Episode 85: A Dietitian’s Take on the 2023 AAP Childhood Ob*sity Guidelines
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Episode Description
In this episode of The Up-Beet Dietitians podcast, Emily and Hannah break down the American Academy of Pediatric’s newest childhood ob*sity guidelines. If you’re a parent, what does this information for you? As health care professionals, what can we do to advocate for our patients? The girls break down the flaws in the guidelines and provide tips on how to manage the information. If you’re feeling lost at all, please know there are many of us who are also frustrated and will advocate for you. Our DMs and comments are open if you need to vent, seek solidarity, or find any comfort.
Link to AAP Guidelines: https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2022-060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and
BMI is BS episode: https://www.theupbeetdietitians.com/episodes/bmi-is-bullshit?rq=bmi
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hello everyone welcome to another episode of the upbeat dietitians podcast hello guys welcome back to a brand new
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episode today we are talking about breaking news
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we're staying on Trend today which I think we are pretty good about but I don't want to get sidetracked today as
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much as we can avoid it because we have a lot to talk about um so we're gonna try our best to stay very on topic if we can
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in case you missed it there have been recent updates from the American Academy
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of Pediatrics in regards to Childhood overweight and obesity and if you follow
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Emily or I you've seen us reposting a lot of content but we are finally going to address it on our own terms today
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um we're going to go over what these very problematic guidelines say what makes them problematic and kind of just
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talk about them and why we think that they're actually going to be doing a lot more harm than good I'm
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excited for today and I agree we have to stay on track because
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this could probably be like a three hour episode and we're not gonna do that to you guys I mean unless you want a part
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two because I have made that's true the outline and I like literally feel like I could like not finish it like I could
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have just like kept going with things I wanted to add to it but okay let's get right in because like we said we got a
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Snapchat today so they just made us cut that out gosh words so the AAP which
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we'll talk about will like abbreviate today as the AAP the American Academy of Pediatrics they just posted these
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guidelines like a week ago and the last time their updated was about 15 years ago so it's been a while and it was much
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needed but unfortunately they did it all wrong they are advising pediatricians and
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other Primary Health Care Providers to offer treatments um offer treatment options early and at
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the highest available intensity for kids as young as two
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um who are struggling with overweight and obesity which they are defining by BMI
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which we have a whole episode on why BMI is problematic and we'll explain it more today but
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right off the bat these guidelines which by the way is a hundred Pages you can get the PDF we can even link it for you
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guys if you want to read it yourselves um the 100 page guideline starts with
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the list of authors almost all of whom are MDS or public health professionals
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no dietitians no mental health professionals at least not in the author
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section they do address eating disorders and disorders eating disordered eating in the guidelines as well address later
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in this podcast episode but there appears to be no input at all from eating disorder Specialists that's the
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very first red flag right off the bat yeah yeah can we talk no
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um I was gonna say I just want you know what I'll give you a read I would like a re section that you just said where
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they're expecting pediatricians to start making weight loss recommendations for two-year-olds two-year-olds
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we are going to already dive into that more but like second red flag we could have a red flag
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tally today okay we're on number two already no eating disorder specialist input even if they mention it doesn't
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the way it reads it does not having us or specialist number two red
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flag no dietitian in any of with any of the authors and
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there are a lot of dietitians in the research space so they couldn't have had one on third red flag
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they said you can pediatricians are expected to make weight loss recommendations for two-year-olds so we
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got so far oh fourth one they're using BMI as a classification of there we go
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before getting these recommendations or guideline pushed upon you which is a good segue so what do the
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guidelines even say so they talk about obesity as a disease which we're going to do a whole episode on in the future
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um because that could be a two-hour conversation as well um but basically the big takeaway is the
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pharmacotherapy or medications that can be pushed upon kids and weight loss
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surgery AKA bariatric surgery is also recommended for a certain age group as we'll describe so again it's 100 Pages
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talk about obesity as as a disease they do discuss disordered eating and eating
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disorders but they basically say it doesn't matter we'll get to it and then they kind of like at the end ish like
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wrap up by saying here's what to do if you see patients that have overweight and obesity which is a disease according
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to them so when it comes to the pharmacotherapy or like weight loss drugs
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it states that pediatricians and other Primary Health Care Providers may offer
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children ages 8 through 11 years of age with obesity weight loss pharmacotherapy according to medication indications
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risks and benefits as an adjunct to health behavior and lifestyle treatment
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so I'm someone who has worked in a space
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where weight loss meds have been prescribed so I know far too much about them unfortunately but it is out of our
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scope to really address like the side effects and things like that
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but they have a lot of side effects and these children can't consent to taking
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them so it's all on the parents to make the choice if their eight-year-old should be taking some Phentermine or not
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which is scary yeah it's also up to the doctor too like
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maybe there are some doctors who are seeing these guidelines and they're like absolutely not but there's plenty I know
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for a fact they're like finally we could not prescribe these eight-year-olds some Topamax
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oh I'm not I'm I'm saving my comments for our
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problematic portion of this because there's already
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so many red flags yeah well I'll quickly explain the bariatric surgery part too so along with meds they the doctors
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pediatricians whoever could also recommend bariatric surgery and they're encouraged to do so
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um the guidelines say that pediatricians and other Primary Health Providers should offer a referral for adolescents
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13 years and older with severe obesity which is classified by BMI for evaluation for metabolic and bariatric
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surgery to local or Regional comprehensive multidisciplinary pediatric metabolic and bariatric
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surgery centers so basically they're saying foreign that if a pediatrician sees a
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patient who has this disease of obesity based on BMI a ratio of height to weight
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this disease that's classified using just a number on the scale and a height stick
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should get a surgery where they amputate their stomach we know there's risks that come along with it including
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malnutrition while they're going through puberty but they should do it because they have obesity
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so as I know we're gonna get into it but the
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fact that they're recommending someone in their most important period of growth
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to anatomically manipulate a component of their body because
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a health indicator that was created based off a data of white men and that
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are were like middle-aged and now we are using that to diagnose children
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of something that's not like strongly backed by science
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is insane right and like after bariatric surgery which I also
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have some knowledge in like professionally as a dietitian it's like
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the first year after surgery is so restrictive and how much you're able to eat that's like the whole nature of the
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surgery and if your body is like still growing like I just can't imagine what
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the outcomes would be if you're eating two ounces of food at every single meal
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and we'll get to this too gosh we're gonna go through a lot today but after surgery too there's also
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um a vitamin protocol where you have to take a certain uh spectrum of vitamins because you're
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not able to eat enough nutrients through food because of the nature of the surgery and I see a ton of adults who
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can barely maintain that protocol because it is like for the rest of your life taking vitamins and that's really hard to do so how are we expecting like
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a 13 year old to follow this protocol where if they don't follow it their risk of malnutrition is like through the roof
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because they're also growing it's ah I like am so frazzled
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it's so bad it's it it's so bad because we both see
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a lot of like weight loss being pushed on children
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and now that there's like a professional organization basically saying like yeah
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by the way keep doing that and also give them meds
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and make them go through an invasive surgery
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right like they're saying all this even though we have so much evidence and support
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that like this doesn't work like these weight loss attempts fail
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most of the time 97 of the time so why are we still pushing this and that's so funny because they literally address it
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I don't want to get there yet but they like literally are trying to co-op like the haze intuitive eating non-diet
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messaging and like spin it so it's like in their own terms so that way someone who maybe doesn't quite know as much as
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maybe we know about like hey he's an intuitive eating and all that who can like see the like right through
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it someone doesn't maybe know as much or doesn't quite fully understand
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all of that wouldn't see that language as problematic and someone who like
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believes that their doctors have their best interests in mind which I definitely did until I started working
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in healthcare say it literally once you work in healthcare it's like oh wow
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yeah this is this is not great here um but yeah even like not even
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from a weight loss standpoint people value doctors opinions in every regard
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oh yeah to a fault and I can say like
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I I'm like thinking of like my friends growing up who are like in larger bodies
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and like if they're if they had to do something like this I'm like
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I already know what the relationship with food like is now and they weren't being pushed meds but like
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it's very scary to think of like kids
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still gonna be dealing with it now who don't know any better and like
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potentially will have a lot of mental health issues going forward after right
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and like with the surgery especially like we see a lot of transfer addiction where you can't use food to cope anymore
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so you turn to drugs and alcohol mental health disorders tend to rise after surgery and like this is a lifelong
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surgery where like it doesn't just like go away certain types you can
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undo reverse the surgery but um for the most part like when you get
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a gastric sleeve like you're probably going to have that for the rest of your life and so like if you're 13 years old
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and you get it out of like because your parents made you basically or you just
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didn't fully understand what you were agreeing to at the age of 13. when you're like in your 30s 40s you still
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could be affected by that surgery that you had
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when you're 12 yeah exactly but I want to get into
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more structured problems with the guidelines so very first thing they do of course is to describe like what
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obesity is and their whole shtick like the whole weight loss industry stick is
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that obesity is a disease and like I said we're gonna do a whole episode on it so we won't go a whole lot into it I
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say that even though I'm really fired up about it I really want to talk about it a lot more um but
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obesity as a disease is diagnosed using BMI which we've discussed in a whole episode
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how BMI is very stupid and pointless and doesn't actually tell us anything about the human body
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and you can't like come down with obesity it can't be cured it does not
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meet any of the criteria of a disease and having a body of a certain size is
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not the same thing as having a health condition with actual identifiable like symptomology
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it's it's just that's just not how it works like when you diagnose diabetes
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you have like an A1C based on like your blood sugars over three months when you diagnose like hypertension it's your
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blood pressure with obesity we're using BMI which is literally a ratio of height to weight
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in incredibly outdated tool that not even the founder wanted us to
