Other Clinical Considerations for Prevention

In addition to the recommendations provided for individual, group, and family approaches, counselors should keep in mind several other clinical considerations while working to prevent pediatric obesity. In the following paragraphs, we address weight bias, technology, and working with adolescents.

Weight Bias

Weight bias is pervasive, even among professionals working in the obesity prevention sector (Bertakis & Azari, 2005; Washington, 2011) and may deter individuals and families from engaging in obesity prevention (Olson, Schumaker, & Yawn, 1994). Thus, providers must increase their awareness of their own biases regarding weight, which might include reflecting on whether they make assumptions about overweight individuals and those who have a history of unsuccessful health behavior change, and taking steps to challenge and change any such biases so they are not communicated to patients. Likewise, acknowledging societal weight bias increases empathy and facilitates discussion of how weight bias might influence youths and their families. With established obesity prevention programming, providers can minimize environmental weight bias by having furnishings and medical equipment that accommodate a range of body sizes and by using materials with images of youths of all sizes engaging in healthy behavior, among other strategies. Links to more information on these strategies are in the Recommended Resources section at the end of this chapter.

In addition to the counselor's efforts to decrease weight bias when interacting with youths and families, direct interventions related to media literacy can reduce perceived weight bias and increase youths' body image (Danielsdottir et al., 2009). Interventions with families or youths can focus on education about changes the media make to images (e.g., computerized editing), looking at advertisements to notice the discrepancy between the product being sold and the message being communicated, and talking about how the media do not show healthy people of all sizes.

Role of Technology

Researchers are beginning to investigate whether technology can assist with pediatric obesity prevention. Game-related technology has the potential to transform inactivity into education, motivation, and activity (Baranowski, Baranowski, Thompson, & Buday, 2011). For example, in one intervention, replacing sedentary video games with active games increased physical activity and reduced sedentary behavior and mindless snacking (Maddison et al., 2011). Internet-based prevention programming is another innovative format to investigate. The anonymity of the Internet may appeal to some youths, and accessibility could widen the dispersion of programming in rural settings. Text messaging and social networking sites may provide youth-friendly designs that facilitate self-monitoring and social support, which is particularly important among adolescents (Dowda, Dishman, Pfeiffer, & Pate, 2007; Salvy et al., 2009). Texting is teens' preferred means of communication, and nearly 73% of teens use social networking sites (Lenhart, Ling, Campbell, & Purcell, 2010; Lenhart, Purcell, Smith, & Zickuhr, 2010).

Working With Adolescents

Secondary obesity prevention may differ for adolescents compared with younger children. Developmental, adolescents' drive for independence is increasing. Counselors can foster confidence regarding health behavior engagement by recognizing and supporting adolescents' emerging autonomy and maturity (e.g., encourage self-monitoring) while continuing to set limits and define boundaries. Teens are particularly vulnerable to media and peer messages regarding an ideal appearance as they undergo significant physical and social changes, and they describe the media as a key source of body image and appearance pressure (Peterson, Paulson, & Williams, 2007). Thus, secondary prevention efforts with adolescents need to be proactive in fostering positive body image and discouraging unhealthy weight control behaviors. Prevention for adolescents can also, as with that for younger children, involve the family to avoid stigmatization and facilitate behavior change. However, unlike pediatric obesity prevention with young children, adolescents need to be involved as well as their parents because of adolescents' developing autonomy (Barlow, 2007).

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