Eugenic Logics and the Pathologization of Children’s Bodies: Evaluating the American Pediatric Obesity Guidelines for Harmful Scientific and Medical Conduct

2025 Irving and Jeanne Glovin Award winner

Left: Dr. Jennifer Andrews, Dean of the Faculty of Arts and Social Sciences
with Clarisse Paron.
Right: Clarisse Paron with George Mencher.

Last year, the American Academy of Pediatrics (AAP) released updated guidelines for treating “obesity”^[1] in children (Hampl et al., 2023). Previously, clinical practice guidelines for childhood “obesity” recommended education and counselling for diet and exercise (Cha, 2023, Jan 20). The new clinical practice guidelines (hereafter “CPGs”) drastically differ by recommending aggressive interventions, including weight loss medications for children as young as 12 years of age, and even surgical intervention (such as bariatric surgery) for youth as young as 13 (Hampl et al., 2023). The report argues: “Because obesity is a chronic disease with escalating effects over time, a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence, and young adulthood, with transition into adult care” (Hampl et al., 2023, p. 2). Ironically, despite the expert panel acknowledging the significant role of environmental and social factors contributing to the childhood “obesity epidemic” and recommending relevant institutions “increase community resources that address social determinants of health in promoting healthy, active lifestyles” (Hampl et al., 2023, p. 68), the authors still recommend “providing immediate, intensive obesity treatment to each patient as soon as they receive the diagnosis of obesity” (Hampl et al., 2023, p. 70). Recognizing that treatments for “obesity” are not covered under most American insurance plans, the expert panel problematically recommend “adolescents with severe obesity”^[2] receive aggressive treatment with pharmaceuticals and surgery that many families will not be able to afford or access.

In this paper, I will argue that the expert report fails to acknowledge the biased science on weight that supports their recommendations and, more importantly, their recommendations harm those with fat bodies. Critically, social biases and stigma against fat bodies has informed research on overweight individuals, and the uptake of this research creates a moral panic that emphasizes radical and urgent treatment is required to address the “obesity epidemic” (Campos et al., 2005). The moral panic is amplified in the childhood “obesity epidemic” as the population worries not about the health of children, but that these children will become lazy adults who will burden the healthcare system. Because scientific and medical authorities (experts) continue to perpetuate these assumptions through medical practice, fatphobia and aggressive treatment to prevent deviant, fat bodies are epistemically justified.

The recommendations for aggressive interventions for the treatment of childhood “obesity” is not aimed at improving the health of overweight children (as I will show in §II) but is more likely to increase the morbidity and mortality of these children as they age. Therefore, the aggressive response to treat overweight children is inherently eugenic since fat bodies are labelled unhealthy and subjected to extreme and harmful medical treatment to prevent future populations of “undesirables.” In §I, I explain how non-epistemic values have infiltrated medical science and practice, thus leading to widespread moral panic and aggressive social response to the “obesity epidemic” via the pathologization of fat bodies. Then, in §II, I will demonstrate how the AAP’s clinical practice guidelines are informed by eugenic logics. In §III, I conclude the paper by arguing that the experts behind the clinical practice guidelines, as well as the scientists who research “obesity” have a moral obligation to prevent harm to this vulnerable group. As people with the power to shape what we know about weight and health, scientists and healthcare providers must acknowledge when they are perpetuating harmful biases in their practice.