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be using for diagnosis purposes so like right off the bat it's not good
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right exactly as for a lot of like weight loss companies are because that's always their hard-hitting thing is
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sheer obesity and no longer being sick and you can like
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heal yourself and all whatever exactly what it's built upon is nothing but like
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very toothpicks of data that's not holding up for anything exactly and I
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know like everyone who does support this is listening to this and they're being like well body fat body fat is so bad
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for you we don't really know for sure like at what level body fat is pathological like
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when it leads to problems every single person's so different so we can't say it like 20 body fat that's when your
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obesity is a disease like we can't even know for sure plus they don't even use body fat percentage as a diagnostic tool
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anyway that would already be more advanced than what it is exactly but they don't even go that far they haven't
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even figured that out um they just say like oh your BMI is 30 because of the ratio of your height to
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weight you're obese you weight your body is a problem yeah you like way too much for how tall you are sorry or yeah
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exactly sucks for you that's yeah so they have a lot to to benefit
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from though by calling it a disease and when I say they I mean like the pharmaceutical industry the bariatric
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surgery Industries the ones who are calling obesity disease are the ones who have the most to gain
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from it I have a whole list here so I have a list of like who benefits from disease
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oh my gosh I'm not getting all fired up I feel like I'm gonna talk for hours okay so first of all scientists who are
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involved in like weight research are able to get more grants when obesity
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is a disease because it's a scary epidemic like we should be focused on this it's terrible for the world
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everyone's dying because of it so they get more grant money to do their research which then goes on to prove
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quote unquote that obesity is a disease governmental agencies Health agencies
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have powerful rationale for increasing their program and budget allocations they're able to say obesity is a public
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health issue we should be very worried about we need more money to stop this
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and then the big two in my opinion are weight loss companies and surgeons they're able to have their services
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covered by Medicare and health insurance providers because it's a disease an epidemic if it wasn't it'd be way less
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likely to be covered and then of course pharmaceutical companies can justify the release of new drugs as well as like
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really pushing for the ones that are already out there and they get a lot of money like drugs are
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very expensive like they get a lot of money by pushing those out there and then interns is covering it so more
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being prescribed because it's to prevent or treat obesity as a disease
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yeah and when it comes down to it's about money that's what
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a lot of this is about unfortunately exactly like
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they call it a z a disease like it's it's all her money it's all her
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money that's the only way anyone benefits from it it doesn't make someone feel better it's not like a mental
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health thing where if you tell someone their body is a disease that's like helpful for them
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yeah that's no no it's about money which is actually one of our points like when
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you tell a child which we're talking about today that their body is wrong their body disease their body should not
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exist as it is this is obviously going to lead to problems down the road as they develop and they think about how
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their doctor told them when they were eight in the doctor's office how bad their body was and how wrong it is yeah
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that's one of the most kids are so easily influenced and
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vulnerable and it's basically setting them up for like dysfunctional eating
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because they are told something was wrong with their body and especially if their
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parents are already pushing that on them which a lot of parents do push that on their kids like you need to start Weight
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Watchers or you need to start whatever diet it is with me
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um now that like they'll look back and like be like if
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like but the bariatric surgery example like they'll look back and be like oh my gosh
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I like even at the youngest age like when kids should not be to care about
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like what their body looks like and how many calories are in foods and lemonade how many calories they eat for x amount
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of time to recover from a very surgery or to keep up with their medications to
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shrink their body that's not something that should be anywhere on their agenda or priority
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list like learning math and developing social
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skills and figuring out who they are as a person this has like no business being there
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exactly exactly oh
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let's talk about one of the other issues with these guidelines which is
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it's like I don't want to say it is an easy way out easy way out to not focus on
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bigger problems that are actually at hand and going on it's a cop-out really
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for like oh yeah look this is a really easy way to make more money by focusing on this ratio of people's bodies
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so first we talk about a lot is the amount of weight bias
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in the world and fat phobia in the world and weight buyers especially in health care and the negative consequences that
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come along with that we always bring up the example of like you went to the doctor for
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all like a runny nose a sore throat uh strain like your knee hurt and weight
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losses probably recommended and some point are they like
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you could benefit like you could breathe better if you lost some weight or you could swallow easier if you lost some
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weight or whatever it is it's so weight Centric unfortunately which is
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this these Protocols are this protocol is feeding into additionally access to Food and Health
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Care is a huge problem that I think that we we as in society I'm
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gonna say um tend to forget about that
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food is not just like
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calories or something anyone can get access to food insecurity is very
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prevalent the average like minimum wage has not
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gone up in relation to inflation over the past 50 years so a lot of people
