Evidence-Based Treatments for Childhood Obesity

  • Hollie A. Raynor
Part of the Issues in Clinical Child Psychology book series (ICCP)

The prevalence of obesity in all age groups has increased dramatically over the past 30 years, such that overweight and obesity are considered to be a major public health concern in the United States (Baskin, Aard, Franklin, & Allison, 2005). Currently, 1.3 out of every 10 children aged 2 to 11 years is overweight (⁥ 95th percentile body mass index [BMI]) (Hedley et al., 2004). The adverse medical and psychosocial effects of overweight in children have been well-established (Dietz, 1998). Childhood obesity is also associated with the development of several risk factors for heart disease, including hyperli-pidemia, hyperinsulemia, and hypertension, and other chronic diseases in adulthood (Berenson et al., 1998; Janssen et al., 2005). Finally, being overweight as a child increases the likelihood of being overweight as an adult (Janssen et al.; Whitaker, Wright, Pepe, Seidel, & Dietz, 1997).

Due to the negative and potentially lifelong consequences of childhood obesity, treatment of overweight is necessary at its earliest detection in childhood (Yin, Wu, Liu, &. Yu, 2005). Treatment of overweight during childhood is believed to have behavioral and biological advantages over treatment in adulthood (Epstein, Myers, Raynor, & Saelens, 1998) that may aid in better long-term weight loss maintenance. Changing eating and activity behaviors may be easier in childhood; problematic behaviors have not been in place as long for children as they have usually been for adults. Moreover, research indicates that preferences, particularly for food, are learned. Thus, in children, food experiences can be encouraged to shape patterns of food preference that are consistent with healthier diets starting at a young age—thereby assisting with better long-term dietary adherence (Birch, 1999; Birch & Fisher, 1998). Family support for behavior change may also be easier to establish for children than for adults (Epstein et al.). Treatment of obesity in childhood has the added benefit of taking advantage of linear growth, and increases in lean muscle mass, as well as reductions in weight, that are not possible in the treatment of adults (Epstein, Valoski, & McCurley, 1993). The advantage of growth may mean that smaller and/or fewer changes in the diet and/or leisure-time activity may produce a healthier weight status in children, as compared to adults, and these smaller changes may be easier to successfully maintain. Finally, while obesity treatment in adults causes shrinkage but not loss of excess adipose cells, treatment of obesity in children may prevent the development of excess adipose cells, again helping with long-term weight loss maintenance (Epstein et al.).


Physical Activity Sedentary Behavior Eating Disorder Childhood Obesity Overweight Child 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Altman, D. G., Schulz, K. F., Moher, D., Egger, M., Davidoff, F., Elbourne, D., et al.(2001). The revised CONSORT statement for reporting randomzied trails: Explanation and elaboration.Annals of Internal Medicine,134, 663–694PubMedGoogle Scholar
  2. Baskin, M. L., Aard, J., Franklin, F. A., & Allison, D. B. (2005). Prevalence of obesity in the United States.Obesity Reviews,6, 5–7PubMedCrossRefGoogle Scholar
  3. Becque, M. D., Katch, V. L., Rocchini, A. P., Marks, C. R., & Moorehead, C. (1988).Coronary risk incidence of obese adolescents: Reduction by exercise plus diet intervention.Pediatrics,81, 605–612PubMedGoogle Scholar
  4. Berenson, G. S., Srinivasan, S. R., Bao, W., Newman, W. P., Tracy, R. E., & Wattingney,W. A. (1998). Association between multiple cardiovascular risk factors and arthero-sclerosis in children and young adults: The Bogalusa heart study.New England Journal of Medicine,338, 1650–1656PubMedCrossRefGoogle Scholar
  5. Birch, L. L. (1999). Development of food preferences.Annual Review of Nutrition,19,41–62PubMedCrossRefGoogle Scholar
  6. Birch, L. L., & Fisher, J. O. (1998). Development of eating behaviors among children and adolescents.Pediatrics,101, 539–548PubMedGoogle Scholar
  7. Braet, C., Tanghe, A., Bode, P. D., Franckx, H., & Winckel, M. V. (2003). Inpatient treatment of obese children: A multicomponent program without stringent calorie restriction.European Journal of Pediatrics,162, 391–396PubMedGoogle Scholar
  8. Braet, C., & Van Winckel, M. (2000). Long-term follow-up of a cognitive behavioral treatment program for obese children.Behavior Therapy,31, 55–74CrossRefGoogle Scholar
  9. Butryn, M. L., & Wadden, T. A. (2005). Treatment of overweight in children and adolescents: Does dieting increase the risk of eating disorders?International Journal of Eating Disorders,37, 285–293PubMedCrossRefGoogle Scholar
  10. Davidson, K. W., Goldstein, M., Kaplan, R. M., Kaufmann, P. G., Knatterud, G. L., Orleans, C. T., et al. (2003). Evidence-based behavioral medicine: What is it and how do we acheive it?Annals of Behavioral Medicine,26, 161–171PubMedCrossRefGoogle Scholar
  11. Dietz, W. H. (1998). Health consequences of obesity in youth: Childhood predictors of adult onset.Pediatrics,101, 518–525PubMedGoogle Scholar
  12. Dietz, W. H., & Gortmaker, S. L. (1985). Do we fatten our children at the television set? Obesity and television viewing in children and adolescents.Pediatrics,75, 807–812PubMedGoogle Scholar
  13. Epstein, L. H., Gordy, C. C., Raynor, H. A., Beddome, M., Kilanowski, C. K., & Paluch,R. (2001). Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity.Obesity Research,9, 171–178PubMedCrossRefGoogle Scholar
  14. Epstein, L. H., Myers, M. D., Raynor, H. A., & Saelens, B. E. (1998). Treatment of pedi-atric obesity.Pediatrics,10, 554–569Google Scholar
  15. Epstein, L. H., Paluch, R. A., Gordy, C. C., & Dorn, J. (2000). Decreasing sedentary behaviors in treating pediatric obesity.Archives of Pediatrics & Adolescent Medicine,154, 220–226Google Scholar
  16. Epstein, L. H., Paluch, R. A., Gordy, C. C., Saelens, B. E., & Ernst, M. M. (2000). Problem solving in the treatment of childhood obesity.Journal of Consulting and Clinical Psychology,68, 717–721PubMedCrossRefGoogle Scholar
  17. Epstein, L. H., Paluch, R. A., Kilanowski, C. K., & Raynor, H. A. (2004). The effect of reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric obesity.Health Psychology,23, 371–380PubMedCrossRefGoogle Scholar
  18. Epstein, L. H., Paluch, R. A., & Raynor, H. A. (2001). Sex differences in obese children and siblings in family-based obesity treatment.Obesity Research,9, 746–753PubMedCrossRefGoogle Scholar
  19. Epstein, L. H., Paluch, R. A., Saelens, B. E., Ernst, M. M., & Wilfley, D. E. (2001).Changes in eating disorder symptoms with pediatric obesity treatment.Journal of Pediatrics,139, 58–65PubMedCrossRefGoogle Scholar
  20. Epstein, L. H., Roemmich, R. A., Paluch, R. A., & Raynor, H. A. (2005). Influence of changes in sedentary behavior on energy and macronutrient intake in youth.American Journal of Clinical Nutrition,81, 361–366PubMedGoogle Scholar
  21. Epstein, L. H., Valoski, A. M., Kalarchian, M. A., & McCurley, J. (1995). Do children lose and maintain weight easier than adults: A comparison of child and parent weight changes from six months to ten years.Obesity Research,3, 411–417PubMedGoogle Scholar
  22. Epstein, L. H., Valoski, A., & McCurley, J. (1993). Effect of weight loss by obese children on long-term growth.American Journal of Diseases in Children,147, 1076–1080Google Scholar
  23. Epstein, L. H., Valoski, A. M., Vara, L. S., McCurley, J., Wisniewski, L., Kalarchian, M.A., et al. (1995). Effects of decreasing sedentary behavior and increasing activity on weight change in obese children.Health Psychology,14, 109–115PubMedCrossRefGoogle Scholar
  24. Epstein, L. H., Valoski, A., Wing, R. R., & McCurley, J. (1990). Ten-year follow-up of behavioral, family-based treatment for obese children.Journal of the American Medical Association,264, 2519–2523CrossRefGoogle Scholar
  25. Epstein, L. H., Valoski, A., Wing, R. R., & McCurley, J. (1994). Ten year outcomes of behavioral family based treatment for childhood obesity.Health Psychology,13,373–383PubMedCrossRefGoogle Scholar
  26. Epstein, L. H., Valoski, A., Wing, R. R., Perkins, K. A., Fernstrom, M. D., Marks, B. L.,et al. (1989). Perception of eating and exercise in children as a function of child and parent weight status.Appetite,12, 105–118PubMedCrossRefGoogle Scholar
  27. Epstein, L. H., Wing, R. R., Koeske, R., Andrasik, F., & Ossip, D. (1981). Child and parent weight loss in family-based behavior modification programs.Journal of Consulting and Clinical Psychology,49, 674–685PubMedCrossRefGoogle Scholar
  28. Epstein, L. H., Wing, R. R., Koeske, R., & Valoski, A. (1985). A comparison of lifestyle exercise, aerobic exercise, and calisthenics on weight loss in obese children.Behavior Therapy,16, 345–356CrossRefGoogle Scholar
  29. Epstein, L. H., Wing, R. R., Penner, B. C., & Kress, M. J. (1985). Effect of diet and controlled exercise on weight loss in obese children.Journal of Pediatrics,107M,358–361Google Scholar
  30. Figueroa-Colon, R., von Almen, T. K., Franklin, F. A., Schuftan, C., & Suskind, R. M.(1993). Comparison of two hypocaloric diets in obese children.American Journal of Diseases in Children,140, 160–166Google Scholar
  31. Foster, G., Wyatt, H. R., Hill, J. O., McGuckin, B. G., Brill, C., Mohammed, B. S., et al.(2003). A randomized trial of a low-carbohydrate diet for obesity.The New England Journal of Medicine,348, 2082–2090PubMedCrossRefGoogle Scholar
  32. Garner, D. M., & Wooley, S. C. (1991). Confronting the failure of behavioral and dietary treatments for obesity.Clinical Psychology Review,11, 729–780CrossRefGoogle Scholar
  33. Golan, M., Wiezman, A., Apter, A., & Fainaru, M. (1998). Parents as the exclusive agents of change in the treatment of childhood obesity.American Journal of Clinical Nutrition,67, 1130–1135PubMedGoogle Scholar
  34. Goldfield, G. S., Epstein, L. H., Kilanowski, C. K., Paluch, R. A., & Kogut-Bossler, B.(2001). Cost-effectiveness of group and mixed family-based treatment for childhood obesity.International Journal of Obesity,25, 1843–1849PubMedCrossRefGoogle Scholar
  35. Gortmaker, S. L., Must, A., Sobol, A. M., Peterson, K., Colditz, G. A., & Dietz, W. H. (1996).Television viewing as a cause of increasing obesity among children in the United States, 1986–1990.Archives of Pediatrics and Adolescent Medicine,150, 356–362PubMedGoogle Scholar
  36. Graves, T., Meyers, A. W., & Clark, L. A. (1988). An evaluation of parental problem-solving training in the behavioral treatmenmt of childhood obesity.Journal of Consulting and Clinical Psychology,56, 246–250PubMedCrossRefGoogle Scholar
  37. Hedley, A. A., Ogden, C. L., Johnson, C. L., Carroll, M. D., Curtin, L. R., & Flegal, K. M.(2004). Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002.Journal of the American Medical Association,291, 2847–2850PubMedCrossRefGoogle Scholar
  38. Hill, J. O., Wyatt, H. R., Reed, G. W., & Peters, J. C. (2003). Obesity and the environment: Where do we go from here?Science,299, 853–855PubMedCrossRefGoogle Scholar
  39. Hoffman, R. P., Stumbo, P. J. E., Janz, K. F., & Nielson, D. H. (1995). Altered insulin resistance is associated with increased dietary weight loss in obese children.Hormone Research,44, 17–22PubMedGoogle Scholar
  40. Janssen, I., Katzmarzyk, P. T., Srinivasan, S. R., Chen, W., Malina, R. M., Bouchard, C.et al. (2005). Utility of childhood BMI in the prediction of adult disease: Comparison of national and international references.Obesity Research,13, 1106–1115PubMedCrossRefGoogle Scholar
  41. Jelalian, E., & Saelens, B. E. (1999). Empirically-supported treatments in pediatric psychology: Pediatric obesity.Journal of Pediatric Psychology,24, 223–248PubMedCrossRefGoogle Scholar
  42. Johnson, D. B., Gerstein, D. E., Evans, A. E., & Woodward-Lopez, G. (2006). Preventing obesity: A lifecycle perspective.Journal of the American Dietetic Association,106,97–102PubMedCrossRefGoogle Scholar
  43. Knip, M., & Nuutinen, O. (1993). Long-term effects of weight reduction on serum lipids and plasma insulin in obese children.American Journal of Clinical Nutrition,54,490–493Google Scholar
  44. Levine, M. D., Ringham, R. M., Kalarchian, M. A., Wisniewski, L., & Marcus, M. D.(2001). Is family-based behavioral weight control appropriate for severe pediatric obesity?International Journal of Eating Disorders,30, 318–328PubMedCrossRefGoogle Scholar
  45. Lowe, M. R. (2003). Self-regulation of energy intake in the prevention and treatment of obesity: Is it feasible?Obesity Research,11, 44S–59SPubMedCrossRefGoogle Scholar
  46. Ludwig, D. S., Peterson, K. E., & Gortmaker, S. L. (2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis.Lancet,357, 505–508PubMedCrossRefGoogle Scholar
  47. Myers, M. D., Raynor, H. A., & Epstein, L. H. (1998). Predictors of child psychological changes during family-based treatment for obesity.Archives of Pediatric and Adolescent Medicine,152, 855–861Google Scholar
  48. Perri, M. G., Mckelvey, W. F., Renjilian, D. A., Nezu, A. M., Shermer, R. L., & Viegener, B. J.(2001). Relapse prevention training and problem-solving therapy in the long-term managment of obesity.Journal of Consulting and Clinical Psychology,69, 722–726PubMedCrossRefGoogle Scholar
  49. Perri, M. G., Nezu, A. M., Patti, E. T., & McCann, K. L. (1989). Effect of length of treatment on weight loss.Journal of Consulting and Clinical Psychology,57, 450–452PubMedCrossRefGoogle Scholar
  50. Rees, J. M. (1990). Management of obesity in adolescence.Medical Clinics of North America,74, 1275–1292PubMedGoogle Scholar
  51. Robinson, T. (1999). Reducing children's television viewing to prevent obesity.Journal of the American Medical Association,282, 1561–1567PubMedCrossRefGoogle Scholar
  52. Rolls, B. J., Roe, L. S., Meengs, J. S., & Wall, D. E. (2004). Increasing the portion size of a sandwich increases energy intake.Journal of the American Dietetic Association,104, 367–372PubMedCrossRefGoogle Scholar
  53. Schmidt, U. (Ed.). (2002).Risk Factors for Eating Disorders(2nd ed.). New York: Guilford PressGoogle Scholar
  54. Senediak, C., & Spence, S. H. (1985). Rapid versus gradual scheduling of therapuetic contact in a family based behavioral weight control programme for children.Behavioural Psychotherapy,13, 265–287CrossRefGoogle Scholar
  55. Sondike, S. B., Copperman, N., & Jacobson, M. S. (2003). Effects of a low-carbohydrtae diet on weight loss and cardiovascular risk factors in overweight adolescents.Journal of Pediatrics,142, 253–258PubMedCrossRefGoogle Scholar
  56. Sothern, M. S., