To effectively intervene with the overweight and obese youth, it is imperative that primary care providers and behavioral interventionists work in concert to help families implement healthy behaviors across socioenvironmental domains. In this article, the authors review current office-based counseling practices and provide evidence-based recommendations for addressing weight status and strategies for encouraging behavior change with children and families, primarily by increasing social support. By providing such collaborative targeted efforts, consistent health messages and support are delivered across children’s everyday contexts, thereby helping the youth to achieve successful implementation of eating and activity behaviors and sustainable weight loss outcomes.
This article includes a brief summary of important points and objectives for recall:
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Family-based behavioral lifestyle interventions using a socioenvironmental approach produce sustainable weight loss.
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Ideally, providers are actively engaged in tracking children’s body mass index (BMI) trajectory and addressing obesity with families.
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By using the socioenvironmental approach, providers can ensure that children receive consistent health messaging and encourage families to implement healthy eating and activity behaviors across contexts.
The obesity epidemic has reached epic proportions in the United States. Approximately 70% of adults and 32% of children in the United States are overweight or obese. For children and adolescents, the Center for Disease Control and Prevention (CDC) defines overweight as a BMI (calculated as weight in kilograms divided by height in meters squared) between the 85th and 95th percentiles and obesity as a BMI at or above the 95th percentile for sex and age. The BMI scores and specified percentile distributions are easy and feasible to obtain and serve as indirect measures of body fat. Overweight and obesity are associated with chronic health conditions, heightened psychological distress, increased medical costs, and reduced quality of life. As children become heavier, their risk for health problems, such as metabolic syndrome and cardiovascular disease, directly increases, as well. Early intervention is essential because elevated childhood height and BMI are robust predictors of young adult BMI, and findings show that children with a BMI above the 85th percentile are more likely to continue to gain weight and to become overweight or obese in adolescence than normal-weight children. Although many assume that children will simply grow out of their overweight or obese status, the reality is that childhood overweight and obesity are critical risk factors for overweight and obesity in adulthood, and risk of developing obesity later in life increases with child age and BMI. The tendency for overweight or obesity to track across the lifespan starts as young as 9 months and necessitates early intervention because pediatric overweight and obesity do not spontaneously resolve with age. Box 1 provides key reasons why childhood is an ideal point of intervention ; in fact, even small weight loss reductions are sufficient for overweight and obese children to satisfy criteria for normal weight. (Goldschmidt AB, Wilfley DE, Paluch RA, et al. Indicated prevention of adult obesity: reference data for weight normalization in overweight children. Submitted for publication.)
Reasons Why Childhood is an Ideal Point of Intervention
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It is more difficult to reverse obesity in adulthood; adult interventions typically lead to only modest weight loss.
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Addressing overweight early can reduce or reverse negative medical and psychosocial sequelae.
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Children’s dietary and exercise habits are not fully ingrained and are more amenable to change.
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Children are still growing taller, which might make it easier to achieve a reduction in overweight percentage even while maintaining weight.
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Traditional universal prevention programs (eg, in-school physical activity) do not yield significant weight reductions, necessitating a more intensive approach.
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