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struggle with money and have Financial issues and also like insurance is the
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worst I I don't Hannah I don't know how much you deal with insurance to like I've been
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dealing with insurance a lot more recently and it's it's the worst outrageous how expensive like if you
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don't have insurance for like one Med it can be like 800 to 1500 for a month
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that's absurd absurd No it should not be that I know it did not take that much
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waiting to make that that pill like no you're it's just Pharmaceuticals and
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insurance benefiting financially off folks like that and
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whatever like I I could have an entire episode of buying beef with insurance
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um I just saw something too after surgery I mentioned the vitamin protocol which is very expensive because it has
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to be very specific Medic or very specific vitamins like you can't do chewables for a certain amount of time
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or excuse me you can't do capsules you have to do chewables for a while they have like bariatric specific ones you can take and then also protein
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supplements are a big part especially for the first six months to a year after surgery
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supplements in general whether it's like the multivitamins the calcium or the
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protein supplements those are all super expensive and if you're food insecure your doctor says
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that your child's obese they need to get bariatric surgery you don't know much about it so you just say okay I'd rather
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them get surgery than be fat so you do it and then after surgery you find out oh that's beyond this vitamin protocol
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and take protein supplements but we barely make enough money to like get regular food like you're going to be in
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a tough spot after that and I just thought of that and that like really sucks yeah
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and it's really frustrating how like that even is something we have to like deal with
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yeah or like we have I wish financially it was not an issue but
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like there is a lot of maybe maybe the right term is politics
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in Food and Health Care and yeah I don't even want to know how
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much the vitamin protocol is or like any of those things it's another bad part is depending on the surgery
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center some surgeons won't like prescribe the vitamin and so it's all out of pocket like no matter what
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insurance you have it's not going to get covered because it's not a prescription a prescribed supplement it's when you have to go out and get on your own
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but even if it is prescribed by the surgeon you still may not get coverage just totally depends on your insurance but
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like you're taking vitamins forever which not only is that hard to do as a kid especially but it can also be very
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expensive and that's just an added thing you have to add every month which is tough if you are food insecure also not all in
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certain insurance is even pay for the surgery like sometimes it's self-pay to get the surgery and that's tens of thousands of dollars
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which is insane I don't even know what it is for kids like I've seen in adults a lot of different scenarios where some
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pay for it some don't but for kids I have no idea like how insurance is going to go about like covering that and they
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can really make up whatever they want because oh yeah no one's really done it because now that
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there are Official Guidelines they can kind of spin it however they want and like there's also guidelines
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currently for adults at like how often they should see their dietitian how often they should see
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um their surgeon they should get Labs a certain amount of times like are those existing for kids at this
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point or are we gonna like just play it by ear let these 13 year olds get surgery and then just like see how it
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goes yeah like the surgery been around for a long time for adults so there have been
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guidelines developed not that it still is a great thing but
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at least there's guidelines for kids what is there besides just this recommendation now that
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your PCP should be telling you to do it if you're obese yeah so
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there are also other issues at hand too that we're ignoring like unsafe environments physical activity not
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everyone lives at a place where physical activity can happen and they mentioned in the
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guidelines frequently um that like meds and surgery are meant to be done in conjunction with of course
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like a healthy lifestyle and family support and with physical activity
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um and that's all fine and dandy but like who has all those things guaranteed I was gonna say family so like
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yeah that's no that's a big privilege to have like if your mom just hates that they have a
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fat child like they're not going to support you after surgery there's going to be glad that you got it so you're not their fat child anymore
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yeah ah it's so bad like anyone can have kids so that's just
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scary I don't we should be working on that we should
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well anyway that's a that's a difference something else that's another really big
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at hand that just focusing on saying obesity is to this disease the stratum
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is like lack of Education in cooking and nutrition as any part of curriculum like
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in school but also I feel like we should throw in like
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budgeting and like almost like consumer Ed but for like basic life
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components especially with like managing food and stuff like that there isn't
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I don't really know much like I think I took Maybe one home at class and I grew up in a
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very privileged area yeah I remember vividly taking like a class
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and it was it was so bad the lady was like saying like carbs are bad and all we
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like really learned was what different colors of fruits and vegetables equate
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to in terms of like the nutrients they offer like what antioxidants you get which is like fine and dandy like yeah
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obviously it's good to get fruits and vegetables and that's why but how does that translate into
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why is a kid going to be like I need my anti-axis right I mean I beta carotene I need carrots right now
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foreign yeah like that doesn't teach you like how to grocery shop or budget like you said so
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you can get your groceries no more like why it's important to eat
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carbs or like protein like Basics right instead of people demonizing them like
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arms are carbs are bad that's I love that I doubt they had any nutrition background I was just gonna say I know
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it was taught by someone who did not have any background nutrition it was just a teacher which teachers are great
