AED releases awesome new guidelines for childhood obesity programs

24th March 2009

AED releases awesome new guidelines for childhood obesity programs

posted in Body Politic, Eating Disorders, Fat Acceptance, Fat Bias, Fitness/Exercise, Health, Nutrition & Fitness, Mental Health, New Research |

Finally! A group that actually *gets* it! The Academy for Eating Disorders has issued new guidelines for childhood obesity prevention programs that take into consideration the harmful effects such programs can potentially have on children’s physical, social and emotional health, not to mention disordered relationships with food and body. As regular readers know, this is an issue I’ve been writing about for some time now — read here and here. Some of the group’s recommendations include (emphasis mine):

Interventions should focus on health, not weight, so as to not contribute to the overvaluation of weight and shape and negative attitudes about fatness that are common among children and have harmful effects on their physical, social and psychological well-being.

The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Consistent with this definition, interventions aimed at addressing weight concerns should be constructed from a holistic perspective, where equal consideration is given to social, emotional and physical aspects of children’s health.

Interventions should focus not only on providing opportunities for appropriate levels of physical activity and healthy eating, but also promote self-esteem, body satisfaction, and respect for body size diversity. [C]onstructing a social environment where all children are supported in feeling good about their bodies is essential to promoting health in youth.

Weight is not a behavior and therefore not an appropriate target for behavior modification. Children across the weight spectrum benefit from limiting time spent watching television and eating a healthy diet. Interventions should be weight-neutral, i.e. not have specific goals for weight change but aim to increase healthy living at any size.

It is unrealistic to expect all children to fit into the “normal weight” category. Thus, interventions should not be marketed as “obesity prevention.” Rather, interventions should be referred to as “health promotion,” as the ultimate goal is the health and well-being of all children, and health encompasses many factors besides weight.

School-based interventions should avoid the language of “overweight” and “obesity” since these terms may promote weight-based stigma. Moreover, several of the most effective interventions have not focused on weight per se.

Interventions should focus on making children’s environments healthier rather than focusing solely on personal responsibility.

Interventions should be careful not to use language that has implicit or explicit anti-fat messages, such as “fat is bad,” “fat people eat too much”, etc.

Children of all sizes deserve a healthy environment and will benefit from a healthy lifestyle and positive self-image. School-based interventions should not target heavier children specifically with segregated programs aimed at lowering weights. However, this should not discourage efforts to provide physical activities tailored for larger bodies or to address the experiences that heavier children share as a group.

Interventions should aim for the maintenance of individually appropriate weights—that is, that children will continue to grow at their natural rate and follow their own growth curve—underscoring that a healthy weight is not a fixed number but varies for each individual.

A sudden shift away from the growth curve in either direction may indicate a problem, but further information about lifestyle habits, physical markers and psychological functioning is needed before a diagnosis can be made. Changes in weight are not always a sign of abnormal development. An increase in weight often precedes a growth spurt in children and some girls begin to gain body fat as part of normal adolescence at a very young age.

Weighing students should only be performed when there is a clear and compelling need for the information. The height and weight of a child should be measured in a sensitive, straightforward and friendly manner, in a private setting. Height and weight should be recorded without remark. Further, BMI assessment should be considered just one part of an overall health evaluation and not as the single marker for a student’s health status.

Weight must be handled as carefully as any other individually identifiable health information.

The ideal intervention is an integrated approach that addresses risk factors for the spectrum of weight-related problems, including screening for unhealthy weight control behaviors; and promotes protective behaviors, such as decreasing dieting, increasing balanced nutrition, encouraging mindful eating, increasing activity, promoting positive body image and decreasing weight-related teasing and harassment.

Interventions should honor the role of parents in promoting children’s health and help them support and model healthy behaviors at home without overemphasizing weight.

Interventions should provide diversity training for parents, teachers and school-staff for the purpose of recognizing and addressing weight-related stigma and harassment and constructing a size-friendly environment in and out of school.

Interventions should be created and led by qualified health care providers who acknowledge the importance of a health focus over a weight focus when targeting lifestyle and weight concerns in youth.

