The Concerning CDC- Recognized Family Healthy Weight Programs - Part 1

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I wrote earlier about the disastrous American Academy of Pediatrics Guidelines, written predominantly by people who were either taking money from the weight loss industry or personally/through their employers selling weight loss to kids.

I also did a deep dive on the serious issues with their recommendations of intensive behavioral interventions starting at 2 years old, diet drugs at 12, and weight loss surgeries at 13 as well as questionable claims around potential harm and eating disorders risk. Recently I also answered a reader question about how BMI works with kids.

Unfortunately the stakes have been raised significantly as their recommendations around weight-focused interventions starting when kids are still in diapers have been given a huge boost in the form of what are called “CDC-Recognized Family Healthy Weight Programs.”

I’ll be writing more about this, including analyzing specific curricula (some of which I’ve already obtained,) but I want to start with the basics.

Let’s start with the CDC main page about these programs (NOTE: Typically I don’t link to pages that engage in weight stigma or the marketing/sale of weight loss, but for this piece I’ll include the links because there are so many people trying to get in on this feeding frenzy that I don’t think it would be easy to Google and be sure you are finding the same page that I’m writing about. Please be aware that these links lead to pages with weight stigma, weight loss marketing, and deeply misleading information.)

Before I dig into the specifics, I want to point out that the entire concept of “healthy weight” is unscientific. There is no such thing as a weight at which someone will be healthy. There are people (of all ages) who are the same size and have vastly different health statuses. There are people of vastly different sizes who have the exact same health status. The idea of “healthy weight” does nothing except prop up the weight loss industries’ (staggeringly profitable) claim that simply existing at a certain size constitutes a “health issue” (regardless of actual health status) that requires “treatment” (that focuses on a change in body size) that often creates significant risk to life/quality of life with the goal of manipulating body size.

There always was, and always will be, an option to focus on supporting the health of children and adolescents directly, rather than being obsessed with shrinking them/controlling their size but, as we’ll see, those with power are actively working to exclude that option.

In this two-part series, we’ll examine two main claims under “About Family Healthy Weight Programs” on the main page:

1.  Family Healthy Weight Programs (FHWPs) are safe, effective treatments for childhood ob*sity.*

2.  CDC maintains a list of FHWPs that meet specific criteria.

Again, I’ll be breaking down their approved programs in future posts, what’s important for today are the evidence criteria that each of these programs are required to meet.

If we follow the link to their Recognized Programs page we get what they call “adequate evidence.”

Here’s how they define that:

Evidence for CDC-recognized family healthy weight programs is from a peer-reviewed study that was:

•        Included in the evidence review for AAP's 2023 Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Ob*sity, or

•        Included in the evidence report for the 2017 USPSTF Recommendation Statement on Screening for Ob*sity in Children and Adolescents, or

•        Identified from reviews of 2006 to 2022 Health and Human Services funding opportunities specific to childhood ob*sity and tested through one or more randomized control trials or comparative effectiveness trials.

Let’s talk about each of these:

AAP Guidelines

I did a deep dive into the research in the AAP 2023 Clinical Practice Guideline (you can go to this link and search “RECOMMENDATION:  Intensive Health Behavior and Lifestyle Treatment (IHBLT)” to skip directly to this section.) Here are some of the “highlights”:

The evidence they used only had to show a “weight specific outcome” within three months of the start of the program.

The single  Randomized Controlled Trials that followed up for 24 months showed BMI increasing from 12 months to 24 months, suggesting exactly the pattern of weight cycling that 100 years of data on adult populations would lead us to expect.

The AAP guidelines admit that

“there is currently no evidence to predict how individual children will respond”

“Many children will not experience BMI improvement”

“those who do experience BMI improvement will likely note a modest improvement of 1% to 3% BMI percentile decline”

Finally, the studies they included were so different in the methodology of the weight loss interventions that this “26 or more contact hours” recommendation is simply the only commonality they could find in the research. And now it forms the entire basis for these CDC-recognized programs. That is shameful.