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but they have no training and nutrition for the most part no no and additionally
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one of the other large issues at hand that him and I emphasize all the big
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time because we are a strong mental health Advocates is the inability for
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people to afford therapy to treat mental disorders so whenever there's weight
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loss involved I always recommend someone works with the counselor because
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nine times out of 10 it's not about the weight and
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and then therapy is expensive a lot of insurances don't it's hard to find one
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it's hard to find therapists because so many people are mentally unwell two
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it's hard to find therapists that are covered by insurance if you even have
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insurance that is and then if you're on like let's say like a Medicare program or some type of an assistance program
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who even knows what the coverage looks like there and going through something as intensive
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as bariatric surgery or taking medications for weight loss should be
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done whether we because like it's going to happen no matter what because no
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matter what Hannah and I say like hey this podcast it's already acting no one but it's not going to stop that but all
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we can do is educate you guys in the decisions you make I don't think AAP is going to listen to our podcast be like
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let's let's let's bring it back to the drawing board guys like Hannah and Emily
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has some good points no those upbeat dietitians they really made me think
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twice please reference minute 13 where they mentioned this I would like to discuss this no they
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they do not care about our opinions but we know you guys do it we at least we
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appreciate that but mental health is something that gets brushed under the rug so much luckily
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there's been a lot more attention brought to it and something as intensive as
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these weight loss interventions needs to be done with the mental health
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professional Eve like even as like a preventative
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standpoint if we wanna I feel like that would be the best they could do in this situation
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would be to attract but but we're going to be realistic here and
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I need to fact check this so if I say this and it's wrong I'll take it out or whoever I take out when
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we edit this but I uh I was like sifting through comments which by the way if you want a good time
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but also want to get fired up go to the aap's Instagram page and look at their
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post on these guidelines the comments are awesome it's People Like Us just oh okay okay I was like
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fired up at all okay okay I think I I read them on something
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I don't think it was Instagram I'll have to look it's good I mean they're like radio silent about it of course but the
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comments are pretty awesome um shoot was I gonna say oh one of the comments had said that the AAP like in
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like 2016 like put out some kind of statement regarding like how
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intentional weight loss diets are problematic and how they don't work long term and all of this and then like here
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they are what seven years later like going back on their words so I gotta fact check that not sure if it's true
32:44
but it just like I don't even know I brought this up something you said triggered that thought in my brain but anyway
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that is just more tea I wouldn't even be surprised yeah it's like where can we make money most
32:57
exactly weight loss is always going to sell as we've discussed
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even just by classifying obesity as a disease is what makes weight loss sell but there's a lot of other reasons too yeah
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yeah so uh that's kind of that's the Obesity it is a disease part like that's
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well I guess we kind of covered that and then also covered like other reasons why these guidelines are problematic our
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next one obviously has to be about eating disorders yeah we're going to have a whole section on this like
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obviously and they do mention it I put in our outline let me rewrite section I'll read
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it you talk I'll read it it's there's a lot to say and it's great that you even cover it in the first place
33:42
like great kudos for even bringing it up some weight loss programs diet guidelines
33:49
whatever wouldn't even talk about eating disorders so it's good they brought it up but
33:54
there's just a lot of reasons why what they say is problematic first of all they say that pediatricians should be
34:02
knowledgeable about the signs of Eating Disorders but in my experience as a healthcare worker many are not no like
34:10
absolutely not in fact they are the ones who are promoting disorder eating habits I've seen this yes like literally on a
34:17
daily basis one of the big things they say in the guidelines to assess for these Eating Disorders is rapid weight
34:22
loss first of all Gene disorders can occur in Many Bodies even those who are not
34:29
losing weight um you are promoting weight loss so if someone's losing weight you're going to
34:35
probably congratulate them not say oh I see you're losing weight something must be wrong like no they just have bariatric surgery and they have an
34:42
eating disorder they're probably going to be losing weight so if they're coming to you for weight
34:47
management and losing weight that's not going to be a Telltale sign for you um the guidelines do list things like
34:53
racism the social determinants of Health socioeconomic factors wait by I started
34:59
eating all things that should be considered but they still go on to recommend these harmful measures that be
35:04
taken like it's like they're like name dropping and say like guys we we like
35:09
thought about this exactly and then they completely ignored exactly and I want to
35:17
find the quote in the little thing here where is it I will cut this out if I'm just like lingering too long oh here it
35:22
is okay so on Part B Emily if you're following me where is it I see it I see yeah I'm
35:28
I'm at the bottom of the second one sorry I see so it says in the field of pediatric nutrition and the treatment of
35:35
both obesity and eating disorders concerns have been raised as to whether the diagnosis and treatment of obesity
35:40
May inadvertently Place excess attention on eating habits body shape and body size and lead to disordered eating
35:47
patterns as children grow into adulthood here's the kicker they say the literature refutes this relationship
35:53
however okay and they go on to explain like what One
35:59
Singular study says that yeah literally one study even though we have
36:07
oogles and boogles I don't know how many I guess a lot of studies an overwhelming
36:13
amount of studies saying quite the opposite exactly
36:18
so they're literally said they say yes we understand that it could inadvertently place attention on body shape and body size
36:26
and lead to disordered eating but that's just not true which like literally that's what the main thing
36:32
driving this is the attention on body shape body size that's
36:39
like you're you're already you're you we didn't bring it up you're bringing of
36:44
like like you're looking a child in the eye and saying your body is a problem
36:49
obviously that could lead to some issues I I read through it and
36:58
it's a whole lot of nothing it's they're trying they're name dropping
37:03
like you said it's like an essay where you get points for bringing up like certain like I'm thinking of like a push
37:09
when like the more like famous people you said The more points you get it's
37:15
like that's what I'm thinking like oh yeah like people are talking about like racism and health care and health is um
37:21
any resource guys we have to mention that someone's like oh yeah yeah oh but by the way this like overruns
37:28
rules all those issues like no something I love that I read an article
37:33