It is important that interventions be evaluated by qualified health care providers and/or researchers, who are familiar with the research on risk factors for eating disorders, as the interventions are being implemented in schools or communities. Ideally, the assessment should not only evaluate changes in eating and activity levels but also self-esteem, social functioning, weight bias and eating disorder risk factors, such as body dissatisfaction, dieting and thin-ideal internalization.

Wow. Just… wow. I’m somewhat blown away. There is not one single guideline that I disagree with. I encourage everyone to do their part and spread word of these guidelines. Give a copy to your child’s teacher or counselor. Mail a copy to your local school. Repost them on your blog or email a copy to friends and family members with children.

(Deb Burgard of the site Body Positive, a wonderful site promoting positive body image and health at any size, had a role in crafting the guidelines — Way to go, Deb!).

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This entry was posted on Tuesday, March 24th, 2009 at 11:41 am and is filed under Body Politic, Eating Disorders, Fat Acceptance, Fat Bias, Fitness/Exercise, Health, Nutrition & Fitness, Mental Health, New Research. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

1 On March 24th, 2009, Cute Bruiser said:

I am not ashamed to admit that I teared up while reading this.

posted on March 24th, 2009 at 12:17 pm

2 On March 24th, 2009, Deb Burgard said:

Hey, All,

Thank you for your enthusiasm about the Guidelines! I am so proud of the Academy for Eating Disorders for taking this stand, and my colleagues and co-authors Sigrun Danielsdottir and Wendy Oliver-Pyatt, for not compromising what we see as basic common sense. I think it is high time for the eating disorders specialists to contribute what we know to the debates about children and weight.

We want to get this document into the hands of as many people as possible. We want this to be a stake in the ground, a way to back up the efforts of people who are trying to protect all kids from the relentless focus on weight.

So use it in every way you can think of – in your local programs, with your pediatrician, with your in-laws, and if you have an organzization that wants to “affirm” or “adopt” it maybe we can replicate the effect.

I just want people to imagine what their childhoods would have been like if the adults organized themselves around these principles. We can do this for our kids. Thanks so much for your support!

posted on March 24th, 2009 at 12:44 pm

3 On March 24th, 2009, Diane said:

This is WONDERFUL, it’s about time. I don’t have myself weighed when I go to the doctor (they get so pissed at me) but it’s not the only indicator of health and I think society focuses on it way too much.

posted on March 24th, 2009 at 12:49 pm

4 On March 24th, 2009, Tari said:

Wow is the right word. That is freakin’ incredible!!

posted on March 24th, 2009 at 12:51 pm

5 On March 24th, 2009, Bronwyn said:

I’m blown away! Definitely going to be spreading the word.

posted on March 24th, 2009 at 12:52 pm

6 On March 24th, 2009, JupiterPluvius said:

“WEIGHT IS NOT A BEHAVIOR.”

Wow. There’s an epiphany right there.

posted on March 24th, 2009 at 1:04 pm

7 On March 24th, 2009, Lisa said:

This is fantastic! Thanks for posting, it made me smile.

posted on March 24th, 2009 at 1:26 pm

8 On March 24th, 2009, buttercup said:

I had to check the calendar to make sure it wasn’t april 1.

now the question is-will anyone listen?

posted on March 24th, 2009 at 1:41 pm

9 On March 24th, 2009, Rachel said:

Diane: I don’t have myself weighed when I go to the doctor (they get so pissed at me) but it’s not the only indicator of health and I think society focuses on it way too much.

Unless you’ve fluctuated significantly in weight, the only reason your doctor should insist on weighing you is if they prescribe medication. That’s the only time I allow myself to be weighed when seeing a doctor about a non-weight-related issue.

posted on March 24th, 2009 at 1:52 pm

10 On March 24th, 2009, Bree said:

Changes in weight are not always a sign of abnormal development. An increase in weight often precedes a growth spurt in children and some girls begin to gain body fat as part of normal adolescence at a very young age.

I’m so glad they’ve put this in their guidelines. In the childhood obesity epipanic, this issue has been convienently forgotten. Not to mention the the theme of shame that runs through the majority of child health programs today.

posted on March 24th, 2009 at 2:12 pm

11 On March 24th, 2009, maggiemunkee said:

this Rather, interventions should be referred to as “health promotion,” as the ultimate goal is the health struck me particularly today.

this changes the entire focus of the “obesity epidemic” wholly. by naming the “enemy” in the fight (ie, “obesity prevention”), it is giving power to said “enemy.” “health promotion,” conversely, gives power to the idea of “health.”

i’ve been reading The Secret somewhat recently and this resonated…

posted on March 24th, 2009 at 2:40 pm

12 On March 24th, 2009, apricotmuffins said:

one word: FANTASTIC!

Im really, very happy that someone with some influence and knowledge in the area has written this down, where it might actually get listened to by the people that matter!

posted on March 24th, 2009 at 2:50 pm

13 On March 24th, 2009, April D said:

I am going to be so happy to repost this. What a beautiful wording for what the focus really should be “Children of all sizes deserve a healthy environment and will benefit from a healthy lifestyle and positive self-image.”

I too had to check to make sure it wasn’t April 1 and this was a cruel joke. What hope just filled my day today!!

posted on March 24th, 2009 at 3:18 pm

14 On March 24th, 2009, Emerald said:

YES.

Now, bearing in mind that this appears to be a US organization, we need to get the health authorities in the UK to sit up and listen…

posted on March 24th, 2009 at 3:22 pm

15 On March 24th, 2009, Nicole said:

This is so great. I am definitely going to print some out and show them to my children’s pediatrician. As it is, I’ve been doing passive-aggressive things like turning around the “What to do when your child is FAAAAAAAAAAAAAAAAT!!!” pamphlets so that people aren’t subjected to them at eye level. Dumb, I know, but sort of all I could manage given the obesity epi-panic…until now!

posted on March 24th, 2009 at 3:24 pm

16 On March 24th, 2009, Twistie said:

(holds beautiful guidelines close and cuddles them)

This makes me happy beyond expression.

posted on March 24th, 2009 at 3:33 pm

17 On March 24th, 2009, kristin said:

*blub*

That’s the most beautiful thing I have seen in, well, a really long time.

posted on March 24th, 2009 at 3:37 pm

18 On March 24th, 2009, Rachel said:

health promotion,” conversely, gives power to the idea of “health.”

Not to mention that this emphasis is very democraticizing. There are plenty thin people who are not healthy and could use health education.

posted on March 24th, 2009 at 3:52 pm

19 On March 24th, 2009, Rachel said:

am definitely going to print some out and show them to my children’s pediatrician.

Haha, you should tuck a copy of these guidelines in each of the pamphlets you see.

posted on March 24th, 2009 at 3:53 pm

20 On March 24th, 2009, spoonfork said:

Multiple copies of this are going to my daughter’s school administration and all the science teachers.

My daughter came home one day and asked me if I was fat because I ate too much, like her teacher said, and if I was going to get sick. I already had a discussion with this teacher (oh, yes . . .), armed with studies about set points and HAES, but now I have serious firepower and the backing of an authority who knows how easily children are damaged by obesity fears.

This is wonderful.

posted on March 24th, 2009 at 5:14 pm

21 On March 24th, 2009, sarah said:

Fantastic! This is so exciting. Thanks for the post, Rachel!

posted on March 24th, 2009 at 5:29 pm

22 On March 24th, 2009, Deb Burgard said:

Y’All, I am so thrilled by your response and help getting the word out. BTW, for our non-US readers, the Academy for Eating Disorders is most specifically the premier INTERNATIONAL association of academic and clinical eating disorder specialists. Many members are from the UK, Emerald.

posted on March 24th, 2009 at 5:33 pm

23 On March 24th, 2009, angrygrayrainbows said:

OMG… beautiful…. just beautiful…. those guidelines have me stunned… and maybe a bit weepy… woooooooooooowwwwwwwwwwwwwwwwwwww

posted on March 24th, 2009 at 7:20 pm

24 On March 24th, 2009, lilacsigil said:

Magnificent! Humanising, sensible and focused on actual health. Well done.

posted on March 24th, 2009 at 8:22 pm

25 On March 24th, 2009, wellroundedtype2 said:

This:
“Weight is not a behavior and therefore not an appropriate target for behavior modification.”
Yesyesyesyesyesyesyesyesyes.

