidelines, pediatricians explicitly move away from a sole focus on BMI as the metric of health recognizing that responsible care plans must be built with the use of multi-disciplinary teams and evidence-based strategies for the optimal care of these children.
NEDA stands with other eating disorder organizations and experts in support of an action plan to support the health of higher weight children and youth:
- Convening a work group comprised of pediatricians and eating disorders experts to look specifically at the implications of eating disorders related to the published guidelines with the goal of creating a compendium of resources to support clinical care and decision making about specific treatment plans for children in higher weight bodies who may be living with eating disorders or who may be at particular risk for developing an eating disorder.
- Expanding training created by eating disorder experts for pediatricians encountering patients with higher weight bodies and those with existing eating disorders, or those at risk for developing an eating disorder, so that they can address these issues in informed, sensitive, bias-free ways, and create treatment strategies with the whole child in mind.
- Enhancing in-office education (brochures, flyers, material on touchscreen tablets) outlining eating disorder risks, as well as other psychological risks. These materials should be created for individuals and parents so that, together, they can hold informed discussions before any weight-related treatments are discussed. We would offer to convene subgroups with lived experiences to review these educational materials before they are rolled out and adopted.
- Screening for eating disorders prior to and during any weight-related treatment is critical. If eating disorder concerns are presented at any point during care, the patient should be referred to an eating disorder specialist prior to and before continuing any other weight-related treatment interventions.
- Embracing the need and making the investment in long term studies focused on the outcomes of these treatments and their effects on children of various ages, with special attention paid to including eating disorders and other mental health concerns.
NEDA is steadfast in our commitment to the physical and mental health of children with eating disorders. We, and the experts on our research and clinical advisory councils, stand ready to be collaborative partners in the development and dissemination of sensitive, appropriate information and training, so that America’s pediatricians are equipped to navigate discussions regarding eating disorders and weight-related concerns with patients and parents in a compassionate, ethical, bias-free, and informative manner. We look forward to a constructive, informed, interactive partnership with the AAP in addressing these concerns for the protection and benefit of our community.