from someone like on our side of this they said there's no such thing as non-stigmatizing care for
37:40
obesity because the concept of obesity is rooted in size and the treatment is changing size
37:46
so like to say it's like it's not it's we're not fat phobic like this isn't
37:51
weight bias it literally is they're focusing on the ratio you're literally focusing on the
37:57
ratio of someone's height to weight and that's all there focusing on and like you're saying their
38:03
body's a problem yeah like let's change this ratio basically I'm like
38:10
it would be maybe it wouldn't be a different story it would still be the same story but I know we've already said this but like
38:16
it's literally just height to weight it's not body fat percentage it's not comorbidities like it's literally just
38:23
you weigh this much and your head height is this much and that's bad you should get bariatric surgery yeah
38:32
but also you're 13 years old and in high school middle school and trying to navigate
38:37
puberty yeah do we have a section okay I don't think we have a section I'll bring
38:44
it up later it'll come to me um but
38:49
it's there's already like evenings had the
38:55
highest mortality rate oh yeah we like went right into it that's okay
39:01
let's that's the same let's get back just eating disorders in general have
39:07
the highest mortality rate of all the mental illnesses people we'll do some trigger warnings there
39:13
should have been trigger wins before but like people kill themselves
39:19
because of their eating disorder yeah and I feel like people
39:24
they're still just like brushed under the rug like oh little like
39:30
Susie hate doesn't like her body and like doesn't eat food like that's what
39:36
it's like minimized to when it's like really deadly mental disorder
39:43
where it can drive people to like end their lives and if it does result in Extreme Weight
39:50
Loss we mentioned that it can occur in any body size any kind of eating disorder but if it does result in being
39:58
severely underweight which is also classified by BMI but anyway um being underweight is shown to be way
40:04
more deadly than being yes overweight or obese yes but we don't talk about that because we
40:11
live in a fat phobic Society yeah so as long as you're thin you are golden
40:18
so it's this is like what all the comments say on the the post it's like
40:23
where were the eating disorder Specialists and creating this like was one even like talked to like they talk
40:30
about eating disorders I feel like I could like imagine
40:36
probably probably from their own weight loss clinics and like whatever companies
40:42
it's true this would be really good for you yeah I bet like the doctors that are
40:48
on the authors list are the ones who wrote the article on how Eating Disorders aren't the problem it's
40:54
obesity that's the problem oh yeah this
41:00
this panel of individuals like it was not probably like anyone
41:07
challenging each other right right we also know that dieting and
41:14
intentional weight loss attempts are some of the biggest predictive triggers for eating disorders yes so they say that like it's likely
41:23
not going to be an issue but we know for a fact that it's like one of the biggest things that leads to eating disorders
41:28
there's a ton of factors that can lead to someone getting an eating disorder but dieting and intentional weight loss
41:34
attempts arguably to the extreme of bariatric surgery and weight loss medications
41:40
being involved is a huge trigger and predictive thing that could lead to someone
41:45
developing an ed yeah I
41:55
it's exhausting we are literally going to have jobs forever
42:01
yeah we will always have jobs unfortunately
42:06
yes let's move on I I don't know I don't
42:15
know what else to say about dinosaurs
42:20
like I besides like they are setting children up to developing disorders that's yeah I
42:28
got a lot of DMs I got a lot of DMS from parents who are like I'm literally scared to take my kids to the doctor now
42:34
because I know like what can happen good for those parents I'm like yeah a good
42:39
that's good that you're even thinking about it like yeah it's good that your kid has a protective parent like you versus ones who just don't even know any
42:45
better or they are intentionally like seeing as a problem and making it worse
42:50
yeah but speaking of it's a good segue into our next section so
42:56
the dynamic of parent-child relationships is also something that could become an issue
43:03
more so from these guidelines we've mentioned it a little bit but these are kids like these are minors and
43:10
so the parents are the ones who will ultimately decide if their child needs to take medications go on a diet have
43:15
surgery with the advice of a doctor who also doesn't know that child personally and
43:22
who likely experiences or has been practicing in
43:27
very weight-centric health care for a long time that's all they know is promoting weight loss on children and adults
43:33
and like what does this do to a child's feeling of safety when like their Guardian the one they trust the most depending on the dynamic is like putting
43:41
them through a stomach amputation because their body is a problem in their eyes
43:47
and in my mind I'm just like thinking about this no kid like is like I want bariatric surgery Mom right no like they
43:57
will either the only way I can see that happening is one another kid gets it and
44:03
they like observe that true to their parents promote restriction and weight
44:09
loss so from them that's I feel like that's one of the number one causes I see of like teenagers dieting is they
44:16
like observe it in their parents or I and I don't even think social media is
44:23
going to play like like bariatric surgery for children I cannot Envision how it would be
44:30
advertised on social media that would actually like that would actually like land with them like social media can't
44:38
even get kids to stop like vaping I don't know because there are a lot of people who get the surgery who like
44:44
that's their whole like Tick Tock page is just like their life after their slave gastrectomy like imagine like a 15
44:50
year old who had the sleeve and they're like that's their Tick Tock page and then like other 15 year olds see it and
44:56
they're like oh I didn't know we could do that no wonder you lost weight and you look so thin
45:01
I guess I was thinking of like from the company standpoint I'm like I just like can't see them developing a like social
45:07
media man but yes yeah medically I don't know how they're
45:13
gonna do that although that that picture on aap's uh Instagram was
45:19
not great first of all it was a minority
45:24
so like was it the black dad and his kid yep okay yeah the kid was not large at
45:32
all and the the caption or like the picture said treatment works even though we have
45:39
God's evidence that shows that treatment for obesity does not work it actually
45:44
fails a large majority of the time it like makes me so mad
45:51
the healthcare space how black people are treated we're just
45:56
we're going we're diverting right a lot of the comments went there I was like yeah because like
46:04
what was what is that acronym not acronym analogy like police
46:11
officers are to black men as what doctors are to black
46:18
women and what I like heard that and I talked to a lot of like I because I did my clinicals I Advocate
46:25
Christ which is uh like they're like it's the biggest Trauma Center in the south side of Chicago so it was like a very
46:31
heavy black population and it is
46:38
so scary hearing about their experiences in healthcare and I saw people talking
46:43
about how like oh yeah now you're just like putting them on the face of this you're like that's and it's not you being inclusive
46:50
like oh we included exactly no that is targeted that was that was a targeted post right
46:58
you're not being inclusive at all it's
47:05
so bad so bad which I'm glad that like these issues are being brought up being
47:12
brought up more and like I try to educate myself a lot and like listen to
47:18
those voices in the healthcare space be like I don't like something you don't
47:24
know as much about but it's just like what's the word I don't want to say conniving but it's like so manipulative
47:32
yeah and this is just what you see
47:38
because how because of how like supported weight losses I was so
47:45
shocked the comments were so like thought out and like educated and
47:50
not supportive of their message at all I was like shocked well I'm glad that's those are the comments I know and I'm
47:57
glad that because then people looking at that being like Oh my gosh yeah am I the problem because this little boy that
48:04
looks like me is the front cover they're advertising for weight loss surgery and
48:10
medications but then you see the comments are calling it out so that's that
48:16
good job social media our time when social media did something good I know I was impressed I was impressed I just
48:22
wonder if AAP is gonna like do anything because someone's seeing that but like probably they're like whoever's running
48:28
their social media but we all know we've had some nice personal experiences
48:35
with professional organizations just ignoring comments so yeah I don't have high hopes
48:42
for that right it's not like one of the doctors that was like an author of this these guidelines is looking do they even
48:48
have an Instagram like yeah right no they're too busy doing bariatric surgery on 13 year olds
48:55
we got sidetracked um that really is the biggest thing on the parent child relationships like of course every
49:01
