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Silence is Deadly: USPSTF Revised Recommendations for Children Living in Larger Bodies Now Open for Comment

While the United States Preventative Services Taskforce (USPSTF) made a positive change in dropping “obesity” and “overweight” from their recommendation, the primary focus is still on weight (BMI) and the main outcome is weight loss. Weight stigma we know from robust data causes profound harm to people living in larger bodies, and there’s no way to say to a family or a kid, “I’m recommending a form of intensive behavior and lifestyle therapy based on your child’s BMI…” without adding to weight stigma and causing harm. It doesn’t matter what tone of voice you use, or what words you put around it, or any other way you try to be sensitive about the topic. The focus always needs to be on health as defined by the patient and family, looking at actual conditions known to harm health, which would include high blood pressure, high cholesterol, high fasting blood glucose, and DEPRESSION, PTSD, ANXIETY, EATING DISORDERS, etc.

The preamble to this recommendation states, “The USPSTF is committed to helping reverse the negative impacts of systemic and structural racism, gender-based discrimination, bias, and other sources of health inequities, and their effects on health, throughout its work.”

Despite the USPSTF‘s stated commitment to reversing the impact of systemic racism, they fail to acknowledge that BMI is an outdated and inherently racist tool, created by a white man for use in white men (for insurance risk purposes) and applied to other racial groups without data specific to those racial groups (such as Black Americans, Hispanic Americans, Native Americans, Asian Americans). It is a tool that perpetuates weight stigma and systemic racism in medicine and disproportionately harms marginalized children.

Another positive in the recommendation was the acknowledgment of potential harms outweighing benefits of weight loss medication for children (which the American Academy of Pediatrics supported in their latest recommendations) as well as the dangerous lack of any long-term data for children on those medications. The recommendation by USPSTF also acknowledges the data supporting their recommendation in this article (intensive behavioral and lifestyle interventions) has no long term data.

One of the most problematic pieces of the recommendation was its BMI-based recommendation for a therapy that many people don’t have access to. Intensive health behavior and lifestyle therapy (IHBLT) requires 26 hours minimum of contact over the course of a year. Many working parents with limited resources and more than one child to care for, even if they had access to such a therapy, would not practically be able to avail themselves of it. This puts both pediatricians who are trying to help and parents in quite a bind. Even those who are able to get to the therapy don’t always have providers of it geographically close to them.

In summary, any intervention for children that is based on the child’s size and that implicitly or explicitly focuses on weight loss as a goal adds to weight stigma. This must be acknowledged explicitly in the recommendation as a harm. Families deserve informed consent, and behavioral therapies come with their own set of potential “side effects.” Further, data to support recommendations from USPSTF needs to include more research that centers mental health outcomes and long term outcomes, especially for children. Finally, recommended interventions must be accessible to those they are intended to serve. We are facing massive burnout in medicine, with a medical workforce ill-equipped to identify eating disorder risk factors and ill-equipped to manage the explosion of mental health crisis facing our nation’s youth. A decade from now, if we continue to head in the current direction, that crisis will be exponentially worse.

Any of you who care about this issue and treat patients who have been harmed by weight stigma, please speak up. The full recommendation is currently available online and open for comments using the following link.: https://www.uspreventiveservicestaskforce.org/uspstf/high-bmi-children-adolescents-interventions-draft-evidence-review

Kim Dennis, MD
CMO, SunCloud Health

Rachel Collins, LCSW
Site Director of Northbrook PHP and IOP

Rachel Collins, LCSW, is the Site Director of SunCloud Health’s Northbrook Partial Hospitalization (PHP) and Intensive Outpatient (IOP) programs for both adolescents and adults. Rachel earned her bachelor’s degree in psychology and went on to complete her master’s degree in social work from Michigan State University. She has since worked in a wide range of settings, including inpatient treatment, PHP/IOP programs, therapeutic group homes, and private practice. Rachel specializes in treating trauma (using Cognitive Processing Therapy) and anxiety, practicing through a relational, compassionate, and client-centered lens. She is passionate about creating a therapeutic space in which clients feel safe and able to explore various parts of themselves with curiosity as opposed to judgement. In addition to her leadership and clinical work, she is passionate about creating art, and learning about the intersection between creativity and mental health.