I. Socially Responsible Science and “Obesity” Research

Many feminist philosophers of science have argued that non-epistemic values — practical, cultural, or social values that are not truth producing — have at least as much influence on the scientific process and knowledge production as epistemic values — values thought to create knowledge or lead to the ‘truth.’ (Douglas, 2007; Harding, 2016; Melo-Martín & Intemann, 2018; Okruhlik, 1994). This feminist criticism challenges social and lay understandings of science as a “value free” project, a project guided by values of objectivity, impartiality, and discovering the ‘true’ state of reality. However, scientists, in virtue of simply being human, are unable to keep non-epistemic values from influencing their research. Feminists have found many examples where non-epistemic values have informed the research question, the design of the study, the choice of method, the data analysis, and the conclusions drawn from a particular study. Douglas’ (2007) main gripe with scientists is that they do not reflect on nor justify the choices that they make during the scientific process and prefer to ignore the role of non-epistemic values on their research. Failure to produce objective science, and rigorous research, is often a result of researchers (based on the norms guiding scientific practice) ignoring how non-epistemic values inform the scientific process (Douglas, 2007; Harding, 2016). The beliefs, values, and biases that inevitably shape the way researchers predict, observe, and analyze the world will infiltrate science (especially when non-epistemic values aren’t explicitly acknowledged (Douglas, 2007)); thus, risking the reproduction of harmful social biases through scientific investigation or the uptake of weak or false conclusions that could inform social practices (e.g., public health mandates, clinical practice guidelines). Consequently, if one was concerned with conducting what I call socially responsible science — that is, science that investigates what can improve society for the goal of improving social practices (Paron, 2021)—then the role of these values in the scientific process (i.e., design, method, analysis, conclusions, and recommendations) should be acknowledged and evaluated. When engaging with research that is likely to inform social policy, researchers have a moral obligation to consider how their research will impact the groups the research purports to help.

As a sub-discipline of the natural sciences, medical science is subject to the same criticism: science, and the knowledge it produces, are not purely objective nor impartial. By drawing on evidence produced through scientific inquiry, medicine legitimizes itself as an ‘objective, impartial authority’ on our knowledge of health and illness. However, as briefly explained above, science does not produce perfectly rational, impartial, and objective knowledge of reality because of the inevitable role of non-epistemic values internal and external to the scientific process. Consequently, “the hegemonic understanding of medicine as a pure objective mode of inquiry that provides access to unbiased and deeply buried truths” (Murray, 2007, p. 367), also fails to acknowledge the influence of social values and biases on medical science. Medical researchers, like other scientists, bring their socially situated values and biases to their inquiry. Moreover, physicians (as interpreters and users of medico-scientific knowledge) not only enact the biases that medical science introduced into medical knowledge and systems, but they also bring biases into patient-provider interactions: a physician’s clinical “gaze is always already structured by the world in which his subjectivity is constituted…it is necessarily a function of power/knowledge” (Murray, 2007, p. 367). The norms, practices, and systems that instruct physicians how to communicate, observe, diagnose, refer, and prescribe are all influenced by non-epistemic values and social biases—and so are the providers themselves. Non-epistemic values, like fatphobia, have infiltrated the way that not only has “obesity” research been done, but also how it has influenced the public health recommendations and clinical practice guidelines.

Yet, while science and medicine are influenced by social norms and values in ways that can significantly undermine the ‘truth’ of the knowledge produced, the hegemonic ideals of medicine and medical science as objective and impartial legitimizes and establishes the authority of medicine in society. While science and, by extension, medical science and practice claim to “stand outside of power, to be unaffected by the [social biases and] discourses that…[affect] us all…, [medicine] too is necessarily implicated in the reproduction of dominant ways of knowing and being” (Murray, 2007, p. 367). Applying Foucault’s power/knowledge, Murray (2007) argues that medicine is shaped by social structures and systems of power (e.g., race, gender, etc.) while also reproducing knowledge that strengthens and reifies these power relations. As an epistemic authority (a social authority trusted to produce ‘good’ knowledge), medical science constructs and informs the way we understand our experiences while simultaneously being affected by the biases and power relations we are all subject to. Under the “clinical gaze,” medicine categorizes and makes intelligible deviant bodies according to social narratives and structures. Social bias against fat (deviant) bodies is confirmed and reinforced when studied, pathologized, and treated. Therefore, medicine is used to survey, police, and discipline deviant (i.e., ‘unhealthy’) bodies, while reinforcing social narratives, encouraging performance of normative ideals, and structuring interactions beyond the clinic (Murray, 2007, p. 371).

I argue that the pathologization of fat bodies in the AAP’s guidelines can be better explained by the fatphobic narratives and prejudices widely held in Western society than the weak scientific evidence supporting any correlation between body weight and health. To remain within the scope of this paper, I will only highlight a couple of counterexamples within science to demonstrate the lack of support for the belief that “obesity” is a health concern requiring treatment and that the “obesity epidemic” is a public health emergency. Campos et al. (2005) criticize the widely held claim that there is an “obesity epidemic” or an “exponential pattern of growth,” in the number of overweight and obese individuals (p. 55). The phrasing of “epidemic” severely overemphasizes and sensationalizes the “subtle shift” of average weight levels from past generations, leading to a public health crisis that is not sufficiently supported by scientific evidence; that is, epidemiological research suggests the increase in average weight is due to an increased consumption of merely 10 calories per day (p. 55). In fact, an increase in body weight often predicts decreased mortality and morbidity (p. 56). Critically, body weight as measured in BMI (body mass index) can only predict premature mortality in cases of extremely high and extremely low BMI (p. 56).

Body weight itself is not an accurate or significant predictor of health and longevity over time; however, many studies correlate body weight and mortality without considering other confounding variables (like exercise, dieting, comorbidities, etc.) (Campos et al., 2005, p. 56). In fact, when these confounding factors are controlled for, the association between BMI and mortality nearly disappears (p. 56). As such, lifestyle factors (such as stress, diet, and exercise) are stronger predictors of health and illness—regardless of one’s weight (p. 56). Extreme dieting and exercising, surgery, and/or taking medications to lose weight are significant factors to consider when studying the relation between BMI and mortality. As these methods are often used by larger individuals to lose weight, the authors argue that these factors play a more significant role in predicting mortality. By measuring health markers in addition to BMI, recent studies show it is unhealthier to lose weight (which often leads to re-gaining the weight and repeating diet cycling), than it is to remain the same weight, even when one is overweight or “obese” (Bacon, as cited in Dooner, 2019). Further, Strings (2019) provides a compelling argument that the creation of BMI was based on a white sample population, therefore the measurement of fat was constructed to perpetuate anti-Black racism under the guise of ‘health. In sum, “body weight seems like a poor target of public health remediation, particularly in the absence of any safe or effective tools for weight loss” (Campos et al., 2005, p. 58).

The moral panic insinuated by the discourses around the “obesity epidemic” suggests that an increase in the weight of a population is associated with “increasing moral laxity and…in driving up health care costs” (Campos et al., 2005, p. 58). Western social values attribute individual responsibility for one’s being overweight, thus blaming one’s weight gain on a lack of apparent will power and reckless behaviour, “rather than on structural factors” (p. 58). Further, public opinion studies reinforce these attitudes of individual responsibility and blame on overweight individuals with intersectionally oppressed identities. Surveys report that people attribute the size of disadvantaged individuals (e.g., overweight people of color or overweight people without jobs) on individual blameworthy factors (like sedentary lifestyles) (p. 58), instead of the structural disadvantages that play a role in their weight gain (e.g., being more likely to live in food deserts, less likely to afford healthy food or access to activities/ green spaces, and other structural determinants of health). Recall, the AAP expert panel explicitly acknowledges that “obesity does not affect all population groups equally,” and those children more affected are from families who live in poverty or have immigrated, or in children who “experience discrimination or stigma” (Hampl et al., 2023, p. 3). If the moral panic about the so-called “obesity epidemic” is largely unfounded in scientific evidence, then, I argue, the AAP’s urgent recommendations for public health and medical interventions to treat “obesity” reveals the medical and social desire to discipline and punish deviant bodies—bodies more likely to belong to racialized and socioeconomically disadvantaged Others.

II. Evaluating the AAP’s Clinical Practice Guidelines

One may oppose the above analysis by wondering how and why the “war on fat” would target children since overweight children would not be blamed for the ‘poor moral choices’ that led to their condition. Surely, the moral panic about the rising rates of overweight children is not related to fatphobia and the associated moral deficiencies. As such, the AAP report and recommendation for medical intervention could be warranted since a child’s size is beyond their control as they are not able to make healthy decisions or afford to buy healthy food, leisure, etc. However, if one considers the issue from a relational perspective, it becomes evident that the moral panic arising from the increase in overweight children is not a worry about the health of the children, but about the number of fat adults in future populations.

