From , , Obesity 7029

Issue Links: Obesity 7029

Topics: Genetics and Psychiatry | Psychotherapy

We are all increasingly asked to identify, assess, and treat overweight and obese children and adolescents. What’s behind what many see as a growing epidemic of childhood obesity in the US? And what are the most effective pscyhosocial interventions for these children?

Research has shown that multiple factors play a role in a child or adolescent becoming overweight or obese (Kelly AS et al, Circulation 2013;128(15):1689–1712). They include

• genetics
• food habits
• activity patterns
• parenting styles
• family relationships
• community resources
• environment
• socioeconomic status

Although weight gain can develop at any age, the prenatal and early childhood periods are critical times for growth and healthy lifestyle development (Vine M et al, J Obes 2013;http://bit.ly/1h1B1Br).

Health Problems Associated with Childhood Obesity

Obese children are at high risk of becoming obese adolescents and adults. Health problems associated with obesity include increased physiological and psychological risks, as well as higher rates of cardiovascular and metabolic diseases, nonalcoholic fatty liver disease, musculoskeletal complaints, and obstructive sleep apnea (Kelly 2013, op.cit).

Psychological conditions include greater risk than normal weight children of being bullied and teased about their weight by schoolmates, and even by family members (Storch EA et al, J Pediatr Psychol 2007;32(1):80–89).

In addition, obese children have a higher risk of low self-esteem, poor emotional well-being, depression, and stress, compounded by poor social skills (Kalra G et al, Ind Psychiatry J 2012;21(1):11–17).

Successful Interventions

While therapists frequently end up treating obese children and/or their parents, primary care providers (PCPs) often first identify families in need of intervention, connect them with appropriate services, and check on their progress. An expert committee was convened in 2005 by the American Medical Association and government health agencies to develop recommendations on the treatment of pediatric obesity. This group recommends a progressive approach to treating childhood obesity. It begins with early intervention in the PCP’s office, followed by an increased structural approach including medical, nutritional, and behavioral interventions if a child fails to make progress (Spear BA et al, Pediatrics 2007;120 (Suppl 4):S254–S288).

Early Intervention. Research shows that in order for a program targeting childhood obesity to be effective, the child and family need a minimum of 25 hours of intervention that typically takes place over a six-month period. The program involves nutrition, physical activity, and behavior change (US Preventive Services Task Force & Barton M, Pediatrics 2010;125(2):361–367).

• Healthcare providers should help the child and family set clear goals in each of these areas, including: etting up feasible goals that can be easily measured.
• Developing a reasonable plan for reaching those goals.
• Assisting the family in focusing on small changes rather than large changes, which can lead to greater success.

Ideally, physicians should refer children and adolescents with body mass indexes (BMIs) greater than the 97^th percentile, who have been unresponsive to other treatments or have significant medical comorbidities, to a pediatric weight management center.

Here, a multidisciplinary team will provide medical and psychiatric evaluation, nutrition assessment, behavioral counseling, physical activity assessment and intervention, and a variety of behavioral therapy strategies targeted for the obese child or adolescent.

Behavioral Lifestyle Modification. The cornerstone in the multidisciplinary approach is behavioral lifestyle modification, and this approach is endorsed by major medical groups such as the American Heart Association (Kelley 2013, op.cit).

Behavioral obesity interventions include:

• self-monitoring
• stimulus control techniques
• goal setting
• positive reinforcement
• problem solving
• social support
• cognitive restructuring
• relapse prevention

These multidisciplinary team interventions are used to create behavioral changes that lead to children’s reduced screen time, increased physical activity, and improved eating behaviors. Counseling can be done in an individual or group support session or a combination of the two (Crocker MK & Yanovski JA, Endocrinol Metab Clin North Am 2009;38(3):525–548).

Involving Parents

Research shows that the odds of success in the long-term maintenance of weight loss for children under 12 years of age are higher in a family-based weight control program with parental involvement (Theim KR et al, Obesity 2013;21(2):394–397).

Parental obesity has been identified as a significant risk factor likely due to shared genetic and environmental factors. Research reports that children with obese parents are at a two- to three-fold increased risk for being obese themselves in adulthood (Wilfley DE et al, Pediatr Clin North Am 2011;58(6):1403–1424).

Interventions for the Family. Providers should encourage families to take small steps and set obtainable goals. It is also important to address potential barriers to treatment success with the parents and/or caregivers. This helps you strategize ways to increase and maintain families’ motivation during the treatment and maintenance period (Wilfley 2011, op.cit). Interventions such as motivational interviewing can help you determine the family’s readiness to change by assessing their motivation and barriers to change, and can increase and maintain parental motivation to complete treatment.

Frequent contact with children and their families, in the form of medical appointments, group or individual sessions, text messages, social media, and/or phone calls, can help providers monitor progress.

TCRBH’s Take: More research studies are needed to better understand the physiological, psychological, and environmental factors that contribute to pediatric obesity. What’s clear, however, is that identification, assessment, and treatment should begin early. The ultimate goal for all healthcare providers should be to improve children and adolescents’ quality of life and reduce their risk of developing chronic diseases associated with obesity.