On Monday, the American Academy of Pediatrics published new recommendations for “Preventing Obesity and Eating Disorders in Adolescents.” The recommendations, which will appear in the September issue of Pediatrics (the academy’s flagship journal), suggest that pediatricians should focus on behaviors, like eating healthy foods and exercising, rather than on weight when talking to young patients. The AAP also recommends that doctors use a method called Motivational Interviewing, “a collaborative, goal-oriented style of communication,” to encourage patients to make healthful lifestyle changes.
After reviewing the literature on adolescent obesity and eating disorders, the AAP’s researchers identified five behaviors that are associated with both. Dieting, defined as “caloric restriction with the goal of weight loss”; weight talk, defined as “comments made by family members about their own weight or comments made to the child by parents to encourage weight loss”; and being teased about one’s weight all increase a teen’s likelihood of developing an eating disorder or gaining weight. Meanwhile, two behaviors seem to protect against both obesity and eating disorders: eating family meals together and cultivating a positive body image. (The latter is easier said than done; half of teenage girls and a quarter of teenage boys are dissatisfied with their bodies.) Considering that so many of the risk factors for obesity and eating disorders are tied up in the family, it’s not surprising that the AAP recommends family-based approaches to preventing and treating eating disorders and obesity.
The AAP’s report is geared toward physicians, but laypeople should also pay attention. Eating disorders and obesity are often talked about as two separate problems, but they’re not. Eating disorders are usually undergirded by a fear of becoming fat—a fear that’s only exacerbated by fear-mongering reporting on the “obesity epidemic.” And people who are already fat often resort to eating-disorder-type behaviors, like severely restricting calories and skipping meals, in an attempt to reduce their weight. The AAP report notes that these attempts often backfire, since dieting is associated with weight gain and binge eating. Adolescent obesity and eating disorders are two sides of the same coin: a culture that tells young women (and, to a lesser extent, men) that the size of their bodies is the most important thing about them and offers them an endless selection of diet and exercise plans.
Dieting is a hazard to teens’ mental and physical health whether they’re fat or thin, and for the AAP to recognize that is a huge milestone. Doctors, alas, are often a central source of fat-shaming in people’s lives, and so if the AAP can convince doctors that their “focus should be on healthy living and healthy habits rather than on weight,” they stand to improve heavier people’s interactions with the medical system. And the AAP’s recommendations could also have an important trickle-down effect. So many people who perpetuate fat stigma use medicalized excuses for their bigotry. When a major medical organization states flat-out that dieting, weight talk, and weight teasing are counterproductive, it’s harder for weight bullies to justify their actions. Of course, our society’s unhealthy attitudes toward food and weight have complex causes and will require complex solutions—but the AAP connecting the dots between eating disorders and obesity is an important step in the right direction.