#61 - What's Wrong With the American Academy of Pediatrics Guidelines for Higher-Weight Children with Anna Lutz

*Content Warning: This week's episode contains use of the O-word, as well as discussion of weight loss surgery.*

Earlier this month, the American Academy of Pediatrics released a new guideline document containing weight loss recommendations for children as young as two years old. So this week, we are talking to Anna Lutz, MPH, RD, LDN, CEDRD-S
about everything that's wrong with these recommendations.

Anna Lutz is a Registered Dietitian in Raleigh, NC.  Anna and Elizabeth Davenport, another anti-diet RD, are the co-creators of Sunny Side Up Nutrition, a blog and podcast that focus on nutrition, cooking and family feeding, free of diet culture. Anna is also the co-owner of a private practice in Raleigh, NC, Lutz, Alexander & Associates Nutrition Therapy. Anna specializes in eating disorders and pediatric/family nutrition and enjoys mentoring and providing clinical supervision to other dietitians. 

We had an amazing conversation about...

• How these recommendations are a full reversal of the AAP guidelines from 2015, and the conflicts of interest that likely influenced this shift
• The life-long physical, medical, and relational harm of weight loss recommendations for children
• The increased risk for eating disorders & weight cycling that will likely result from these recommendations
• Why weight loss recommendations are never a solution to weight stigma
• How parents can navigate pediatrician appointments in light of these recommendations
• And what health markers actually are important for kids!

You can find out more about Anna & about diet-free parenting at Sunny Side Up Nutrition or Lutz Alexander Nutrition Therapy | Raleigh Durham Chapel Hill (lutzandalexander.com).

Or you can connect with Anna via social media on Instagram or Facebook!

Referenced in this episode:
Serious Issues with the American Academy of Pediatrics Guidelines for Higher-Weight Children and Adolescents by Ragen Chastain

Special Edition: Dangerous New American Academy of Pediatrics Guidelines for Higher-Weight Children by Ragen Chastain

A Letter to Your Child's Doctor

Don't Talk About My Child's Weight Cards

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Here's where to find us:
Sadie Simpson: www.sadiesimpson.com or IG @sadiemsimpson
Naomi Katz: www.happyshapes.co or IG @happyshapesnaomi

Transcript

Naomi Katz: 0:03

Welcome to Satisfaction Factor, the podcast where we explore how ditching diet culture makes our whole lives more satisfying. Welcome back to Satisfaction Factor. I'm Naomi Katz, an intuitive eating, body image, and self trust coach.

Sadie Simpson: 0:26

I'm Sadie Simpson, a group fitness instructor, personal trainer, and intuitive eating counselor.

Naomi Katz: 0:31

This week, we are talking to Anna Lutz, a registered dietitian who focuses on eating disorders and pediatric and family nutrition, and we are talking to her about the new guidelines for higher weight children that were just released by the American Academy of Pediatrics. They are very problematic, and this is a super important topic, and so we are really, really grateful to have Anna's input on it. Before diving into today's episode, we're gonna give you a quick reminder about The Satisfaction Space, our new podcast community. We know that it can be hard to find anti diet community that's aligned with your values, especially if you're the first in your family or friend group to make moves towards ditching diet culture, and that is why we created The Satisfaction Space. If you've ever found yourself listening to the podcast and wanting to add something to the conversation or ask a question, this space was created for you.

Sadie Simpson: 1:27

The Satisfaction Space is our online community that includes a private virtual community of folks who share similar values and interests that you can talk to and connect with outside of Facebook, bonus content during the podcast off weeks, monthly live virtual hangouts with us. And we just finished our hangout yesterday, and I want to plug that for a minute. That is a really fun and exciting thing. I really look forward to that every month, getting to know the folks in The Satisfaction Space. That's a really cool feature of this membership.

Naomi Katz: 1:58

I could not agree more. It's such a good time. And I feel like like- when we wrapped up last night, we- the- the feedback was, I feel so energized right now, which is just what I love to hear.

Sadie Simpson: 2:10

Yeah, I felt very energized too. It's good to have that community and that connection with other folks, and not just us talking. I mean, I love talking to you. But it's also nice to have like input from other folks too.

Naomi Katz: 2:21

Totally.

Sadie Simpson: 2:22

And within The Satisfaction Space, we also have a community feed, where you can post comments, ask questions, and get feedback from us, as well as the fellow community members. Membership to The Satisfaction Space is just $10 a month, and you can enroll at thesatisfactionspace.mn.co. And we will link that in the show notes.

Naomi Katz: 2:47

Or if you want to support the show but you don't want to commit to a monthly membership, we've got merch now. We have got a handful of designs up on Teepublic that can be printed as stickers, T shirts, sweatshirts, mugs, tote bags, or whatever you like. T shirts and sweatshirts come in sizes up to 5X. You can check out all the merch at teepublic.com/user/satisfactionfactorpod. And of course we will link that in the show notes as well. Well, welcome Anna. Thank you so much for joining us

Sadie Simpson: 3:17

Now on to our episode. Anna Lutz is a registered dietitian in Raleigh, North Carolina. Anna and Elizabeth Davenport, another anti diet RD, are the co-creators of Sunny Side Up Nutrition, a blog and podcast that focuses on nutrition, cooking, and family feeding, and it's free of diet culture. Anna is also the co owner of a private practice in Raleigh, North Carolina, Lutz, Alexander and Associates Nutrition Therapy. Anna specializes in eating disorders and pediatric and family nutrition, and enjoys mentoring and providing clinical supervision to other dieticians. Anna received her Bachelor of Science degree in psychology from Duke University and Master of Public Health and Nutrition from the University of North Carolina at Chapel Hill. She is a certified eating disorder specialist and approved supervisor, both through the International Association of Eating Disorder Professionals, or IAEDP. Anna serves on the board of the Carolina Resource Center for Eating Disorders, and as a content expert NCEED. Previously she worked at a Children's National Medical Center in Washington DC and Duke University Student Health treating individuals with eating disorders. She has completed extensive training through the Embodied Recovery Institute and strives to provide her clients trauma and somatically informed care. Anna delivers workshops and presentations on eating disorders, weight inclusive health care, and childhood feeding. Well, let's talk to Anna. today to talk about this extremely important and bothersome issue.

Anna Lutz: 4:54

Well, I'm thrilled to be here to talk with both of you. I wish it was under better circumstances. But I'm really excited about our conversation.

Sadie Simpson: 5:08

So normally what we asked folks at the beginning of every episode is to share a little bit about their experience with diet culture, and how that has impacted them throughout their lives, and has led them to where they are today. But I'm kind of curious if you have anything to share with us that is related to sort of what we're going to talk about in this episode.

Anna Lutz: 5:33

Well, yes, definitely, two things come to my mind. The first thing is my work as a pediatric registered dietitian. When I was right out of school, I worked at Children's National Medical Center in Washington, DC, and four days a week, I was in what they call it a general pediatric clinic, and one day a week I was in their eating disorder clinic. And it became really evident to me really quickly that what I was treating one day a week, I was probably causing harm the other days a week- that the focus was on children's weight- the- in that general clinic. And so that kind of led me on this path of, you know, as diet- as a dietitian, I wanted to practice in a way that was universally helpful to kids and families, and of course, not causing harm. Because I think back to that time, and I cringe, and- over the harm that I caused. I think some of that might have been highlighted- my experience as a child- I remember going to the pediatricians office, you know, being weighed, and then that pediatrician talking to my mother and I about my weight. You know, I don't remember the words, but I remember the feeling. And I remember not not wanting to go to the pediatrician. And so I think that personal experience comes up right now. But also, that professional experience comes up. And I just can't believe we're still in this place where we're not seeing the harm that we're causing children and people when we focus on body size.

Naomi Katz: 7:06

Wow. Yeah, that's- that's so powerful. I- I mean, I want to say I love that you can approach this from both personal and professional standpoint, but I don't know if love is the right word. I think it's very helpful to this conversation that you're able to approach it from both of those sides. Because this is an issue that is going to impact people both personally and professionally. You know, clinicians need to understand what's wrong with these guidelines. And also, you know, parents are going to need to know that this is going to impact their kids on a personal level, too. Okay, so just to sort of give a little background, we mentioned this a little in the intro, but what we're talking about here is the American Academy of Pediatrics has put out new clinical guidelines for the care of higher weight children. And it is a very long document. It's something like 100 pages or something like that. But, you know, the real the highlights here- the real standouts are that they are making recommendations for the manipulation of the body size of toddlers, children and adolescents. I think it's- you know, they're recommending diets for kids as young as two, weight loss drugs for kids as young as eight, and weight loss surgery for kids as young as 13. Which is really extreme.

Anna Lutz: 8:39

Yes. I mean, even just saying that. You know, I hope people that aren't in our field and don't know all the harms that that can cause- I think just hearing that can be shocking. Prescribing children weight loss medications? But you read this document, and it's like the circular logic that someone might read it and think it's a good idea.

Naomi Katz: 9:00

Yeah, absolutely. That- you know, the other thing that really stood out to me was what a huge like 180 this is from a few years ago, when this same group specifically recommended that doctors not talk to kids about weight and weight loss.

Anna Lutz: 9:18

Yes. I mean, I cite that paper almost every time I speak- that American Academy paper- I think it was 2015- that said pediatricians should not talk directly to children about weight. And I would love to hear from someone from the American Academy of Pediatrics who would speak on that. Why did they put out that paper, and why did they put out this paper, and is it just that these are two different hands of the same body, or have they done a 180, or what? But it's- all of it is very confusing.

Naomi Katz: 9:49

I vividly remember when all the- there was all the controversy around Kurbo, the Weight Watchers app for kids, and, again, the American Academy of Pediatrics like specifically came out against this app and putting kids on diets.

Anna Lutz: 10:04

Right. But now, they've come out with with these recommendations that are- it's- what people keep saying is they're doubling down on all that. But it's even worse. I mean, I think it's even worse than that. It feels like they're, you know, tenfold coming down about that, because it's this very- that first recommendation is very intensive, what they call behavior change intensive program. That is caloric restriction. It's a diet, just like you said. And then the thought of these- of medications, and then the recommendations of surgery. I was outraged about Kurbo, but this is even more concerning because of the harm. And that's probably what we're gonna get into more today. But thinking about the harm this can cause children and families.

Naomi Katz: 10:46

Yeah, absolutely. There's been a fair amount written about the various conflicts of interests of the authors of this paper, that many of them get funding and work for, like, literally Weight Watchers, and also the pharmaceutical companies that make these weight loss drugs that are being recommended. Many of them own bariatric surgery centers. Like they are directly profiting from these like kind of brutal guidelines. And all I can think about is, in the 1990s, when all the BMI categories were shifted to make more people in the, quote, overweight and obese categories, exactly because of the funding that was coming from the pharmaceutical company that was about to release a new weight loss drug,

Anna Lutz: 11:35

Like, here we are, again. I remember that- when, you know, overnight, you know, everything was changed, and all these people woke up and were, quote, in this overweight category, when the day before they were in this, quote, healthy category. And just like you're saying, if you look at the committee who made that decision, every single person on that committee had a tie to the diet industry, whether it was a company like Weight Watchers, Jenny Craig, one of those, or pharmaceutical company that benefited from weight loss medications. And that's what our medical system is being driven by. It's shocking. It also really makes me think about- and this is- this whole paper, this whole clinical guideline is based on this fact or situation that obesity- and I'm putting that in quotes, and I'm using that word because I have to right now- that has been deemed or designated a disease. And it was designated a disease by the American Medical Association in 2013. And that went against the very committee, their own committee, they asked to decide if that should be the case. So they did all this research, their own committee, the recommendation is, we should not do this. The American Medical Association did it anyway. Now the American Pediatric Association is now putting out these guidelines based on the fact that body size is, quote, a disease and that children's bodies should be manipulated.

Naomi Katz: 13:06

My understanding from everything that I've read is that the thing is that like, again, quote unquote, obesity does not meet the guidelines for being defined as a disease. Is that correct?

Anna Lutz: 13:20

Yeah, that's what I understand. And this, you know, is that- that's why that committee, the AMA committee, made the recommendation it should not be. But I think it benefits- kind of going back to your point, is kind of why I went off on this tangent is- is that, to your point, I think it benefits the pharmaceutical companies, bariatric surgeons- right- to- to have this designation. And so that's what just- so it's sad.

Naomi Katz: 13:45

It is. Like, I always feel like a conspiracy theorist, like when I have these conversations- that like I should have a wall in my room with like, you know, strings, connecting things or whatever. But like, it's also just so clear and obvious. Like the connections are right there for anybody to look at. The money is public, like none of this is hidden.

Anna Lutz: 14:07

Exactly. Exactly. You know, we've- we've talked about how great Ragen Chastain's work is. And she has recently published a great newsletter about the background of the researchers of- of this American Pediatric Association clinical guidelines, and it's all right there. She really does great research and lays it out for us.

Naomi Katz: 14:26

Yeah, we we love Ragen Chastain around these parts, and we will absolutely link in the show notes to both of her newsletters on this- both the one that outlines the conflicts of interest, and then also the one where she really breaks down the research- which, PS, is terrible. Like the research they rely on is not good research.

Anna Lutz: 14:48

No. No. Ugh.

Naomi Katz: 14:51

Yeah. It's very, very frustrating. I think there's gonna be a lot of that in this podcast. Everybody just pausing and like having to take this like, sigh of exasperation.

Anna Lutz: 15:07

I have so much to say, but it's so confusing even in my mind, I'm holding myself back to one step at a time.

Naomi Katz: 15:14

Yeah. So, Anna, let's just kind of go one by one through these awful recommendations. And maybe you can sort of tell us about what's wrong with recommending diets for kids as young as two. Like, where does that go wrong? And maybe what would you do instead?

Anna Lutz: 15:34

I want to start off by saying, we know that diets are a risk factor for eating disorders. That is very, very clear in the research. Something else that we know is that weight cycling- so losing weight, and then gaining weight and, and losing weight- is tied to the very health condition- conditions that are associated with higher weights. And so if you are putting people- in this case, we're talking about children- on diets, we're putting them at risk for eating disorders, we're putting them at risk for medical complications by we know that if someone loses weight, they're gonna gain the weight back. And that's even laid out in this clinical guideline. They even say that, and they call it relapse.

Naomi Katz: 16:23

Yeah, they basically rebrand the idea of weight cycling, and like yo yo dieting, as like, it's a feature, not a bug kind of a thing. Where they're like- I think the exact thing is there- I guess there's an illustration that shows like the squiggly line of like, treatment- quote, unquote, treatment- throughout the lifetime, essentially. And they say it shows the relapsing and remitting nature of obesity as a chronic disease. What?

Anna Lutz: 16:53

That we've made up, that is a chronic disease, right? Like that. So now we have to, like make a pretty graphic that supports that, you know, that shows what that chronic disease looks like, that doesn't really exist.

Naomi Katz: 17:05

Right, like this chronic disease, that we are literally- like, we're creating the conditions that make this look like a chronic disease by creating the weight cycling that we're illustrating in this graph, right?

Anna Lutz: 17:19

And oh, by the way, we're also- we know that the weight cycling causes the medical concerns that we're saying are caused by weight. And so, I mean, there's so many levels. You know, and I think about the harm that's caused to a child's self worth, self esteem, to the parents' self worth and self esteem. You know, I worry that individuals and families with marginalized identities are going to hold this harm more- experience this harm more. You know, the shame that goes along with a doctor, who may have a different- may or may not have a different identity than you, saying you're- you're parenting wrong, or your body is wrong. And so you asked me what would I do differently? You know, I think we have to talk about two different things. As a clinician, as a dietician, a registered dietician, what I do differently is, with a younger child, work with the family to see if there are any nutrition concerns. You know, just because someone is in a higher weight body doesn't mean there's like nutrition concern, right. And this is all based- the recommendations are based on that assumption. To be screening for food insecurity, I'd be talking to parents about family meals. I'd be supporting the parents in feeding their child in a way that honors the child's hunger and fullness, is not restrictive, because we know that restriction leads to disordered eating. And that's complicated. Now, that's like the one on one individual clinician answer. And then my, like, if I had a magic wand answer would be we would take all the money and time that went into writing this 100 page paper, and we'd focus on decreasing health disparities and focusing on social determinants of health. And that's what we need to put- as a society, that's what's going to help improve health outcomes.

Naomi Katz: 19:08

Yeah. You know, one of the things that really stood out to me within that section is like they basically acknowledge that all the sort of- that the sort of studies that they cite- that like nothing shows success past the 12 month mark- past the one year mark- and then they go on to say two things. One, that this requires a lot of medical intervention and a lot of visits to medical providers, which in a country where medical care is exorbitantly expensive, is like, okay, who can- who's gonna be able to afford those- like that- all of these visits that you say are necessary. And two, the other thing they said is that past that 12 month mark, it was hard to keep family involvement. And so they're already framing it as the reason it's not successful long term is because parents aren't doing their job. And like, just the extent to which that can be harmful is- I mean, it's- it sets the stage for some really, really ugly things.

Anna Lutz: 20:19

It's so true, it's so true. And it's, I mean, it's heartbreaking, because I'm thinking, everything you just explained is so true. And what's happening is the child is being told, there's something wrong with you, there's something wrong with your body. And all these parents, all these adults are so worried that we're gonna get all these appointments and do all these things. And what does that do to a human being for the rest of their life? And then we're telling their parents, there's something wrong with you as a parent, you're not parenting right. And if you can't do this very intensive- even intensive is in the name of the program, right- thing that we know is going to have a high dropout rate, and we know, there's what they're calling, quote, relapse with their pretty drawing, what does that do to a parent? Right? And so then what does that do to the relationship, the feeding relationship? You know, I mean, it just the ripples. The ripples are so big, and I don't think people understand it.

Naomi Katz: 21:16

Yeah. Where you're absolutely interfering with a child- obviously, you're interfering with the child's relationship to their own body, and food, and movement, and all of that stuff. But you're also interrupting the family relationship, the parent child relationship, all of that stuff, the relationship to consent and autonomy, like these very big things,

Anna Lutz: 21:37

Right? And the relationship to the medical provider, right? So if I'm a parent, I'm feeling like I'm not a good parent, because my- my child's size, and I'm being told to do these things, and it's not going anyway- very well. I'm not going to want to go back to the pediatrician, right? I'm not going to want to go and be honest. And yeah, just a breakdown of all relationships.

Naomi Katz: 22:00

Yeah. Well, I mean, you shared about how that happened to you as a child- that you didn't want to go to the pediatrician because of your experiences. But even- I mean, we see the how that functions for adults, even, who have the capacity to process that stuff. Like I know so many- especially, you know, in the anti diet, fat activist space- like Bri Campos, in particular, talks a lot about medical trauma as a fat person, and what that has done to her relationship to her own health, to medical providers, to medical care in general. We're trying to say like, oh, this is about health, then like, we can't not talk about these very important things that determine our health.

Anna Lutz: 22:42

Yeah, right. Exactly. Exactly. We know- the research is very clear that weight stigma causes people avoiding medical care, just like you're saying, and causes different emotional and physical diagnoses. We know that. It's even stated in the early part of the paper. Yet, as a medical establishment, we continue over and over to focus on on weight.

Naomi Katz: 23:11

You know, you mentioned that, you know, dieting is a predictor for eating disorders. Can you talk a little bit more about that relationship, and- and you know, why this is of concern here?

Anna Lutz: 23:22

Yeah. So, you know, when we look at what the risk factors are of eating disorders, there are many, and so that- there's just not one. You know, we know that genetics play a role. We know that exposure to media plays a role. We know that food insecurity is a risk factor. I could go on. There's lots of risk factors for eating disorders. Trauma. And one of those risk factors is dieting. There's a biological and neurobiological change that happens when we don't get enough food. Because our bodies want to survive, right. And so by a body not getting enough food, there's a change that happens in our brain. And we think that that's part of what puts someone at the risk of going on that path of having an eating disorder. And so, you know, again, the research is clear that people that diet are at a severely higher risk of developing eating disorders. And I kind of wanted to highlight that it's- it's not just like a decision- you know, I'm going to restrict my intake, I'm gonna go on a diet and then suddenly they have an eating disorder. There's something that happens biologically, that's- and neurobiologically.

