Pediatric Obesity Intervention

While the need for obesity prevention is clear, intervention will be necessary for the millions of children and adolescents who are already overweight and the millions more who will develop weight problems in the coming years. Fortunately, the treatment of pediatric obesity is a growing area of research, and much important work has already been done (Black & Young-Hyman, 2007). Interventions often employ behavioral or cognitive-behavioral approaches to bring about behavior change with a specific focus on changing diet and exercise habits. Recognizing the role of the family in children's and adolescents' habit formation, many intervention programs incorporate family elements and attempt to use parents as role models for positive behavior change (Germann, Kirschenbaum, & Rich, 2007; Johnston & Steele, 2007).

A plethora of laboratory-based (i.e., efficacy) studies have been conducted, identifying promising intervention strategies for addressing weight problems in children (Becque, Katch, Rocchini, Marks, & Moorhead, 1988; Epstein, Valoski, Kalarchian & McCurley, 1995; Holtz, Smith & Winters, 1999).

Fewer examinations of such treatments in "real-world" settings (i.e., effectiveness studies) have been completed (Jelalian, Wember, Bungeroth & Birmaher, 2007); however, such investigations are beginning to emerge in the literature (Johnston & Steele, 2007). Similar to other areas of child treatment, the next step for pediatric obesity intervention research will be to demonstrate effectiveness in typical clinical settings and disseminate effective programs widely (see Clinical Treatment and Services Research Workgroup, 1999 for discussion of efficacy, effectiveness, and dissemination research).

EARLY RECOGNITION

Routine assessments of eating and activity patterns in children and recognition of excessive weight gain relative to linear growth are essential throughout childhood. At any age, an excessive rate of weight gain relative to linear growth should be recognized, and underlying predisposing factors should be addressed with parents and other caregivers. The Centers for Disease Control and Prevention percentile grids for BMI are important tools for anticipatory guidance and discussion of longitudinal tracking of a child's BMI. Significant changes on growth patterns (eg, upward crossing of weight for age or BMI percentiles) can be recognized and addressed before children are severely overweight. An increase in BMI percentiles should be discussed with parents, some of whom may be overly concerned and some of whom may not recognize or accept potential risk.

Although data are extremely limited, it is likely that anticipatory guidance or treatment intervention before obesity has become severe will be more successful. Discussions to raise parental awareness should be conducted in a nonjudgmental, blame-free manner so that unintended negative impact on the child's self-concept is avoided. Data from adult patient surveys indicate that those who were asked by their physician about diet were more likely to report positive changes. Similarly, the efficacy of physicians discussing physical activity, breastfeeding, and smoking prevention is well documented. Thus, pediatricians are strongly encouraged to incorporate assessment and anticipatory guidance about diet, weight, and physical activity into routine clinical practice, being careful to discuss habits rather than focusing on habitus to avoid stigmatizing the child, adolescent, or family.