So let’s sum up:  “many” children won’t lose any weight at all with these “intensive” interventions and, unless they were very close to the threshold to begin with, most will end the program in the exact same weight categories that “qualified” them for the program to begin with.

When faced with these facts, sometimes there is a pivot to suggest that weight loss isn’t necessarily the goal after all but, rather, that “success” means children not gaining more weight and/or having them “grow into their bodies.” The problems with this are that

1. There was no way to know if these individual children were actually going to gain more weight (or if any subsequent weight gain would have been part of those individual children’s normal growth trajectories)

2. Their bodies are still being judged in comparison to decades-old, statistically manipulated data about other kids that may underrepresent them, and

3. There is no long-term research to say that this IS the long-term outcome or, as we’ve seen in a century of research for adults, if the period of these interventions will be followed by impaired metabolism, disordered relationships with food, movement, and their bodies, and/or increased eating disorders.

We must always be wary when the weight loss industry, or those working for them (intentionally or unintentionally,) move the goalpost and declare victory. 

I hope that they are setting these expectations with parents and children before they undertake these intensive interventions, but based on what I’m seeing and hearing, neither the parents nor the children are being informed that there is a good chance that they won’t lose any weight at all and that, even if they do, it will be a very small amount.

USPSTF Guidelines

The 2017 guidelines concluded with “moderate certainty” (Grade B recommendation)

“Comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older who have ob*sity can result in improvements in weight status for up to 12 months”

Again, they found small amounts of weight loss for, at best, a year. With no information about what happens long-term.

They actually updated these guidelines in 2023 which I think is worth discussing. (which I wrote about in depth here and also here.) The good news here is that they DO NOT recommend these interventions for children below six years old.

Here are some “highlights”:

• The vast majority of the evidence on which their recommendation is based is only rated as “fair.”

• The guidelines say “Data on behavioral interventions were extremely limited beyond 12 to 13 months… Maintenance of weight changes beyond one year are unknown”

• They found that after 26 or more contact hours, the children lost only 4.4 to 6.6 pounds and in a 24-month study published after the review, the children in the weight loss group had returned to their original BMI at 24 months.

Here again, the marketing spin is that this is a positive thing since subjects didn’t gain weight, however, we know that weight cycling can create significant harm in adults, now we are ramping up programs that are known to induce weight cycling in pediatric populations without any long-term research to suggest that they won’t suffer the same harm.

Also, and this can’t be stressed enough, we don’t know what long-term impact these intensive interventions will have on kids’ relationships with food, movement, and/or their bodies.

The USPSTF admits that weight loss attempts have been steadily increasing since 1991 while average weights have been steadily increasing during that same time. Then they call for…more weight loss attempts? Make it make sense!

Just as with the AAP guidelines, there is no data to support long-term, significant weight loss and the data they have suggests small amounts of body size change that is not sustained with completely inadequate tracking of harm.

As for the 2006 to 2022 Health and Human Services, using this as a standard is nothing short of ludicrous. We are to believe that a single study from an HHS funding opportunity from up to 18 years ago is sufficient basis for a program foisted on children?

They continue:

“Also, to meet CDC criteria, the evidence must have:

Included primary study outcome(s) of at least one measure of weight or BMI, such as BMI, BMI z-score, or BMI percentile.

Demonstrated improvements in at least one outcome of BMI or weight status in youth aged 2 to 18 years.”

So, like the AAP Guidelines and the USPSTF recommendations, the CDC is purposefully excluding any research that seeks to support the health of children without exposing them to the myriad risks of intentional weight loss programs. This is a certainly a testament to weight stigma and/or weight loss industry involvement in this process. It is also an affront to science and, I suspect, a tragedy for many kids.

This is also something to remember when they try the “well, it’s not about weight loss, it’s about not gaining weight” marketing spin since the evidence requires proof of (at least very short term) weight loss.

In part 2 we’ll look at the CDC requirement of being “Appropriate for childhood ob*sity”

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.