Naomi Katz: 24:33

Yeah, that's a really important aspect to cover because I think a lot of people mistake that it's a behavioral thing, only- that it's like, oh, the behavior of a diet. You know, you just start to restrict and restrict even more or something like that. And so it's- I think it's really important to recognize that eating disorders are complicated multifactorial things- that it's biopsychosocial, right. Like it's all of these factors. And so yeah, obviously, it's important to recognize that like this is- like we're literally changing people's biology and making them more predisposed to eating disorders as a result.

Anna Lutz: 25:11

Right.

Sadie Simpson: 25:12

That's a good segue for the next recommendation, where this paper is suggesting that weight loss drugs for children as young as eight is appropriate in this situation. So even thinking about how biology of the body is changed, due to dieting, can you speak a little bit to that related to like side effects of weight loss medications, especially for kids?

Anna Lutz: 25:41

Well, I, you know, I want to kind of make sure I say, I'm not a medication expert. It's just not my specialty. But what I do know is that the medications that are out there that are being used for weight loss have very concerning side effects, and have not been researched long term. A lot of them have not been researched long term, and we're dealing with growing bodies- there's that really important piece- these are growing, developing bodies, that- you know, why in the world would we give them a medication that could change their neurobiology, their physical body, and have really, really concerning side effects. So some of the medications that they are talking about in this clinical practice guidelines, is Metformin, and Vyvanse, which is a medication that has been used for binge eating disorder, originally was a diagnostic- used for people with ADHD. And then these more recent injectable medications that go by the name Wegovy or Ozempic that, originally, on label, they're being used for diabetes care, that- they have very, you know, very significant side effects of nausea, vomiting, extreme lack of appetite. So people don't eat as much, because they don't feel good, right? And so then, you know- now it's- it's become a- on social media people saying you need to take this medication for weight loss. And then just coincidentally, last week, one of these medications was approved for children. And so the timing- I mean, again, am I a conspiracy theorist? Like you're saying, Naomi.

Naomi Katz: 27:26

Yeah. It was the exact same way that the timing worked for the BMI shift also, like I actually- what was the- I think that the drug- that it was like orlistat, maybe, that was that came out right when the BMI categories were shifted? Like, again, it's right there- like nobody's like- you don't need a tinfoil hat for this.

Anna Lutz: 27:54

Seriously. So you know- you know, I'm not an expert on these medications, and I may not be using the right trade names, but they've become so popular people who have diabetes- there's not enough of them, there's a shortage, because people who want to think they're gonna lose weight on them- it is on label for, quote unquote, weight loss. But the thing is, there's definitely not long term research on what happens to an individual who would be to be on this medication for their life, and certainly not what would happen to a 12 year old, who might take it all during puberty and the development of their brain. You know, our brains develop until we're 25. Right? And so we don't have any research that shows what the side effects of that would be long term. And so for a pediatrician to be able to say, yes, you should inject your child with that. Goodness gracious.

Naomi Katz: 28:46

Yeah. I think a couple things stood out to me while I was reading, actually, while I was reading through Ragen Chastain's like extensive newsletter on this research, and a couple of things that stood out to me were, one, that like, even in the research they did on adults, it's pretty clear that when you stop taking this drug, you will gain all the weight back just like you would on a regular diet. So like, are we talking about these kids taking these drugs for their entire lives? Because that's not something that's being said out loud enough.

Anna Lutz: 29:21

Right, right.

Naomi Katz: 29:23

And then the other thing is that like, because Wegovy, which is Novo Nordisk's new, like miracle drug or whatever, because it's so new, there's no studies on this- especially with kids, but really like not even, at least long term, with adults. And yet, they've included that in the guidelines because Novo Nordisk is a donor to the AAP.

Anna Lutz: 29:51

Like you said, it's surprising but it's not surprising, right? It's like, of course they are.

Naomi Katz: 29:56

It's funny, in our notes for this, like as I was writing up each section, I have a little bullet point in each one that says surprise, at least one of the authors takes money from. But like, obviously, the surprise part is sarcasm. Yeah, the- these drugs are- it's so scary that we're recommending drugs like this for kids. And, you know, I'm just kind of thinking as we're talking, that the whole idea of restricting the calories of a child who is growing- like they're still growing, and I think about- we adopted a kitten over the summer, and the thing is, like, if you look at all of the feeding recommendations on all of the food bags for kittens, they all are like, you probably have to double what you would feed an adult because they're growing. And it's like, we know this for kittens, are we really saying that that can't- that that's not true for like human children? Like they need calories in order to grow.

Anna Lutz: 31:02

Totally. And very predictable things happen if a human body doesn't get what they need to sustain everything that's happening, right? We have these very predictable things happen. Our brains over focus on food, when we do have access to food we will compensate, right? Well, so they go off the medication, and of course, their body was like, yes, finally enough nutrition. Right? It's very predictable things happen. Certain biological processes will shut down, someone might not go through puberty, endocrine system will stop making those hormones, because your body's like this body is starving, we're not going to do that. Right. So it's like, we know these things.

Naomi Katz: 31:46

Something that really stood out to me- and it's, you know, it's interesting, there's been a lot of talk on social media- I guess there are a number of people out there who are comparing this to gender affirming care for, you know, children and adolescents. And you know, one of the first things that went through my mind when I read this is that there's so many people out there who object to gender affirming care, and things like puberty blockers and stuff like that for adolescents and teens. And yet, like we're kind of fine with blocking puberty through food restriction and weight loss and stuff like that. Seems like something we should be calling attention to.

Anna Lutz: 32:31

That is such a good point. And so well said. We're okay with all of these- these things, if it's- if it ends up that a person in a larger body ends up in a smaller body. Like we're okay with all of these things, these side effects, stopping puberty. The next topic we're going to talk about, which is the surgery- you know, mutilating a GI system, like we're okay with it, because of all of our, you know, our collective society's extreme weight bias.

Naomi Katz: 32:57

Yep. Even just for temporary access to a smaller body. Well, I mean, since you brought it up, let's talk about that- that last recommendation there, which is- I mean, it's hard to say that any of these are the worst, but this one's probably the worst. And that's that recommendation for weight loss surgery for children as young as 13.

Anna Lutz: 33:21

I mean, that's beyond shocking to me- why any physician would think that taking a functioning GI track and cutting it apart would be a good idea in any one, but but particularly a growing child. And, you know, the- the long term side effects of that for a lot of people are really concerning. I will say, you know, I do approach this topic with some kind of a bias because I work with people that- often that weight loss surgery did not go well for them. Right? They're seeking out my help, because they have some of the really, really concerning side effects. So that, you know, that's the- and I'm an eating disorder specialist. So that's the angle I come to this with. Maybe it's because I live in this bubble, but I would think anybody would think weight loss surgery for a child is horrifying.

Naomi Katz: 34:14

Can you tell us a little bit about some of the side effects that are known to come from weight loss surgery so that we can sort of get a sense of like, what this recommendation is really recommending for people?

Anna Lutz: 34:26

I think most people listening probably know that weight loss surgery is taking someone's GI tract and making it smaller- stomach and making it smaller. Side effect of that is initially that people cannot eat as much- they can eat very little. Everyone experiences different side effects, but what- we know dumping syndrome is a very common one, which is when someone eats very quickly, the food will go through them and they'll have, you know, diarrhea, upset stomach. Malnutrition is almost across the board, because there's not as much- you're not eating as much, and not as much is going in. But also the person is not absorbing as much, and someone who's had weight loss surgery has to be on supplements, vitamins for the rest of their life. Hypoglycemia that can lead to fainting is common. Severe increased risk of alcoholism or substance use for people who are post bariatric surgery is a common one. I'm sure I'm missing a bunch, but those are the ones that kind of come to the forefront. And death.

Naomi Katz: 35:30

Yeah, and so when we're talking about exposing children to the- to a lifetime of that- children who can't consent to the surgery for themselves, like we are- that's- that's a pretty significant amount of life altering, you know, impact that they cannot consent to themselves. You know, like, I think it's arguable the extent to which even adults fully consent and make this autonomous decision because of the social pressures that they're under and stuff like that. But, you know, they're adults- they're- you know, they- they have more access to consent and autonomy. But for a child who just, you know, this is what your parent has decided for you. And for a lot of lifetime changes to be putting on a kid.

Anna Lutz: 36:22

I can understand why people make that decision, because of our society. I do want to name that. And so my outrage is not individuals who make that decision. It's more at our medical system is is where my outrage is.

Naomi Katz: 36:35

100%, I could not agree with you more. And thank you for naming that as well, that like none of this is ever a judgment on people who choose to go through with bariatric surgery. There's a ton of reasons why people might do that. So yeah, we're never judging individuals for their decisions. We're definitely talking on like a higher level of like, this- the systems that influenced them into making those decisions. Absolutely. But my understanding with bariatric surgery, too, is that you have all these risks, but a lot of people also, ultimately, over time, slowly regain the weight as well- like even this is not actually that much more effective than a diet.

Anna Lutz: 37:18

Correct. Yes. I don't know the research on it. Like I can't name exactly the percent or that, but- but that is what- is what is a common occurrence is that over time, though- you know, that there's weight loss after a year, but just like any other diet, after five years, most of the weight- I don't know, the exact percentage, like I said- is regained. But then the onus is still always put on the patient. You know, the people that I've worked with, it's, don't turn into those people that regain all the weight back. And you know, it's all like, if you don't do it right, this is going to happen. Instead of, your body is fighting to survive, right. That regain is that body surviving a trauma.

Naomi Katz: 38:00

Yes. Yep. And that's true of literally all weight loss- like dieting is trauma, these drugs are trauma, the surgery is trauma- like- and so that's always what it is, your body is literally surviving a trauma, the trauma of caloric and energy restrictions. So, but especially when we're talking about a surgical trauma like this.

Anna Lutz: 38:21

Right.

Naomi Katz: 38:22

That's all very dire, and it's quite terrible, and it makes you- it like boggles the mind that people who call themselves medical professionals would recommend things like this in the name of, quote, unquote, health. One of the things that's also really appalling in all of this is that they're kind of trying to frame this as a way of addressing weight stigma. And I would love to hear your thoughts on that.

Anna Lutz: 38:52

I feel like what I've witnessed is, ever since there was this disease designation of, quote, unquote, obesity, then this- the medical field that focuses on weight has co-opted this research about weight stigma. They act as if- they're using all the right words, and we need to make bodies smaller, and you need to have bariatric surgery, and- right. So it's, it's very confusing. And especially, reading this paper, because they name the harms of weight stigma, but then go on to make these very extreme recommendations about changing people's weight that will inflict weight stigma on individuals, on families, perpetuate weight stigma for professionals, right? If I was a young pediatrician and I got this paper, my internalized weight stigma would increase right? So it's confusing and it's it feels like it's just a way to kind of get people to be quiet, like, oh, but they mentioned weight stigma in the paper when the whole paper is called causing weight stigma.

Naomi Katz: 40:01

It's interesting, this is a thing that I have navigated with a couple of one on one clients since this- some of these drugs started coming out, and stuff like that, because a lot of them are framed as, we're addressing weight stigma. You know, it's not your fault that you're in a larger body. But let's make your body smaller. It's neutral, like we're not judging you, we just want to fix you. And it's a very, very, very sneaky new form of diet culture and weight stigma, and even adults have a hard time navigating it. And so I can only imagine how hard that would be for children to reconcile. We, we live in a fatphobic society. So instead of doing the work to unpack that fatphobia, and the roots of it in things like white supremacy, and ableism, and all of that- because that sounds hard and terrible- we're just gonna get rid of fat people, and then we can't stigmatize them. And it's like, no, that's not actually a solution here.

Anna Lutz: 41:04

It's not, and it's- you're- they're making the situation way worse, right? So it's just not, not only not asleep solutions, Oh, yeah. And so not to be fooled that just just because someone says they understand weight stigma, in my mind, they really don't. Because if they really understood weight stigma, they would be focusing on people's true health, by decreasing health disparities, rather than focusing on changing people's bodies. Absolutely.

Sadie Simpson: 41:34

So as a parent, my question, and I'm sure a lot of other parents are kind of wondering the same thing. How do we navigate this when we're taking our kids to their wheelchair x? Or if these things even start coming up at school, in the lessons and health classes and things like that? Do you have any suggestions for us? And how to how to handle this?

Anna Lutz: 42:00

Sure. Good. Good question. And, you know, I think it's going to be different for each person and each family, what privileges someone might hold. And so, you know, I absolutely don't pretend I have the answer. I hold a lot of privileges. You know, one thing I'm to think about is, you might ask your pediatrician, like send them a note through the portal asking how the office is handling or digesting this new paper? And just kind of just be curious, like, I saw this in the media. How are you know, have y'all been talking about it? And what is what is your discussions around the office because I want to give the people on the ground the benefit of the doubt, this was written by really higher ups. And so you know, people that are every day working with families, I'm competent, there are people out there, pediatricians that are out there that are just as horrified as we are. But that's one thought. You know, we do talk about that it does state this in the paper that a parent needs to give consent about the doctor talking about weight. And so you can ask your pediatrician not to discuss weight in front of your child, we have a letter that I wrote with Katya row, well, that is a template, it's on our blog and download it, you can also just cut and paste pieces that pertain felt like pertain to you. And so that letter, you could send in the port, or you could hand it to the doctor, I personally believe growing children need to be weighed at least about once a year at a well child visit. Because if they're not gaining and growing as expected, that can be a red flag, that they certainly do not need to have a whole discussion about their growth charts in front of them because it's very abstract and very concerning. So I'm of the mind that when they're young, and I'm talking about like middle school and below ish, that they don't need to have a whole discussion about their weight. If they're if the doctor is concerned, they can talk to the parent on the side, that's easier said than done. And there, some people may not feel comfortable asking that I love

Sadie Simpson: 44:05

the like the idea of preemptively sending this in the patient portal, like even for me as an adult before going into an appointment. I don't know why I haven't thought about that before. Because that takes a lot of the anxiety away of kind of preemptively having this conversation. And the note is in there. Hopefully somebody has read it prior to the appointment. And it seems just very helpful. That is a practical tip. For sure. I'm gonna take away from this

Naomi Katz: 44:33

I love. I also want to say that I really love that you mentioned that like there is utility to weighing kids through certain ages because, you know, it's very similar to like within intuitive eating. There's a lot of stuff where like sometimes the practice almost looks the same but the goal is totally different. Like we want to make sure we're eating enough not that we're not eating too much and stuff like that. And this is similar to that like there is a utility We want to make sure that kids are gaining enough weight, not that they're gaining too much weight.

Anna Lutz: 45:07

Yeah, I was just thinking back to the last time I counted my children to the pediatrician. And again, the pediatrician knows what I do. So it's very easy for me to say we are not talking about weight. So that's an a, you know, easier probably than other people. But I, you know, I put a note through the portal, you're seeing this child tomorrow, just a reminder to not discuss weight in front of them, she walks in, she hands me a printed growth chart. And that's that, and so she I don't think it necessarily agrees with my stance, but at least, we've kind of come to this agreement that, that that's what we do. I also wanted to put in a plug for Ginny Jones, who is more love.org, and she has a card, I don't weigh my child card. So if you would rather have little like business size cards, they're great. You can just hand them out in the office, if that feels more comfortable than a letter.

Naomi Katz: 46:00

Yeah, we'll link both to the letter and those cards in the show notes also, for folks who want those resources, because those are great. You know, I'm curious, obviously, as much as it's nonsense, all of this stuff is framed within like we're looking out for your child's health. And so, beyond just like, Okay, well, I don't want the doctor to weigh my child or to to or I don't want the doctor to talk about weight in front of my child. What health markers should a doctor be looking for? Instead of have this like, if, you know, as you're a parent, you're going into the doctor and you're like, Okay, I know, wait is not something that I want to talk to the doctor to talk to my kid about, like, what health markers should I be concerned about?

Anna Lutz: 46:48

That's a great question. Pediatricians have guidelines, as far as blood pressure, right, they're going to be taking their blood pressure and noticing if there's a concern there. There are certain ages where they take certain blood values, whether it's iron, whether it's glucose levels, they're going to be doing that at certain age well child visit or if there's something concerning going on, you know, we want to think about them screening for mood issues, right. So a doctor doing some kind of screen for anxiety, depression to see if they need a referral to a specialist psychotherapist, I think about sleep, right? Children need so much sleep. So screening that they're getting enough sleep, something else I think about is safety in the home, or their guns in the home, what's going on in the home, is this child safe? Are they wearing their seatbelt in the car, they're wearing their helmet, those type of things that might kind of be getting off on a tangent. But so there's like the the true vital signs and medical, you know, there's the measurements that could indicate that there's, quote, a problem. And then there's also these other kind of screening tools that pediatricians can can use. So those are the things that come to my mind.

Naomi Katz: 47:58

Yeah, I love the how reflective that is of the social determinants of health as well. Like, you know, we always talk about how you know, there's these categories, and only like 30% is personal behavior. And even within personal behavior, only, like 10 of that is diet and exercise. And I feel like you captured a lot of that.

Anna Lutz: 48:22

Good To your point, I'd just love to say real quick that like provider, and the people who are at this or medical providers to your point are worried about children's health. And so but weight is not, you know, is not an indication of health. And I guess I just want to kind of make that point that we need to be looking at, you know, true signs of health, and that we have been sold this false assumption that weight equals, if someone's healthy or not.

Naomi Katz: 48:48

This has all been so incredibly helpful. And I think our listeners are going to be really grateful for the way you broke this down and the suggestions you've given about how to navigate this stuff. Where can people find you if they want to connect with you and your work and learn more about you know, these kinds of topics.

Anna Lutz: 49:09

Regarding pediatrics, I'd love for people to find me at Sunny Side Up nutrition.com So that's a blog and a podcast that I create with Elizabeth Davenport, another weight inclusive dietitian. She's actually a former professional chef and so she writes about simple cooking. I write about cooking, although that's not my biggest forte but my you know I really believe in that. Cooking Can Be simple and without diet culture. So on Instagram you can find us at sunnyside up nutritionists. I also have a private practice in Raleigh, North Carolina, which is let's and Alexander nutrition therapy.

Naomi Katz: 49:46

Awesome. Well, thank you. And so I mean, that brings us to our last question that we asked all of our guests, which is what's satisfying for you right now?

Anna Lutz: 49:57

Well, I'll be honest, what has been satisfying for For me lately is really simple meals. I've been very overwhelmed. I think getting back into the swing of things of school and work. And I've really been heavily relying on prepared food. I really am a big fan of Trader Joe's the frozen food that I can, you know, Mandarin chicken, I can put it with some broccoli and rice and call that dinner last night I had some Indian food from Costco that was in the freezer section and I could just heat that up and put it with some rice feel satisfying that I feel like a cooks. So I'm sad. Like, I'm like, I cook something, but really I just heated it up. That's really all I did was heated up. But it's kind of what I needed lately.

Sadie Simpson: 50:44

Yes, I'm a big fan of the hate and eat situation.

Naomi Katz: 50:48

Yeah, we both are. I'm not even a parent. I just

Anna Lutz: 50:54

someone else can do that for me.

Naomi Katz: 50:56

Exactly. Yeah. Well, and thank you so incredibly much for being here with us today. And for you know all of your insight into this debacle. We really, really appreciate it and it has just been a pleasure talking to you.

Anna Lutz: 51:12

Well, it's been a treat for me. Honestly, I feel like it's a gift that you gave me the space to talk about it and I'm really love talking to both of you. Thank you so much.

Naomi Katz: 51:22

Once again, big thank you to analysts for coming to talk to us about this incredibly important topic and we hope that you all were able to get some insights and maybe some strategies that will help you navigate this going forward.

Sadie Simpson: 51:36

If you enjoyed this episode, be sure to tell us about it. Leave us a rating or review on Apple podcast and Spotify or come find us on Instagram we are at satisfaction factor pod send us a message. Let us know what you thought about the episode because we love hearing from you.

Naomi Katz: 51:55

That's it for us this week. Catch you next time