Kayla Corirossi, MA, LCSW
Site Director, Naperville PHP/IOP (Adolescents & Adults)

Kayla Corirossi, MA, LCSW, is the Site Director of SunCloud Health’s Naperville Partial Hospitalization (PHP) and Intensive Outpatient (IOP) programs for adolescents and adults. She brings extensive experience working with individuals across the lifespan, including adolescents, adults, and geriatric populations, and specializes in the treatment of mood disorders, trauma, substance use, family systems, forensic populations, and individuals in crisis.

Kayla has worked in a wide range of clinical and community settings, including community-based interventions, police crisis response, correctional facilities, inpatient treatment, PHP/IOP programs, and with vulnerable and underserved populations. In addition to her clinical and leadership work, she is passionate about providing mental health education and advocacy within the community.

Kayla earned her Bachelor’s degree with a double major in Psychology and Sociology from Aurora University and went on to complete her Master’s degree in Forensic Social Work, also at Aurora University. Her clinical approach is evidence-based, compassionate, trauma-informed, and integrative, emphasizing collaboration and individualized care.

Driven by a personal mission to meet individuals where they are, Kayla is committed to helping clients feel safe, supported, and understood. She strives to create a natural and empathetic healing environment while ensuring individuals from all backgrounds and identities know they are not alone and have access to meaningful resources and support.

Elizabeth E. Sita, MD
Medical Director of Adult Services
Dr. Elizabeth E. Sita, MD, is a Board Certified psychiatrist specializing in the care of patients with eating disorders. She completed her undergraduate training at the University of Chicago and graduated with Highest Honors. She then earned her medical degree at Northwestern University Feinberg School of Medicine and was recognized with the Chairman’s Award for Excellence in Psychiatry. She subsequently completed residency with the Department of Psychiatry and Behavioral Sciences at McGaw Medical Center of Northwestern University, where she was elected Chief Resident and received the Resident Psychiatrist Leadership & Service Award. Upon completing her training, Dr. Sita came to Ascension Alexian Brothers Behavioral Health Hospital, where she served as Assistant Medical Director of the Center for Eating Disorders and Director of Transcranial Magnetic Stimulation Services before transitioning to lead the new inpatient eating disorder unit as Medical Director of Eating Disorder Services at Ascension Saint Joseph Hospital – Chicago. In these roles, she has cared for a multitude of adolescents and adults struggling with anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders as well as severe, cooccurring mood, trauma, personality, and substance use disorders. Dr. Sita has been recognized throughout her training and practice for a commitment to excellence in patient care and for her ability to engage patients in their most challenging moments. Her passions include the care of treatment-resistant eating and mood disorders as well as questions of medical capacity and end-of-life decision making. She believes that, first and foremost, human connection is key to mental health and well-being and strives to share this philosophy in each and every patient encounter. She is excited to bring her expertise to SunCloud Health as the Medical Director of Adult Services!   VIDEO: Meet Elizabeth E. Sita, MD, Medical Director of Adult Services  
Lacey Lemke, PsyD
Assistant Vice President of Clinical Services

Dr. Lacey Lemke (she/her) is a licensed clinical health psychologist with specialized expertise in the treatment of eating disorders and the practice of medical and health psychology. She completed her doctoral training in clinical psychology with a Primary Care emphasis at the Adler School of Professional Psychology. Dr. Lemke went on to complete both her predoctoral clinical internship and postdoctoral fellowship through Ascension Health, where she gained advanced training working with individuals experiencing eating disorders and self-injurious behaviors, as well as within pediatric subspecialty settings including endocrinology, neurology, and adolescent medicine.

Dr. Lemke is deeply committed to providing evidence-based, compassionate care and collaborates closely with interdisciplinary teams to ensure comprehensive treatment. Her professional mission is to support patients in achieving their fullest potential by guiding them to the most appropriate level of care and empowering them to make meaningful, sustainable progress toward improved health and well-being.

VIDEO: 2. Meet Lacey Lemke, PsyD.