I said something along these same lines in sheer frustration at work last week when I read this sentence in a Preventing Chronic Disease Journal article:
“CDC placed 4 risk behaviors for chronic diseases at the top of the list of actual causes of death in 2000: tobacco use (435,000 deaths per year), physical inactivity, unhealthy eating, and overweight/obesity (the latter 3 together account for 365,000 deaths per year).”

“Obesity is not a behavior!” I cried/shouted to my (thin) coworker/friend.

posted on March 24th, 2009 at 9:46 pm

26 On March 24th, 2009, wellroundedtype2 said:

Also, I would love to take this list of recommendations and sub “person/people” for “child/children/adolescents.”

While this is so critical for children, it also applies to adults.

posted on March 24th, 2009 at 9:48 pm

27 On March 24th, 2009, wellroundedtype2 said:

And, this:
“It is unrealistic to expect all children to fit into the “normal weight” category.”

It is also unrealistic to expect all PEOPLE to fit into the “normal weight” category.

posted on March 24th, 2009 at 9:49 pm

28 On March 24th, 2009, Meowser said:

Thank you, Deb Burgard. You did wonderful work here!

posted on March 24th, 2009 at 10:52 pm

29 On March 25th, 2009, spacedcowgirl said:

I don’t have much to add except my thanks as well, Deb. This is so sorely needed–I can’t express how grateful and excited I am that kids might now get this alternate message rather than the usual anti-obesity message that I think does them more psychological harm than good.

posted on March 25th, 2009 at 12:47 am

30 On March 25th, 2009, Ostara said:

“I just want people to imagine what their childhoods would have been like if the adults organized themselves around these principles.”

Without a doubt mine would have been much improved. Not to mention it could have saved me from engaging in a lot of unhealthy behaviors as an adult all for the sake of trying to be “healthier”. If that’s not ironic, I don’t know what is.

Thanks so much for this. I want to substitute person/people for the instances of child/children and plaster this on every street corner. Finally, health professionals are getting it and are SPEAKING UP!

posted on March 25th, 2009 at 9:17 am

31 On March 25th, 2009, Lisa said:

This is wonderful. I teared up reading it. I loved “Weight must be handled as carefully as any other individually identifiable health information” and “BMI assessment should be considered just one part [...] and not as the single marker for a student’s health status.”

I can clearly remember being in middle school and having to get both height and weight measured, by classmates, for my “health” class. I had just grown 5 inches in less than a year, and my weight hadn’t caught up yet. I was feeling incredibly self-conscious about my bony collarbones and lack of breasts, and to top it off my teacher created a chart of our class’s statistics, clearly labeling the lowest BMI, which everyone knew was mine, and the highest, which was a friend’s.

I got removed from class several times to go see the school counselor. He wanted to discuss my weight because they were “concerned that I wasn’t eating properly.” My friend got the same treatment. My mother, a recovered anorexic, was beyond furious. I wish she’d had something like this to support her arguments. As it was, she brought in my pediatrician, who reamed out the teacher, the principal, and the counselor for ignoring other health indicators and creating a weight-hostile environment.

Thank goodness I had knowledgeable and caring adults in my life; hopefully these guidelines will create more knowledgeable and caring adults to help other children avoid unhealthy views of weight.

posted on March 25th, 2009 at 11:10 am

32 On March 25th, 2009, Big Fat Deal » Awesome Childhood Obesity Guidelines Are Awesome said:

[...] new guidelines for childhood obesity programs are just amazing. Rachel has them listed at The F Word, complete with highlighting. In this case it indicates not white-hot rage, but happiness. Consider [...]

posted on March 25th, 2009 at 1:05 pm

33 On April 10th, 2009, Gattaca: A not-so-distant or fictive reality? » The-F-Word.org said:

[...] are both more affordable and accessible to people at all socio-economic levels. Schools would adopt weight-neutral standards like those defined by the Academy for Eating Disorders so that future generations would develop [...]

posted on April 10th, 2009 at 12:07 pm