Section 3 Effective Prevention and Early Intervention for Eating Disorders and Obesity

Preventing Childhood Obesity

Janet A. Lydecker, Elizabeth Cotter, Rachel W. Gow, Nichole R. Kelly, and Suzanne E. Mazzeo

Nearly one third of youths in the United States are overweight and, of these, 17% are obese (Ogden, Carroll, Curtin, Lamb, & Flegal, 2010). Among youths, overweight and obesity are defined using body mass index (BMI) percentiles. Values above the 85th percentile are classified as overweight, and those above the 95th percentile are considered obese (Barlow, 2007). Obesity in children and adolescents is associated with negative physical and psychosocial comorbidities that decrease quality of life and increase risk for adult obesity and associated chronic health conditions, including coronary heart disease, Type 2 diabetes, certain cancers, hypertension, stroke, liver disease, and sleep apnea (National Heart, Lung and Blood Institute, 1998). Approximately 70% of obese youths have at least one risk factor for heart disease (Freedman, Zuguo, Srinivasan, Berenson, & Dietz, 2007) and are more likely than their peers to have prediabetes or diabetes (Centers for Disease Control and Prevention, 2011b). In addition to these physical comorbidities, pediatric obesity is linked to psychosocial issues that include depression, anxiety, and disordered eating. Moreover, the number of overweight and obese individuals has increased dramatically in the past few decades. To address the pediatric obesity epidemic, prevention efforts are urgently needed.

Biological, psychological, sociocultural, and environmental factors influence whether an individual is at risk for becoming overweight or obese. For example, metabolic mechanisms, endocrine disorders, stress, or neighborhood safety might increase or decrease an individual's relative risk of becoming overweight. Environmental factors are among the most important to consider for prevention because of their widespread influence. The U.S. culture creates a toxic environment for maintaining a healthy weight (i.e., with food and activity conditions that make it difficult to avoid weight gain; Brownell & Horgen, 2004). Furthermore, providing effective interventions is difficult in that dieting and weight loss treatments are generally not effective over the long term and may lead to disordered eating, weight cycling, or failure to lose sufficient weight to mitigate physical comorbidities (Brownell, Schwartz, Puhl, Henderson, & Harris, 2009). Prevention assumes that individuals have some degree of susceptibility to obesity and would benefit from medical and psychosocial interventions to counter that susceptibility. Prevention has multiple levels: primary, secondary, and tertiary. Primary prevention is universal treatment: all individuals receive the programming. For example, primary prevention occurs in schools when all students receive information about nutritional guidelines. Policy can serve as a primary prevention strategy when state or federal policies seek to promote healthful behavior. Secondary prevention addresses subsamples of the population who are at greater risk for becoming overweight or obese or who are at risk for negative medical or psychosocial consequences of obesity. For example, borderline overweight BMI, less healthy dietary or physical activity habits, or a strong family history of obesity are risk factors (Daniels et al., 2005). Tertiary prevention comes after the problem and seeks to prevent worsening severity or negative consequences. In this chapter, we focus on primary and secondary prevention.

Cultural factors play a role in pediatric obesity and are addressed throughout this chapter. These factors include race, ethnicity, socioeconomic status, age and gender, among others, and must be considered in pediatric obesity prevention (Freedman, Khan, Serdula, Ogden, & Dietz, 2006). For example, African American youths may value traditional soul foods high in fat and salt and might view more healthful eating as giving up a part of their cultural heritage (Airhihenbuwa et al., 1996; James, 2004). Likewise, various cultural factors may influence the financial resources that families can invest in food and activity, neighborhood safety, patient provider communication efficacy and style, perceived norms about physical activity, and ideal body size and shape, among others. Because the nature of prevention programming is far reaching, providers must proactively seek to include culturally relevant material targeted to their intended recipients.

In this chapter, we describe current prevention programming for pediatric obesity and offer effective strategies for counselors working with individuals, families, and schools. We focus on prevention rather than treatment because prevention can be more far reaching than treatment and aims to avoid health problems that occur with obesity. First, we address primary prevention, or universal prevention programming aimed at improving the health of all children. The primary prevention section covers strategies that occur in public settings including schools, government, and the community. Next, we address secondary prevention, or prevention programming that targets youths at risk for becoming obese or developing obesity-related health problems. In this section, we review the interdisciplinary approach to prevention and specific strategies for counselors working with individuals, groups, and families. We review motivational interviewing and parental role modeling in depth. Last, we present clinical considerations and a list of resources for counselors who are engaged in preventing pediatric obesity.

< Prev   CONTENTS   Next >