The American Academy of Pediatrics is now recommending weight loss surgery for children. Will this do more harm than good?
The American Academy of Pediatrics (AAP) released a policy statement in October 2019 in the form of an academic journal review entitled “Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices.” This journal article provides an overview of the current research on the use of weight-loss surgery in adolescents, which is notably sparse. Despite this lack of substantial evidence, the AAP decided to publish this article as a policy statement, thereby stating that as an organization, AAP now publicly supports weight-loss surgery interventions for adolescents in larger bodies. The article notes that this should only be used in “extreme” cases.
If the boldface statement of fact that a large, public, national organization is now recommending weight-loss surgery as a treatment modality for children doesn’t immediately concern you, let’s break some things down.
Weight-Loss Surgery Is Dangerous
Though the data regarding adolescents and weight-loss surgery is lacking, the research for doing the procedure on adults is much more robust. Because of this, we know that weight-loss surgery comes along with a whole host of issues, including lifelong nutrition struggles that are not easily managed without special and expensive vitamins, potential complications that interfere with being able to participate in activities, a higher risk of suicide, an extremely high risk for alcoholism, a high risk for developing an eating disorder (if they did not already have one, as screening protocols often miss many eating disorder pathology), and so much more—if you even make it off the table.
In other words, these procedures are dangerous, often don’t deliver on their intended impacts—preoccupation with body image increases rather than decreases in most cases, and most individuals end up regaining any weight they lost via the weight loss surgery, if not more—and most often leave an individual worse off than they were without the surgery.
In fact, research shows us that a sustained higher weight is often better for the body than repeated weight cycling, the most common side effect of repeated diets and weight-loss surgery.
Body Size Is Not Indicative of Health Status
Though there is a high level of hysteria regarding increasing body size throughout the world, particularly for children, research indicates that we may not need to be as terrified of expanding waistlines as previously thought. Instead, focusing on health behaviors such as reducing stress, improving sleep hygiene, adding variety to your dietary choices, and incorporating an enjoyable movement practice into your life can all have a marked positive impact on your health regardless of whether it results in weight loss.
It has also been suggested that children who grow up in heavier bodies are more at risk for being in larger bodies in adulthood. This claim has been debunked, and is misleading regardless. Body diversity is a fact of life. If we are larger in childhood, perhaps that means that we are simply larger people. There is nothing inherently wrong with being in a fat* body.
AAP Is Not Considering the Various Reasons a Child Might Be in a Larger Body
Another concern is the lack of an intersectional perspective regarding AAPs recommendations. Children are in bigger bodies for many reasons, and one of them is eating disorders.
As explained by the National Eating Disorder Association:
With a clear emphasis in the 2019 Policy Statement on ensuring access of bariatric surgery to marginalized youth, including Black and Latino youth, and low-income youth, NEDA feels strongly that the AAP must be aware of, and that any position statement going forward must be informed by, emerging research that shows a strong correlation between food scarcity and binge eating disorder. Research indicates that 17% of the most food insecure children met clinical diagnostic criteria for binge eating disorder. This is approximately three times the rate of binge eating disorder in the general population. Notably, this study also found comparable trend for compensatory behaviors in the most food insecure youth, including vomiting, laxative and diuretic use, skipping meals, and exercise. This preliminary data is being replicated with comparable results.
It is extremely concerning that this point is not at all considered in these recommendations for bariatric surgery.
Long-Term Consequences
The AAP seems completely comfortable promoting bariatric surgery for children even though they have minimal research on the effectiveness and risks for bariatric surgery for children. Furthermore, the AAP seems completely comfortable with promoting a treatment that has a demonstrable negative impact as evidenced by heaps of research. We are able to take care of our health without cutting out pieces of our anatomy. There is a way to promote our wellbeing that puts our bodies and our intuition back in the driver’s seat. I highly encourage AAP to reconsider this recommendation and release a statement acknowledging the harm that such a promotion would contribute to.
*Though the term “fat” may have been used to insult you or those you know, I use the term fat in a reclamatory way. It is a neutral descriptor, similar to tall or short. Fat does not mean ugly, lazy, etc. It is a body size description, and nothing more.
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About the Author
Ashley M. Seruya is a social work student, virtual assistant, and content creator specializing in eating disorder recovery, Health at Every Size, and weight stigma. Learn more about her work at ashleymseruya.com or on her Instagram at @fatpositivetherapy.