New guidance warns of hidden harms in teen dieting, calls for shift in weight messaging

OTTAWA—New guidance from the Canadian Paediatric Society (CPS) warns that dieting during adolescence can have serious and lasting physical and mental health consequences and is urging health care providers to move away from weight-focused care.

Most teens have tried to lose weight, regardless of their body shape or size, with many turning to increasingly extreme measures such as prolonged fasting, skipping meals, fad diets and excessive exercise. The CPS cautions that these practices can lead to long-term health problems, including poor growth, nutrient deficiencies, and even paradoxical weight gain over time.

Dieting and unhealthy weight-control behaviours increases the risk of developing eating disorders—such as anorexia and bulimia— by five- to 18-fold. Adolescent dieting is also linked to a greater risk of suicidal behaviour in adulthood.

“Teens are actively developing their body image and are especially sensitive to appearance,” said Dr. Megan Harrison, Chair of the CPS Adolescent Health Committee and lead author of the new guidelines. “They can internalize often-conflicting health messages, which then affects what they see as a normal or healthy body.”

Weight bias—negative assumptions about a person based on body shape, size or appearance—is another concern highlighted by the CPS. Adolescents frequently encounter stigma from peers, family members, teachers, and even within health care settings. This bias can contribute to poor self-esteem, anxiety, depression, and disordered eating.

CPS is urging health care providers to adopt a “health at every size” approach, promoting balanced eating and sustainable lifestyle habits over restrictive diets. The organization recommends that practitioners routinely screen for recent changes in eating habits, provide targeted nutrition counselling when needed, and refer patients for specialized care when an eating disorder is suspected.

“We know tweens and teens are thinking about health and how they feel in their bodies,” said Dr. Harrison, an adolescent medicine specialist in Ottawa. “I encourage adults— parents, teachers, coaches—to lead by example by focusing on healthy habits, like eating regularly, getting enough sleep, and helping kids be active in fun and supportive environments. It’s about creating a positive, balanced approach to health, not talking about weight or body shape.”

The CPS also recommends health care providers:

• encourage variety and regularity in eating rather than labeling foods as “good” or “bad”.
• discourage restrictive eating and highlight that adolescents have different nutritional needs than adults.
• help parents and caregivers avoid weight-focused language and modelling healthy attitudes toward food and body image.

The CPS reminds clinicians that weight alone cannot determine health status and calls for reflection and training to reduce weight bias in care.

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