FYI: Childhood Obesity

The following excerpts are taken from Childhood Obesity: The Epidemic of Today’s Youth by Keeley Pratt, MS and Angela Lamson, PhD an article found in Family Therapy Magazine, July/August 2009.

Obesity has been identified by researchers as an established pediatric condition for over 50 years. Of late, however, childhood obesity is considered a nationwide epidemic that impacts children regardless of sex, age, race, and ethnic group. In 2004, 18 % of children in the US were reported to be overweight.

Researchers have found that 80 % of children who were overweight or obese from 10-15 years old remained obese when they were 25 years old.

In the National Survey of Children’s Health parental/family structure (e.g., single parent or children from blended families) were found to be factors that influenced overweight in childhood. for example, children who dwelt in two-parent (biological or adoptive) households were least likely to be overweight as compared with children who lived with a step parent; children who lived with single mothers had the greatest prevalence of overweight. While some have speculated that family/parental structures (eg., single or two-parent families) have implications into childhood overweight patterns, others suggested that parental behaviors (e.g., physical activity and food choices) have significant correlates with children’s health.

the medical literature has documented several biological comorbidities of childhood obesity including type-2 diabetes, heart disease, high cholesterol, hypertension, early puberty, enuresis, polycystic ovarian syndrome, and trouble sleeping/sleep apnea.

In a sample of obese children entering treatment, it was found that 29 % met or exceeded clinical levels for psychosocial problems on the Child Behavior checklist, specifically with regard to anxiety and depression.

…the social implications for children who are overweight were evident in children as early as six years of age, when children begin to understand societal messages that being overweight is not desirable. Not surprisingly, children who are overweight were more likely to be at risk for peer victimization such as teasing. Additional social issues for children who are obese included problems associated with school, relational issues, social isolation, promiscuity and bullying.

The expert committee recommendations described four stages of childhood obesity treatment: 1) prevention plus; 2) structured weight management; 3) comprehensive, multidisciplinary intervention; and 4) tertiary care intervention.

In a prevention plus encounter, which could take place in a variety of settings including private practice offices, agencies, or healthcare settings, a family therapists’ initial interaction should include joining and exploration of family dynamics for potential strengths and challenges in the adaptation of a healthy lifestyle.

Structured weight management visits take place at a primary care office with the added support of a healthcare provider who has specific training in weight management. Visits provide an increase in structure and support, specifically toward setting physical activity and nutritional goals and creating rewards. These visits ideally occur on a monthly basis.

Stage three intervention goes beyond stage two by employing multidisciplinary childhood obesity treatment (e.g., with a behavioral specialist, nutritionist, and physical activity specialist) and a structured behavioral program (e.g., negotiating and reinforcing positive healthy behaviors). Ideally, families are seen weekly for 8-12 weeks with additional follow-up services.

Stage four is aimed at severely obese youth by utilizing treatments such as medications (e.g., Sibutramine or Orlistat), very-low calorie diets, and/or weight control surgery (i.e., gastric bypass or lap-band) in addition to behavioral treatment.

Behavioral interventions have been seen as the “first line treatment” for weight loss since at least 1987. …behavioral interventions defined as including the modification of food consumption, increasing physical activity, frequent involvement of the child’s family members, and optimally cognitive and behavioral therapy.

There are inherent benefits to treating a family rather than a child in isolation. Obesity runs in families.