Dynamic is so different and so how that plays out is going to be unique to that
49:06
duo trio maybe um but yeah like parents your kids lives
49:13
are in your hands and we know that weight loss and dieting fails most the time
49:19
so don't put your kids through that no you're just gonna be
49:26
ruining or that relationship kids are so easy to
49:33
traumatize like I think everything yes I think every single one of my friends
49:38
says I've been traumatized by their parents in one way like
49:43
and this is just really gonna mess them up please don't like don't do this to your kid
49:50
yeah I just can't imagine I'm not a parent so I can't even like no drop my head around
49:56
it but can't imagine it'd be good no
50:02
let's talk about the actual yes interventions
50:07
we have a little bit already talked about like meds and surgery but we have a few more points to make and then we'll be done for now that's all we got for
50:14
now for now so with meds the guidelines even state
50:20
that which my point here is that we don't know the long-term implications of weight loss meds on people who are
50:26
developing um but the guidelines even say like for children younger than ages for children younger than 12 years there is
50:33
insufficient evidence to provide a key action statement for use of pharmacotherapy for the sole indication of obesity
50:39
so like they literally say we don't know what's going to happen basically and
50:44
there are a lot of different classifications of weight loss medications they're they're all very
50:49
different in what they do and how they work um but all of my side effects and that's
50:56
true for any medication you take for the most part but like you're getting these side effects for
51:01
what like weight loss might happen and then you're gonna just gain it back
51:08
like your body is changing you're trying to manipulate your body
51:14
like you're going through all of this just to meet the ideal of someone that doesn't even know you
51:21
it's ah so that's the biggest thing on meds
51:28
is we just don't know the long-term evidence like even with like adults that take these medications
51:34
these meds get like FDA approved rather quickly and they just want to be
51:42
able to sell them and so like what was the one it was like oh it's an M it ended up like it worked
51:49
well for weight loss but it ended up like pretty oh I think I know you're talking about like assuredly lead to
51:55
like heart problems it's like Meridia or marilda or something like that it's off the market now because it like
52:03
led to heart issues and almost everyone that took it because it wasn't studied long enough to
52:08
know the long-term effects of it so how can we know what's going to happen when a 12 year old takes Topamax for 10 years
52:14
of their life also I know with these meds which we haven't talked about these very often yet I'm very much in detail
52:20
which do help sell meds themselves but um like the whole point of the med is to
52:28
be a tool to help you navigate whatever your issue is whether it's like appetite which is the biggest reason
52:34
um but then like once you get off the med you don't have that appetite suppressant anymore and you're just back
52:40
to normal in fact appetite could even be increased because your weight went down that often leads to our appetite
52:47
increasing due to our body's biological response to dieting and so it's tough to
52:52
maintain any weight loss you saw from those medications when you're not on them anymore and who wants to take Topamax for 30 years when all the side
52:59
effects that come with it Are Not So Glorious and like kids don't want to take meds I
53:04
feel like that's also like yeah that's like the whole fighting thing too like you could barely get your kid to take a
53:10
vitamin like the mall type vitamin like probably about Flintstones that tastes
53:15
kind of good like imagine like an injectable like absolutely
53:20
a lot of their body now relies on based off of this change this dramatic change they
53:28
did to their body let's talk about the surgery because I feel like
53:34
I can't even like fathom this happening um so I have so many children like don't
53:42
understand a lot of things that's and that's okay you know they're kids I feel
53:47
like you're just now at age 26 like I'm just now grasping what is happening like
53:53
what's going on like my frontal lobe just developed like I'm just now there
53:58
when I was 12 years old I was worried about like what Lady Gaga's next new
54:04
song was right or like did I have enough those silly bands on my arm and like what if the yellow one doesn't match the
54:09
pink one they can't understand what is about to happen in that surgery
54:16
it's just like it's not going to make sense like and like how far into the
54:21
future can kids really comprehend like they don't understand what's going to happen 30 years from now because the surgery they're getting right now at age
54:28
13. no and they are
54:33
going to do it they're a minor brain is not fully developed and it's a
54:42
it's not like a small surgery it's it's pretty big yeah
54:48
um I was reading a book recently oh did I put it on here
54:55
oh I did okay bariatric surgery is one of the few surgeries that targets a
55:00
healthy organ to cure a disease that isn't really a disease like maybe you have to get a
55:08
heart surgery because you have a heart condition that's like doing a surgery to fix an organ that has an issue but like
55:14
with bariatric surgery you are targeting a healthy stomach and small intestine and like creating a problem
55:23
you're paying a lot of money or Insurance paying a lot of money to go in there and create an issue which is bad
55:29
enough for adults but in children in the middle of puberty we're going to permanently alter their
55:34
Anatomy based on a mathematical equation that was never even intended to be used in healthcare
55:42
yeah that's I didn't I didn't even think about that part where it's like literally like a
55:47
healthy organ it's a healthy organ like there's nothing there's nothing wrong with the organ it's
55:53
not dead it's not malfunctioning but you're going to alter it so it
55:59
doesn't work anymore and you can't metabolize the nutrients from your food anymore properly which is most important
56:06
when you're at this age where you're growing
56:14
we have the most job security we've ever had yes
56:19
[Music] oh man it's insane I saw a comment on
56:26
Instagram that I quoted on here because I thought it was really good it says Advocate I forget who said I
56:31
should have wrote the name down I think it was just like some random person who was all about this or on our side of things they said
56:38
advocating for the permanent alteration of a child's digestive tract so they'll appeal to your sense of Aesthetics is
56:43
the opposite of advocating for the well-being of children I was like yeah snaps snaps retweet yes
56:51
yes that basically sums up the whole thing it really does I was like that's a good one I gotta write that down yeah wow
56:59
we love the comments were I was so proud that's maybe that's what I'll go do
57:05
after this yeah it's it's frustrating because it's happening but the comments
57:11
bring some hope for society maybe 12 year old kids will listen to our podcast
57:17
and when their parents bring up weight loss surgery they'll be like no I think
57:22
most of our demographic is adults but maybe yeah if you're a kid let us know write us oh
57:29
we have comments now turned on for our posts so you guys can now comment whether you're a child or an adult
57:38
like the internet you could anyone can comment yeah whether you're in your 80s
57:43
or your teens we want to hear your thoughts yeah so should we wrap it up so
57:51
let's let's conclude so unfortunately this isn't new the biggest
58:00
new thing about this is just there's a Professional Organization like flat out
58:05
saying yes let's you should prescribe
58:10
weight loss medications in surgery to Children the guidelines are not helpful at all this is this isn't helping anyone
58:17
like Hannah said before like this is you're just telling people things are wrong with their bodies like this isn't
58:23
going to be good for mental health this is not uplifting in any way this is not empowering this is not empowering
58:29
anymore I forget what they said I think it's like in the very beginning like the authors say like we've worked so hard
58:36
people work tirelessly in weight management and we've just really all the best Minds came
58:42
together to create these guidelines it's like wow congratulations for all
58:47
embarrassing what would we do without you like that's sad yeah that this is
58:52
what the best their best Minds came up with right
58:58
I'm embarrassed for them this is a roast now
59:03
this is her for us of the AP like this is the best you can
59:09
do right good job docs I'm so glad you went to school for 10 years for this yeah for
59:17
telling kids it's worth it they're bad and body shaming them because of it
59:26
yeah creating more problems like I don't like your body
59:32
let me change it it's it's crazy
59:39
so all we can do in these slightly scary times
59:46
I'm glad to bring this up I maybe I'll say this in your next breath but I'm cutting you off apologize for that um I
59:52
went to say this earlier and write this down somewhere I had a lot of comments when I posted like on my Instagram story like what you guys wanted to hear about
59:58
on this and they said like what do we do yeah like what do we do like as practitioners like us and also like
1:00:05
parents like what do we do so let's answer that so I think practitioners we should
1:00:12
