The institutions that hope to repair the damage of structural violence are often the same ones that cause it.
I began listening to the Maintenance Phase podcast recently, and I would highly recommend it. Today, I want to discuss the episode “Doctors Have a New Plan for Fat Kids,” that came out in February 2023, because it touches on several trauma-informed concepts that we need to talk about and address.
A little over a year ago, in January 2023, the American Academy of Pediatrics published a new set of guidelines for “childhood obesity.” This paper is called the Clinical Practice Guideline for the Evaluation of Treatment of Children and Adolescents With Obesity.
This paper and its connected content demonstrate one of the most devastating challenges we face when trying to implement trauma-informed practices: breaking away from existing harmful structures.
Maintenance Phase published an hour-long podcast episode (linked at the end of this article) walking through the paper and identifying what it says and how its recommendations have real impacts. I highly recommend you give this episode a listen after reading this article.
The Maintenance Phase podcast is hosted by Aubrey Gordon and Michael Hobbes, and they “debunk the junk science behind health and wellness fads.” Aubrey Gordon is an author, speaker, and former community organizer. Michael Hobbes is a journalist, speaker, and former human rights activist. Both self-identify as fat and dedicate their time and energy to confronting fatphobia.
Before we dive in, I need to explicitly state that while this paper addresses the social determinants of health and ACEs, I would not describe it as trauma-informed. Why? It causes active harm to a community. In contrast, the podcast episode addressing the paper is aligned with trauma-informed and healing-centered values.
There is Nothing Wrong with Fat Kids
While there are some beneficial takeaways from this document, it is also riddled with facts, figures, and assumptions that are based on and further harmful narratives about fat people. What’s worse is that this paper specifically addresses weight in children (ages 2-12), forwarding the narrative that “there is something wrong with fat kids.”
If you’ve done any work with us, you know that we work on ditching the idea that “there’s something wrong with you” all the time. It’s one of the very first lessons of training, and it’s something even experts find challenging every day. It’s hard work, but we can’t not do it. When we don’t, we contribute to harm and allow harm to spread.
TIC Lessons: Understanding Fatphobia and Structural Violence
Fatphobia is one of the most overlooked types of structural violence, and many people with a basic understanding of systemic oppression still fail to recognize fatphobia as structural violence.
Fat people experience medical discrimination, and doctors often disregard genuine concerns by brushing symptoms off as weight-related. At nearly every appointment, fat people are lectured about their weight (thanks to harmful policies that providers are forced to follow) even when their concerns have nothing to do with weight, furthering stigma and the narrative that there is something wrong with their bodies.
Just like white supremacy negatively impacts white people or how patriarchy harms men, fatphobia also impacts thin people. How has the pressure to be skinny or lose weight shown up in your life? Those ideas and feelings uphold fatphobia, and we all contribute to harm unknowingly.
Similarly to other forms of structural violence, those in power aren’t harmed the most by the violence of fatphobia.
Fat people are harmed the most, which is why their voices must be centered in this conversation.
Oh, and fat is not a bad word. It might make you feel bad, and I encourage you to unpack that.
Listening to Voices with Lived Experience
Now that we’ve established a shared understanding of some foundational concepts, let’s talk about why we’re going to use the lens of a podcast episode to explore a harmful paper.
The hosts of the podcast, Aubrey Gordon and Michael Hobbes, self-identify as fat people, which means their lived experiences as fat people navigating a fatphobic world define their expertise on this topic. This is a moment where we are called to listen and learn when people tell us what it is like to be them.
In a trauma informed framework, leaders carefully consider who’s voices are at the table—and who’s voices are missing. Why does it matter? Because it is crucial that the voices of those impacted the most by decisions, projects, and programs are included in the decision-making process.
As you listen and learn, consider that the thoughts and ideas shared in the Maintenance Phase podcast shouldn’t be an afterthought or a critique, they should have been a part of the process, and an extremely critical piece at that.
Why This Paper is Structurally Violent
To fully understand and appreciate this article and the situation we’re discussing, you need to have a basic understanding of structural violence. If you need a refresher, check out this article.
1. It expands existing structurally violent practices to children.
This paper now expands “best practices” such as lectures about weight regardless of the issue a patient is experiencing and reccommendations for weight loss medications to children.
2. It enables doctors to avoid seeing how they contribute to the problem.
Several populations have a complicated history with medical professionals due to historical trauma, including black, brown, disabled, and fat folks.
This paper mentions trauma and ACEs, but somehow leaves strategies for medical professionals to support their patients in this regard out of the picture and instead makes recommendations that contribute to ACEs.
Doctors often perpetuate structural violence culturally and technically, in their core beliefs and in the policies they are trapped in.
3. It’s recommendations are not evidence-based.
This paper is positioning itself as beneficial to the general public because it’s “in the best interest of children’s health,” but, in reality, it’s causing active harm. The paper hides behind strong writing and valid points, and beneath it are flimsy statistics and illogical recommendations.
4. It misunderstands the social determinants of health.
In this paper, “the social determinants of health” is thrown around so easily as if it were a single small factor and not a complex system that prevents access to basic needs.
While the social determinants of health is a good tool, boiling it down and allowing the boiled down version to be tossed around flippantly allows people to avoid addressing structural violence, poverty, and other systemic issue.
The result is professionals who become detached from the real issues that impact their patients.
5. It’s a paper from a trusted source with misinformation.
Doctors, leaders, researchers, and those in power have a responsibility to provide accurate, honest and holistic information to their audiences and patients, to those who trust them.
Did anyone ever stop to really consider what’s in the best interest of fat kids?
Because this paper isn’t. These guidelines give the best advice for how kids can should lose weight despite the fact that we know their recommendations are inaccessible to most people and even when it’s done right, has minimal impact on the lives of most children.
On the Maintenance Phase Podcast, Ava says, “It’s sort of staggering to me that you could just ignore the entire social context and the entire context of your own patients’ lives.”
6. It’s all about losing weight and disregards the root cause of health issues.
This paper furthers harmful beliefs that fatness is the cause of the problem and focusing on losing weight is the best practice for health and wellness, which is harmful for both children and adults.
On the webpage for this paper, the American Academy of Pediatrics state “This work is a true testament to their passion and dedication to combatting childhood and adolescent overweight and obesity.”
In other words, these leaders in pediatrics are devoted to ensuring that fat kids become skinny. It completely disregards the implications of ACEs, despite mentioning them.
By seeing weight as the key issue and focusing on changes that have little impact, this paper pushes changes that can have a real impact to the wayside.
Final Thoughts: Critical Thinking for Systems Change
While I wish we lived in a world where we could trust leaders and researchers, especially when it comes to our health and wellbeing; it is imperative that we use our critical thinking skills when considering the best practices of the systems we live and work in.
Structural violence is baked into our systems, including the healthcare, education, and justice systems in the US. In order to accomplish collective change, we need to start listening, learning, and critically thinking about how we do things and why.
Listen to the episode mentioned in this article, “Doctors Have a New Plan for Fat Kids” here on Spotify. Helpful links and resources are available in the description of the episode.
If you want more podcasts to support your journey of accepting all bodies (including your own), check out this Business Insider article.