American Academy of Pediatrics Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity: What we can learn versus what we can apply in clinical practice

The American Academy of Pediatrics released its first guideline for the evaluation and treatment of children and adolescents with obesity, which was negatively received by eating disorders experts and anti-weight stigma activists around the world. As a primary care physician and an eating disorders practitioner, dealing with the devastating effects of both excess weight and eating disorders in kids and teens, I read with great interest the recently published guideline. A large section was dedicated to the complexity of the problem at hand, from the multifactorial causes to the long list of obstacles to treatment including the significant harm caused by weight stigma in healthcare. The main proposed management, Intensive Health Behavior and Lifestyle Treatment seemed inclusive of multifaceted components needed by kids and their families, unfortunately the feasibility, availability and affordability of such treatment are very problematic. On the other hand, the benefit-harm assessment used was quite confusing especially when it comes to eating disorders risk, and the evidence used to back up the strategies proposed was very weak. While we can learn a lot from AAP clinical practice guideline for the evaluation and treatment of children and adolescents with obesity, there is very little we can apply in clinical practice because of lack in resources and risk of doing harm.