Body Image

Life In A Plus-Size Body Is Complicated — Especially For Kids

What parents need to know about the American Academy of Pediatrics’ new guidelines for the treatment of childhood obesity.

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The American Academy of Pediatrics recently released new guidelines and recommendations for the treatment of childhood obesity. I had a complicated emotional reaction to the report because it contained something I found fairly shocking: the suggestion that children over the age of 12 may be safely prescribed weight loss drugs.

Curious to understand more, I reached out to Dr. Sandra Hassink, director of the AAP Institute for Healthy Childhood Weight and a guideline author, to understand better. “The guidelines are important in reframing obesity as a complex chronic disease. Evidence-based treatment for obesity exists and is safe and effective,” she told me, adding, “Comprehensive obesity treatment may also include pharmacotherapy for obesity and metabolic surgery as indicated.”

In theory, maybe that sounds pretty straightforward to you. But as somebody with a lifetime of experience navigating the medical system in a bigger body, I have my concerns.

Being fat in childhood was a turbulent experience that defined the rest of my life. I remember being around 8 years old, watching my Catholic school girls' socks slide down my calves as I swung my legs off the examination table in my pediatrician's office, dreading getting weighed. I eyed up the scale like it was the bullies who relentlessly teased me for my fat body. By this point in life, I already knew that my peers looked at me as less than them because of my size. In the 90s, TV shows and magazines told us to strive for waifish Kate Moss frames, and Slimfast was sitting in my fridge waiting for my mother and grandmother. The message was clear and everywhere: Fat is bad.

When the pediatrician rolled in and went over the results of my physical, the only thing that stuck out on my chart was my weight. I remember looking that doctor in the eye and asking him (much to my mother’s surprise) what I should do about it... if I, too, could sip some Slimfast or pop one of those diet pills I saw infomercials on. I remember he looked at me and said, “We don’t put kids on ‘diets.’ We focus on healthy eating, exercise, and making good choices.” I remember being disappointed that there was no magic-bullet fix. But that was quite literally it. I distinctly remember his advice was not to eat the soft pretzels at recess and that he’d see me next year.

Ever since, the number on the scale has been labeled as the culprit for every ailment I’ve ever had. These visits became a cycle of doctors expressing their concern, me assuring them that I tried every suggestion they made, and every diet I ever went on plateauing. Everything was always chalked up to my lifestyle, without running any lab work. Fat was always the perpetrator and never the symptom. It wasn’t until I hit my early 30s and began experiencing secondary infertility that doctors finally ran enough tests to conclude I actually had polycystic ovarian syndrome, an immunocompromising disease with symptoms that make it hard for the body to lose weight. I also learned — thanks to TikTok, not a doctor — that the gallbladder I had removed actually impacted my weight gain and retention too.

No doctor ever, ever looked at the entire picture, and it’s cost me dearly.

So when I awoke to the news that the AAP’s new clinical practice guideline recommends weight loss drugs and even bariatric surgery for children 12 and older experiencing chronic obesity, my hackles were raised. I have experienced firsthand what focusing on weight loss over comprehensive care can do, and I immediately envisioned it happening to so many kids.

I also reached out to Dr. Jen Trachtenberg, Assistant Clinical Professor at Icahn School Of Medicine at Mount Sinai and partner at Carnegie Hill Pediatrics, LLP, for more context. The way she and many other pediatricians look at it, the guidelines and drugs are merely just expanding treatment options.

“The causes of obesity are not limited to just genetics, nutrition or physical activity,” Trachtenberg told me. The full picture can involve unjust food systems, toxic stress from racism or childhood neglect, and lack of access to safe spaces to play.

“It's important for parents to understand that these guidelines are NOT saying ‘oh I see your child is overweight or gained 10 pounds, so here's a prescription pill to take to lose weight,’” she explained, stressing the importance of comprehensive, ongoing care. “Our kids need the medical and emotional and emotional health support, understanding, and resources we can provide within a fully comprehensive treatment plan that involves the whole family.”

But the truth is, comprehensive care for bigger-bodied folks isn’t the norm. Scientific American reported that one survey found 24 percent of physicians admitted to being uncomfortable having friends with larger bodies, and 18 percent said they felt disgusted when treating a patient with a high BMI. Weight bias has ripple effects and lasting implications. For instance, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), “People in larger bodies are half as likely as those at a ‘normal weight’ or ‘underweight’ to be diagnosed with an eating disorder.”

In my personal experience, so many care providers took “fat” as the ultimate enemy, the thing that needs to be eradicated before anything else can get better. When in reality, being fat is a multifaceted issue. There are countless anecdotal stories of doctors pushing weight loss to the detriment of the patient, spurring them to disordered eating habits or low self esteem. Medical fatphobia takes a toll.

We truly need is our medical providers — especially pediatricians — to truly hear and consider their patients with their concerns. To treat obese children with compassion.

Hassik stresses that pediatricians should turn to this kind of care only if it takes in the whole picture. “It is important to keep obesity treatment in the context of the whole child,” she reiterated.

From small things like finding clothes to bigger picture issues like fatphobic doctors, living life in a plus-size body is complicated. However, it’s important to remember that healthcare and body justice need to coexist, especially when it comes to our kids. They need good habits at every size, and inside of looking at their bodies as the problem, we need to take a step back and look at the larger picture. Kids need our patience, our kindness, and reminders that their feelings and concerns are valid. Doctors need to ensure they see our children as whole people and not rush through a parent’s concerns or hesitations with pharmacological solutions.

“When discussing weight, I recommend thinking of it not as numbers but rather as how can we make healthy choices together and how can we make it sustainable for the entire family long-term,” Dr. Nadia Sabri the Assistant Dean of Wellness of Graduate Medical Education, Director of Lifestyle Medicine, and Assistant Professor of Pediatrics at East Tennessee State University Quillen College of Medicine and founder of Mindful MD Mom advised. “This means really understanding the family culture, the attitudes around food and mealtime, making meals a time of connection and reduced stress, identifying parental and caregiver disordered thinking around food, minimizing and eliminating negative self-talk, and identifying triggers to emotional eating.”

Perhaps if 8-year-old me had heard this from my support system, my relationship with my body would be entirely different. It’s something that a pill alone cannot address, and it’s absolutely vital.

Lauren Gordon has been an editor and writer for 15 years and a mom for 4. Her passions, besides her family, is an intersection of plants, art, and angsty fantasy YA novels. While her toxic trait is thinking she can DIY anything and crying when she's angry, ultimately she's a fully transparent author who isn't afraid to share the raw, honest truth about motherhood.