challenge these guidelines recommendations
1:00:17
I no one is paying us to enforce them luckily God and our our my our job is
1:00:25
not at risk if we don't follow these so I feel like at the end of the day we have to advocate for the patient that's what
1:00:33
I feel like our philosophy is very much so both of ours like you have to think about two but whatever yeah and when you
1:00:40
hear problematic recommendations make sure that you're advocating for the
1:00:46
patient like does this have their best interest in mind what is this person's background in
1:00:53
Eating Disorders or even the harms like dieting just like does this person who's
1:00:59
maybe making this claim a recommendation have that background and have a conversation about it it doesn't need to
1:01:04
be like a fight it should be a critical thinking exercise
1:01:10
we'll say like challenge the thoughts like ask why ask like what how
1:01:16
questions don't ask why questions because that comes out if it's judgmental um and I feel like for the pair
1:01:23
advocating for your kid your one practitioner say
1:01:30
get another opinion and if you're not able to get another opinion because that there in itself is being able to make
1:01:36
the time for multiple doctors appointments to have insurance that would cover multiple doctors
1:01:41
appointments that's a problem very well aware it's a privilege to like be able to have another opinion if you
1:01:47
don't like the initial opinion you don't have to go through or you can you don't have to do what the doctor says yes like
1:01:56
like you are your own health Advocate and your child's best health Advocate as
1:02:01
well like the doctor yes they they likely are trying to do their best but they may
1:02:08
unintentionally not have your child's best interests best interest a heart I
1:02:14
feel like it's going to be a lot of advocacy and challenging opinions and at the end like
1:02:20
even if they're like oh the evidence says this or like I
1:02:26
strongly encourage this or like they even start like fear mongering like you
1:02:32
they can't force your hand right no one's forcing you to get a
1:02:37
surgery that you don't want to get well unless your parent is but that's a whole other story that yeah for the for
1:02:44
the kids out there yeah uh Advocate but
1:02:51
but yeah like they can't force you onto a table and sedate you or like put you
1:02:57
under and chop like cut your stomach they they can't do that right
1:03:05
they can recommend it and you might take their word for it because they're your doctor but I guess it's our main message
1:03:11
is you don't have to just like blindly follow what they say or at least either
1:03:16
like do your own I know we always say this maybe do your research is not the right phrase but
1:03:22
seeking a second opinion or like serious second opinion listen to other people like listen to other people like maybe
1:03:29
go saw a podcast advocating for this maybe go listen to that well I was just
1:03:35
gonna say like three years ago I've been like oh cool new guidelines we're saving the children this is so great like I
1:03:41
think that's how these doctors that made these guidelines are too like they just don't know the other side or they choose
1:03:46
not to know the other side of it and so they're not intentionally doing harm for your children I'm not
1:03:52
supporting them don't get me wrong I'm on our side not theirs but
1:03:57
like it's just been weight Centric healthcare for so long that 75 of the field doesn't know any better
1:04:04
yeah this isn't surprise to us
1:04:09
but it's about to be like really harmful also you can't have carbon so life after
1:04:14
surgery so these kids will never get to have a sparkling wine or a beer I was
1:04:21
thinking of like breathing or something that I was like what do you mean carpet
1:04:28
carbon dioxide I know it's like you can't breathe it out like what are you
1:04:35
gonna like become metabolic like ask like are you gonna experience like metabolic acidosis like
1:04:40
oh my gosh yeah that's that's you know that's such a good point I
1:04:46
always forget that no bubblies no more I just saw our bonus question and I
1:04:52
thought of that good segue um but yeah they don't ever get to experience like a soda ever again or a
1:05:00
beer or sparkly champagne champagne not that
1:05:07
everyone follows that rule forever after surgery but that's the guideline that's the guideline
1:05:13
which we don't follow blindly no no okay let's do our Bono's question
1:05:19
because I need to pick me up this episode that'd be sad what's the best seltzer which my first
1:05:25
question for you actually is do you even like seltzers I don't either okay I use
1:05:31
them to like like make like mixed drinks and stuff but I'm not a huge fan of like a Lacroix just like straight I don't
1:05:37
think they taste great no have you seen the memes of like it's like a Skittle
1:05:43
was like in a truck two miles away from the LaCroix
1:05:49
I could like smell like there's like there's like a watermelon field next to me it's like
1:05:55
rinsed a banana onto my LaCroix yeah
1:06:00
yeah I was gonna my answer was gonna be um the hint Waters yeah
1:06:06
but it's not a self search I was paid by them at one point but I promise this is not my paid opinion I
1:06:13
was not paid Hannah liked them before she got paid yeah that's why and you guys she knows about me I do not promote
1:06:20
Brands I don't like I actually like hit water um but theirs are not really seltzers
1:06:25
though they're not carbonated but I know you don't like carbonation anyways this whole question is just a bust for us today I guess
1:06:32
yeah I've tried a few times I like the name
1:06:37
yeah the name Lacroix fun yeah I haven't mentioned out too much though
1:06:44
because I just know I don't like them that much same okay maybe we should say this
1:06:50
question for if we have a fun guest who we know like sparkling beverages we'll get their opinion
1:06:58
so seltzer enthusiast
1:07:04
why don't you guys let us know what those questions for you guys it's not for you let us know in the comments on
1:07:10
this Honor on this post on our website what's the best seltzer what's the best flavor too like if you like Lacroix
1:07:16
what's the best of Croy yeah I gotta know
1:07:22
do you like like white claws though when like high noons and that kind of stuff I don't I drink a lot of white claws but I
1:07:28
don't like that I know I don't know why I drink them
1:07:33
they're fine they're just like not that great no I think there was one Seltzer I
1:07:39
liked and I'm blinking on like no I'm taking Twisted Tea that's not a
1:07:44
it's not a seltzer yeah no I'd rather have like a cocktail or wine oh yeah something like that
1:07:52
yeah I'm definitely not a beer person I may not drink a beer but if I have more than one I think I'm gonna throw up
1:07:58
my stomach feels like it's like humongous I have tried to convince myself to like beer just because of like
1:08:04
how convenient it is in Social settings and I care for you especially yeah
1:08:10
you've got a beer lover in your midst I know and I've tried probably every single one of his and
1:08:17
every time I'm like it smells like beer bread uh I like it tastes like beer
1:08:22
bread it's like with a meal I like to have beer with a meal if I don't say like I will tolerate beer if it's with a
1:08:28
meal yeah but like drinking like just five beers back to back makes you wanna that does it
1:08:36
I don't get it I think you're all frauds I don't know they actually like it and like I think those things where yeah
1:08:43
definitely where like it's like cool to like drink like a ton oh yeah
1:08:48
it's weirdly normalized which is a whole other conversation we've already had
1:08:54
before I think on here but like you know I don't get how physically like I would feel like garbage if I had more than like two no no
1:09:02
that was my at one point and now I'm like disordered eating way I like would tell people I'm
1:09:10
like it's not worth the carbs because you don't get drunk
1:09:16
wait earlier in my drinking years that was primarily the reason I was drinking
1:09:23
to become intoxicated I'm like yeah what is this like four percent alcohol that
1:09:30
smells horrible and tastes horrible gonna do for me I have to drink like eight to feel something
1:09:36
ugh then my gut is like extended by like a foot yeah no thanks no
1:09:43
I like I like a a cider though I do like ciders like a cider yeah
1:09:49
but I know the beer enthusiasts are like that's not fair
1:09:55
whatever you can have your yeast water probably fully cut over here East Water
1:10:01
I'll be having my grape water thank you very much yeah and my potato water yeah
1:10:09
grapes and potatoes already better
1:10:15
okay that should be our wrap this episode has made my brain hurt yeah
1:10:21
if you guys have any questions about this topic let us know like I said we have our little comment section open now
1:10:27
on the website yeah and we'll keep brainstorming new fun ideas to make it more interactive for you guys so we can
1:10:32
keep like having your input it can be fun to have like listener mailbag episodes like
1:10:37
once every 20 episodes would you like a listener only thing I don't know we'll keep brainstorming but anyway for now
1:10:43
the comments are open yes and we want to hear from you yeah what's
1:10:50
your favorite seltzer yeah and also what are your thoughts on childhood obesity Barry
1:10:56
opposite topics yeah well thanks for tuning in today we'll
1:11:02
see you guys next week otherwise have a good rest of your day and go at Kate for
1:11:08
yourself and all the children go children
1:11:14
okay bye okay bye
