Why You Shouldn’t Put Your Kids On Diets – Full Interview

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I was recently one of the experts interviewed for a great article by Erin Heger about why you should not put your kids on diets, against the backdrop of the disastrous new AAP guidelines.  I’m honored to have been included and, of course, Erin couldn’t use my full interview, so I thought I would share it here!

1. Can you talk about why BMI (or even weight in general) is not a great way to assess someone’s health? Can someone be healthy at any weight/size?

Body Mass Index is simply a ratio of weight and height. Using BMI (or weight in general) as a proxy for health creates a lot of harm with no benefit. People can be the exact same weight and have vastly different health statuses, people can be vastly different weights and have the same health status. In healthcare settings, attempting to use weight to assess health can quickly devolve into practicing stereotypes instead of medicine. The Weight-Neutral Health paradigm recognizes that there are people of all sizes at every point along the health spectrum and that weight-neutral, health-supporting behaviors provide more benefits with less risk than weight loss attempts.

2. What are some factors that matter more than someone’s weight when it comes to overall health?

There are many aspects of our health outside of our control, everything from genetics to social determinants of health to experience of oppression, access to healthcare, and more. In terms of the portion of our health that is impacted by our personal practices, research (Wei et al., Matheson et al., Gaesser and Angadi, and others) finds that people with similar health-supporting behaviors have similar relative risks of all-cause mortality and health hazard ratios regardless of size. Health-supporting behaviors can include things like adequate sleep, stress management, social connection, movement, and eating nourishing foods. We also know that experiencing weight cycling (or yo-yo dieting, which is the outcome of roughly 95% of weight loss attempts,) as well as experiencing weight stigma, are correlated with the same health issues to which being higher-weight is often correlated.  

3. Can you point me toward research showing diets aren’t effective? Has this ever been studied in kids or just adults?

For adults, in this piece I offer a timeline that goes from the 1920s to the present

In terms of kids:

Neumark-Sztainer et. al, 2012, Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass index found that none of the behaviors being used by adolescents for weight-control purposes predicted weight loss, and that “of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors…including eating disorders and weight gain”

In an overview, Raffoul and Williams, 2021, Integrating Health at Every Size Principles into Adolescent Care found that current weight-focused interventions have not demonstrated any lasting impact on overall adolescent health

4. How might talk of weight or having food restricted affect a child's development in terms of both their physical and mental health?

In terms of mental health:

The BEAT UK, 2020 Eating Disorders Association, Changes Needed to Government Anti-“ob*sity”* Strategies found that government-sanctioned anti-“ob*sity” campaigns increase the vulnerability of those at risk of developing eating disorders, exacerbate eating disorder symptoms in those already diagnosed with an eating disorder, and show little success at reducing “ob*sity.” They found that strategies including changes to menus and food labels, information around ‘healthy/unhealthy’ foods, and school-based weight management programs all pose a risk.

Pinhas et. al. 2013, Trading health for a healthy weight: the uncharted side of healthy weights initiatives found that “ob*sity” prevention programs that push “healthy eating” are triggering disordered eating in some children, creating sudden neuroses around food in children who never before worried about their weight and that “They were all affected by the idea of trying to adopt a more healthy lifestyle, in the absence of significant pre-existing notions, beliefs or concerns regarding their own weight, shape or eating habits prior to the intervention”

There is an in-depth discussion specific to the AAP guidelines and eating disorders here if that helps

There are also quotes from over 20 experts in this piece if that helps: https://health.usnews.com/health-news/blogs/eat-run/articles/for-healthy-kids-skip-the-kurbo-app

In terms of physical health, the fact that these recommendations exist despite almost no data on the long-term physical health outcomes of providing “intensive” interventions, drugs, and surgeries to children, some of whom are still in diapers, is deeply troubling. What happens when we interrupt a child’s growth cycle to try to manipulate their body size? The surgeries are some of the most concerning recommendations because they take a currently healthy, perfectly functioning digestive system and surgically create an irreversible disease state and they have almost no data past five years, despite the fact that this disease state will last a lifetime. I’ll also point out that if this situation happens to a child because of a disease or an accident, it’s considered a tragedy, but for higher-weight kids the AAP is calling it “healthcare.”

5. Should a child ever be put on a weight loss diet in your opinion?

No. I think the research shows that weight loss diets put children’s physical health, mental health, and relationships with their bodies, food, and movement at risk. The new AAP guidelines admit, repeatedly, that the interventions they suggest for kids as young as two don’t produce long-term, significant weight change. What they’ve done is rebrand weight cycling (yo-yo dieting) as a “successful intervention” that people should undertake for life. This is especially dangerous given that we know that exposure to weight cycling is independently linked with numerous health issues including increased overall mortality. I think the focus should be on supporting the health of children rather than trying to manipulate their body size.

6. If diets don’t work and trying to help a child lose weight can negatively impact them, why is the American Academy of Pediatrics (AAP) encouraging weight loss for children? Why and how does anti-fat bias persist in medicine and healthcare?

I think there are a lot of layers to this. It's important to understand that almost every author of the guidelines has absolutely pinned their career to the body-size-as-disease/weight management paradigm, and none of the authors come from the weight-neutral paradigm. In fact, the evidence review methodology specifically excluded any study whose primary outcome wasn’t focused on weight/weight change (meaning that they didn’t even consider research that supports weight-neutral health-supporting interventions.) The truth is that many of them run pediatric weight loss programs whose business is likely to be increased if these guidelines are adopted. That’s not to say that I think these doctors are necessarily purposefully manipulating the guidelines to line their pockets, on the contrary, I think they’re likely well-meaning. I just think that they have been so thoroughly miseducated, and are so myopically focused on the body-size-as-disease paradigm, that they aren’t able to see their way out of it. I am personally both fat and queer, and I think that a few decades ago if you had gathered a bunch of doctors who had pinned their careers to the “homosexuality”-as-disease paradigm they would have created guidelines very much like this.  

I also think we can’t overlook how enmeshed the weight loss industry is (in particular pharmaceutical companies that manufacture weight loss drugs and interests who market weight loss surgeries) in the world of healthcare. For years they have been quietly driving healthcare policy, everything from having the BMI of a “normal weight” lowered in 1998 (making tens of millions of Americans overw*ight literally overnight) to lobbying the AMA to ignore the recommendation of their Committee on Science and Public Health to declare “ob*sity” to be a disease, and more. They create medical education (sometimes through third parties who obscure the fact that the “education” is based on weight loss company marketing messages.) Finally, they are absolutely pouring money into campaigns to keep promises to their shareholders of blockbuster weight loss drugs. Three of the manufacturers of the drugs that the AAP guidelines recommend (Novo Nordisk, Genentech, GlaxoSmithKline) are direct donors to the AAP itself, and at least half the doctors who are authors of the guidelines have taken money from these companies, one in excess of $50,000. I think this is especially important to point out because, in lieu of traditional conflict of interest disclosures, the guidelines just say that the AAP conducted a “independent review for bias” which I don’t think they are in a position to do for these reasons and more.

You can find the full article here. If you want to learn more, I highly recommend checking out Virginia Sole-Smith’s new book Fat Talk: Parenting in the Age of Diet Culture (Virginia’s substack Burnt Toast also has excellent information about this! )

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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.

Note I don’t link to everything I discuss in this post because I don’t want to give traffic and clicks to dangerous media.