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This eating disorder expert is worried by new guidelines to treat childhood obesity


For the first time in 15 years, the American Academy of Pediatrics has updated its guidance on how to treat childhood obesity. It calls for early assessments and interventions at, quote, "the highest intensity level that's appropriate and available." Kids as young as 6 could get treatment recommendations if they're overweight. For older kids, weight loss medications or bariatric surgery might be on the table. But some experts worry this guidance, while meant to prevent health problems, could actually raise the risk for eating disorders. Let's talk about that with Nooshin Kiankhooy. She's an eating disorder specialist and the founder of Empowering You, a therapy practice in Maryland. Welcome back to ALL THINGS CONSIDERED.

NOOSHIN KIANKHOOY: Thank you so much for having me.

SUMMERS: So these AAP recommendations move away from this idea of watching and waiting for kids to grow up before considering obesity treatment. So when you look at them, what concerns you the most about these guidelines?

KIANKHOOY: I think that the potential risks are that there have not been any long-term studies on - from my understanding, at least - on how these weight loss drugs and how these surgeries can really impact a child and their body. And we're talking about the age of 12 or 13. The fact that we are placing such an emphasis on the size of a child's body, to me, is a huge concern - and how that not only is going to impact a child's body from a physical standpoint but how it's really going to impact them from a mental standpoint in - this is what your body is, and we must now change it - because I don't think children can conceptualize what that really means. I mean, a lot of us as adults, we can't.

SUMMERS: So the authors of this guidance do stress that providers of any kind who are caring for these children in this manner, they do need to screen children for disordered eating throughout any treatment course. To your mind and from your experience, does that offer any sort of reassurance?

KIANKHOOY: What's really interesting about that is there are many clinicians out in the field that, quote-unquote, "specialize in eating disorders," yet they are a part of these bariatric surgery evaluations. And from what I understand is these evaluations are very short, maybe an hour long, and they're kind of put on a timeline by the physician or even by the insurance company, right? And that is not at all an amount of time, I think, that can allow for a proper evaluation.

SUMMERS: These are, of course, just guidelines. They're not hard-and-fast rules. But I am curious - how influential can this AAP guidance be for pediatricians and parents? Like, for better or for worse here, do you see this is as a big effect on health outcomes or even just in the culture around weight and eating for kids?

KIANKHOOY: I do. It's really, really scary. I have two young girls myself, and I cannot imagine going to a doctor's office and having these conversations. And I believe that this is all coming from a good place. I think the problem is that there hasn't been enough involvement with maybe the eating disorder community and how it could cause some really - a huge increase in eating disorders in the future. We already saw a huge increase with COVID. And so there's - they're a huge, huge concern on our end - that this is going to cause a big shift.

SUMMERS: What is your best practical advice for a parent or someone else who cares for a kid in their life who receives a recommendation from a doctor that's based on this new guidance? I mean, how should they handle it, especially as they're trying to navigate both protecting a child's physical health while also protecting their emotional wellbeing around food and their bodies?

KIANKHOOY: The one thing I can say is to make sure you're getting some opinions from maybe eating disorder professionals or medical professionals, even, that practice with a health-at-every-size lens. We want to make sure that we're looking at it holistically and making sure there aren't other things going on that we can support clients with as opposed to kind of jumping to - now let's try this medication, and let's, you know, put our child in an incredibly major surgery.

SUMMERS: We've been speaking with eating disorder specialist Nooshin Kiankhooy. Thank you so much for this information.

KIANKHOOY: Oh, you're very welcome. Thank you so much for having me again.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

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Alejandra Marquez Janse is a producer for NPR's evening news program All Things Considered. She was part of a team that traveled to Uvalde, Texas, months after the mass shooting at Robb Elementary to cover its impact on the community. She also helped script and produce NPR's first bilingual special coverage of the State of the Union – broadcast in Spanish and English.
Ashley Brown is a senior editor for All Things Considered.
Juana Summers is a political correspondent for NPR covering race, justice and politics. She has covered politics since 2010 for publications including Politico, CNN and The Associated Press. She got her start in public radio at KBIA in Columbia, Mo., and also previously covered Congress for NPR.