According to Wilson and St. Pierre (2018): “Eugenics is: (i) an applied science advocating ideas, practices, and policies that (ii) aim to improve the quality of human lives across generations (iii) by changing the composition of particular human populations to produce more desirable and/or fewer undesirable people” (p. 94). Although Wilson and St. Pierre use this theoretical understanding of historical eugenics to trace “newgenics” in contemporary gene editing and embryonic enhancement, I argue the account also explains the biopolitical logic underpinning the AAP’s recommendations for aggressive medical interventions to ‘treat’ childhood “obesity.” As explained in Section I, medicine (including medical research and practice) is influenced by and simultaneously influences social narratives, beliefs, and (power) structures. The epistemic legitimacy of medicine as an objective, impartial science provides medicine and its practitioners the power and authority to categorize, pathologize, and treat deviant bodies (as defined by social discourses of power-knowledge). The surveillance and discipline of fat bodies by medicine both produces and is produced by social disgust and prejudice against fat bodies, which are viewed as undesirable bodies that must be treated (i.e., eliminated) and prevented by any means necessary. Wilson and St. Pierre’s “eugenic logic” is a form of Foucauldian biopower that describes the goal to continuously scientifically and medically control populations. I argue that their account can help explain the expert panel’s failure to uptake scientific studies that reject deeply held fatphobic beliefs that weight and health are somehow causally related, and their recommendation to opt for increasingly aggressive medical interventions to discipline fat (deviant) bodies, are fuelled by similar eugenic logics.

Arguably, eugenic logic is more evident when we consider the use of extremely aggressive, ineffective, and dangerous interventions to manage the weight of children. It seems that social discourses surrounding individual responsibility and blame are not strong enough to encourage self-surveillance and self-discipline to achieve the hegemonic ideal (“skinny” as a measure of health) because the population’s weight is still trending upwards. The moral panic about the “obesity epidemic” depicts an immense social fear that the population is not just getting larger, but subsequently, moral laxity, dependence, and drain on the healthcare and social system is increasing alongside it. As such, it is justified to do anything possible to prevent overweight, at-risk children from becoming morally deficient adults. The moral disgust of fat bodies is so overwhelming and resistant to biopolitical surveillance and discipline — i.e., it is happening in children who cannot make decisions to manage their own weight — that experts are willing to overmedicalize children so they do not become fat adults. Obesity science is thus eugenic as it: (i) proposes practices and policies (such as the AAP’s new CPGs) that (ii) “aim to improve the quality of human lives across generations” (Wilson & St. Pierre, 2018, p. 94) by eliminating obesity because it is supposedly correlated with high morbidity, mortality, and moral laxity, (iii) thus, “changing the composition of particular human populations to produce… fewer undesirable people” (p. 94) by using aggressive interventions and preventing fat at all costs.

Although criteria (i) and (ii) have been sufficiently established, I will elaborate more on Wilson and St. Pierre’s criterion (iii) to demonstrate the eugenic logic at play in the AAP’s proposed clinical practice guidelines. Recall from §I how aggressive medical interventions (such as extreme dieting, exercising, surgery, and medication) are not healthy, since rapid and significant weight fluctuations due to these (“confounding”) factors correlates with increased morbidity and mortality (Campos et al., 2005). When we consider the interventions recommended by the expert panel, it is critical to understand that the medications recommended are weekly injectables that are effective for weight loss as long as users do not stop taking the drugs (Cha, 2023). Since these medications would be prescribed to children, “pediatric obesity” experts fully acknowledge that children will be on these medications “for their lifetime” (Cha, 2023). Semaglutide medications, such as Ozempic and Wegovy (injectables), are relatively new to the market and were developed as diabetes medications. The existence of long-term studies that even remotely indicate the side effects of taking the medication for a lifetime on populations without diabetes who are using this medication solely for weight loss do not yet exist, nor do they exist on adolescent participants. In fact, the expert panel primarily cites a study that shows drastic weight loss in children given the medication after only 3-6 months (Hampl et al., 2023, p. 36). The same study reports that the 12-17 year old participants experienced mild to moderate adverse gastrointestinal effects in 62% of participants, as well as “[h]ypoglycemia…, acute pancreatitis, acute kidney injury, injection-site reactions, serious hypersensitivity reactions, and increases in heart rate…, Suicidal ideation and behavior have been observed…, [and] [w]orsening of diabetic retinopathy in patients with type 2 diabetes” (The Medical Letter, 2023). The AAP is recommending potentially dangerous medications with unknown long term side effects and uncertain efficacy in children who will take these medications into adulthood.

Likewise, bariatric surgery is an invasive procedure with many risks and is cited to be only effective when coupled with a holistic, individualized plan for pairing it with an improved lifestyle (Hampl et al., 2023, p. 64). Exposing children to the risks of an invasive surgery that alone is not effective in preventing weight loss and does not have any correlation with good health outcomes in the future is not worth the risk. Children’s genuine well-being is obscured by negative social stigma of fat bodies. This is not to say that some children will not benefit from these medications or procedures, however, the interventions are so drastic it seems that there should not be a broad recommendation to surgically and/or medically treat all adolescents that are diagnosed as “severely obese.”

Eugenic logics are evident when we consider the demographics of those who were historically targeted by eugenic policies. For one, many of the families of overweight children will be unable to easily access or afford these medications, and this is a significant financial concern if they are to be on these medications for their entire lives. Similarly, the cost of bariatric surgery and the support of a team of obesity specialists does not seem like an affordable nor accessible treatment, especially in the context of the United States healthcare system. While there have been movements to include bariatric surgery and other treatments for “obesity” by Medicaid (i.e., universal insurance coverage for those who cannot afford private insurance in the United States), there are no current mandates to add these treatments to Medicaid and make these treatments affordable for lower income families (Cha, 2023). The intersectionally oppressed identities of overweight children not only prevents them from receiving adequate healthcare and access to social determinants of health, but it strengthens my argument that obesity science and policy are influenced by eugenic logic. The report acknowledges that many overweight children are racialized minorities and/or occupy a low socioeconomic status. Historical eugenic policies deliberately aimed to eliminate deviant bodies and undesirables who were considered responsible for “social ills” — groups such as immigrants, criminals, persons of color, and people who lived in poverty (Wilson & St. Pierre, 2018, p. 94). The high proportion of overweight individuals who have multiply oppressed identities is not coincidental but is due to intersectionally interwoven systems of power-knowledge that reinforce the surveillance, discipline, and punishment of deviant bodies.^[3] Therefore, the recommendations not only aim to improve the health and morality of future generations by ‘treating’ “obesity,” but the recommended interventions will likely increase the morbidity and mortality of overweight children as they age; that is, making them less healthy, for instance, by ingraining weight cycling as the ‘cure’ for their condition, subjecting them to dangerous and uncertain side effects of medications/ surgery, or preventing them from affording other necessities for well-being because of the cost of the treatments. Such recommendations seem to desire the elimination of undesirable fat bodies that are too deviant to be controlled and punished, instead of improving the health outcomes of the group the guidelines purport to help.

Garland-Thompson (2012), a prolific disability theorist, argues that eugenic logic is inherently eliminativist. Elimination of undesirables is an effective eugenic method of preventing undesirable social characteristics from being passed to future generations. Based on social and genetic factors, it is more likely that overweight adults will have overweight children. Eugenic logics are evident in the recommendations when considering how aggressive medical interventions will likely decrease the quality and length of these children’s lives (i.e., encouraging weight cycling from an early age), prevent them from affording other critical health services in the future, and maintain their lack of access to social determinants of health.

Further, research demonstrates that weight stigma negatively affects the psychological and physical health of overweight individuals as it increases one’s psychological stress that both “exacerbates and triggers” poor health outcomes and diseases, “such as heart disease, pain, and respiratory illness, even after related sociodemographic factors are controlled” (Puhl & Heuer, 2011, p. 1020). Not only do negative attitudes towards overweight individuals lead to discrimination in various social institutions, but these prejudices cause medically overweight individuals (including overweight children) to internalize harmful attitudes about themselves and increases unhealthy behaviours (e.g., binge eating, greater caloric intake, and avoiding exercise) (p. 1022). Research also shows that weight stigma is a strong risk factor for suicide (Brochu, 2020). Such research (as highlighted in Nature) should have been available to both the researchers who studied the effects of the injectable pharmaceuticals on weight loss in children/adolescents (recall: researchers witnessed increased suicidal ideation from the medication) as well as the AAP’s expert panel. These examples reveal a direct connection between the harms of fatphobia and the eugenic aim to eliminate an undesirable population. The negative effects of weight stigma compound with the negative effects on one’s health from the other discrimination and prejudice they likely face (e.g., race and socio-economic status). Policies that perpetuate and reinforce weight stigma are not effective “public health tool[s] for changing health behaviours” (p. 1019), but, instead, effectively increase the morbidity and mortality of individuals who are overweight—especially if they also experience discrimination and stigma from other intersections.

