New pediatric guidelines aim to treat obesity without stigma. Critics say they’ll make bias worse.

From the time Alexandra Slick was little, she knew that when she went to the doctor’s office, at least one person was probably going to tell her that she needed to lose weight.

She remembers sitting in an examination room as a middle schooler, watching her mother cry as a nurse practitioner asked her if she wanted her daughter to die. At that point, while Slick’s weight was considered obese by the body mass index, she already had been dieting for about four years and practiced karate every week.

“It used to be that if I had a doctor’s appointment in the day, I wouldn’t eat or drink anything until I had gone to the doctor — whether or not that appointment was at 10 a.m. or if that appointment was at 3 p.m.,” she said. “I just wanted to be as small as I could going into the doctor’s office.”

When Slick, a 31-year-old Baltimore resident, heard about the American Academy of Pediatrics’ new guidelines for treating childhood and adolescent obesity, she shuddered.

The guidelines, released in January by the country’s leading pediatricians group, advise primary care doctors to offer families a variety of treatments early for childhood obesity. “Watchful waiting” to see if children with obesity developed into average weight adults — the group’s previous recommendation — would no longer cut it.

The guidelines became an immediate subject of controversy, triggering backlash from nutritionists, eating disorder clinicians and people like Slick, who know what it’s like to live in a larger body.