Understanding the AAP’s Obesity Guidelines: What Parents Need to Know

In 2023, the American Academy of Pediatrics (AAP) released updated guidelines on the treatment of children and adolescents with overweight and obesity — the first major update in 15 years. These new recommendations have generated a great deal of discussion — especially among pediatricians, therapists, dietitians, and parents of children in larger bodies.

Whether you’ve read the headlines or heard whispers of “medications” or “surgery,” we’re here to break it down in a thoughtful, non-shaming way — and to help you understand what these guidelines actually mean, how they intersect with eating disorders, and how to best support your child.

What Do the AAP Obesity Guidelines Say?

The AAP now recommends a more proactive, long-term approach to weight management in children and teens. Key points include:

Early and Ongoing Evaluation

Pediatricians are encouraged to screen for BMI percentile trends, family history, and comorbidities (like Type 2 diabetes, high cholesterol, or sleep apnea) earlier and more consistently.

Intensive Health Behavior & Lifestyle Treatment (IHBLT)

For children 6 years and older, the guidelines endorse 26+ hours/year of structured lifestyle counseling, ideally with a multidisciplinary team (physicians, dietitians, behavioral health providers). This includes:

• Nutrition education

• Movement in joyful, sustainable ways

• Emotional and behavioral support

• Family involvement

Medications for Adolescents

For teens 12 years and older, anti-obesity medications (such as GLP-1 agonists like semaglutide, i.e. Wegovy/Ozempic) may be considered in addition to lifestyle support, particularly in cases of severe obesity.

🏥 Bariatric Surgery Consideration

For teens 13 and older with severe obesity and significant complications, metabolic/bariatric surgery is now included as an option.

What the Guidelines Get Right

There’s a lot in the AAP’s recommendations that reflects positive, updated thinking:

• Weight stigma is real — and harmful.
  The guidelines openly acknowledge that children in larger bodies often face bullying, bias, and shame from adults (including medical providers).

• Obesity is not a moral failing.
  The AAP classifies it as a complex, chronic disease — influenced by genetics, environment, social determinants, and more — not just “too much food” or “not enough exercise.”

• Family-based care matters.
  Interventions that include the whole family, emphasize behavior over numbers, and center the child’s well-being are far more effective — and protective.

Where Concern Arises: The Eating Disorder Lens

As a clinic that works with children, teens, and young adults struggling with eating disorders, we have to approach these guidelines cautiously — because we’ve seen how weight-focused conversations can unintentionally trigger or worsen disordered eating.

Risks include:

• Overemphasis on weight/BMI rather than health behaviors or emotional well-being

• Moralization of food (“good vs bad”) that can lead to guilt, shame, or secretive eating

• Increased likelihood of restrictive dieting in children — a known risk factor for the development of eating disorders

• Early exposure to weight stigma — even within the home or doctor’s office — which can cause long-term body image issues

Even with good intentions, a “weight-first” approach can backfire, especially for children in high-risk groups (e.g., those with perfectionist tendencies, anxiety, or body image concerns).

So... What Should Parents Do?

Here’s how we suggest families approach these new guidelines:

1. Focus on behaviors, not numbers.

Ask your pediatrician:

“What health habits should we focus on, regardless of weight?”

Encourage balanced meals, family dinners, joyful movement, and good sleep — not calorie counts or step goals.

2. Be mindful of language.

Avoid terms like “good” vs “bad” foods, “junk food,” or “watching your weight.” Instead, talk about how food makes us feel, energy, and taking care of our bodies.

3. Center body respect.

Help your child know that all bodies are different — and that health is not a size. Kids do best when they feel safe, not scrutinized.

4. Know your child’s risk factors.

If your child has a history of anxiety, OCD, body dissatisfaction, or rigid food preferences, be especially cautious about weight-focused interventions. Consider involving a therapist or pediatric ED specialist.

5. Advocate for supportive care.

Ask your doctor to connect you with Registered Dietitians, therapists, and programs that take a weight-inclusive, behavior-centered approach to health.

Our Take

At our clinic, we support the AAP’s mission to address chronic health conditions early and compassionately — and we also hold space for the real risks that come with medicalizing body size.

We believe:

• Kids need nourishment, not numbers

• All children deserve respect, not shame

• The best health outcomes come from a foundation of trust, curiosity, and connection — not fear or control

Final Thoughts

If you’re a parent confused about the AAP guidelines — or unsure how to support your child’s health without promoting fear or restriction — you’re not alone.

We specialize in non-stigmatizing care for children and young adults struggling with eating disorders, body image, or emotional eating. Whether your child is in a larger body, a smaller body, or anywhere in between — we’re here to help.