III. Conclusion

In conclusion, the AAP’s recommendation for medical intervention in overweight adolescents indicates prevalent fatphobic biases in the medical community and the moral panic caused by the “obesity epidemic.” Such fatphobia and moral panic has resulted in the recommendation of overly aggressive, ineffective, and harmful interventions for the treatment and prevention of childhood “obesity.” The stark contrast between the acknowledgement of the role of environmental and social factors in childhood weight gain with the call for urgent, intensive medical intervention reveals the use of biopower to pathologize undesirable bodies. In this paper, I have argued that the recommendations from the AAP do not actually put the health and overall well-being of overweight adolescents at the fore, but instead reveal the influence of eugenic logics to discipline, punish, and eliminate such undesirable bodies. My paper highlighted key examples of “obesity” research, medical practice, and policymaking that do not sufficiently consider the influence of negative non-epistemic values in the creation and implementation of the AAP’s clinical practice guidelines. Importantly, fatphobic non-epistemic values have allowed some studies to inform the guideline uncritically, while also preventing the medical practitioners from sufficiently considering counter-evidence which shows “obesity”: i) to be less harmful to one’s health than they believe; ii) mostly a product of one’s lifestyle and their social location; and iii) therefore, the recommended and aggressive individualized treatments are not evidence-based nor will they benefit the multiply oppressed group diagnosed with “pediatric obesity.”

As the medical field is intimately connected with the people and populations it serves, medicine — its scientists, practitioners, administrators, and policymakers — ought to consider their socially responsibility to every member of their communities. As medical research is conducted based on health concerns within the population that affect the larger society, medical scientists, practitioners, and policymakers have a duty to acknowledge the role of values that infiltrate their practice in order to ensure that their conclusions and recommendations are improving the lives of the people they strive to help. In virtue of acknowledging the vulnerable and intersectionally-oppressed status of the demographic of the AAP’s clinical practice guidelines (i.e., racialized, fat children of a lower socioeconomic status), the expert panel has an obligation to ensure that their recommendations address the inequity experienced by this group and not continue to perpetuate it. This population, in virtue of their oppression, experiences disproportionate health inequities. Socially responsible science — which aims to inform policy and improve society — should address health inequities and, in order to do so, must consider the wider social context that create and perpetuate these inequities. Good medical and scientific conduct requires medical practitioners and scientists to evaluate how their own biases might lead them to incorrect conclusions and step back from their research by considering the social and cultural milleu that informs their beliefs.

Furthermore, I argue that good human conduct towards fat folks actually hinges on the ability and willingness of researchers, medical practitioners, and policymakers to recognize the harmful values that influence knowledge-making practices in society. As discussed in Section I, scientists and medical practitioners are epistemic authorities; generally, we trust science and medicine to understand human health and illness. Scientists and medical practitioners are involved in the creation of knowledge — what we know about our bodies and our health, how to diagnose illnesses, and how to more effectively treat and prevent these illnesses is a product of their work. The creation of knowledge about health and illness informs how people in society understand their reality and how we should act (for instance, by seeing a physician when we get sick). Importantly then, if scientists and medical practitioners bring harmful, non-epsitemic biases like fatphobia into their practice, they shape social knowledge about weight, health, and fat. In other words, fat bodies are not simply harmed by medical practice when they do not receive the care and treatment that each person deserves in the health care system, researchers and medical practitioners epistemically justify harmful attitudes about weight and health in general. The prevalence of weight stigma underscores this observation. Stereotypes that “fat people are unhealthy and a burden on the health care system” — which supposedly justify the fatphobic violence people experience in the world — are a result of medical attitudes and beliefs that fat is a disease that must be treated and eliminated at all costs. “Obesity” researchers and medical practitioners must consider the impact of their practice as creating knowledge that can justify fatphobic attitudes and discrimination even beyond the clinic. Good conduct within research, medical practice, and policymaking has ripple effects that can improve and mitigate negative social towards fat people in all facets of society.

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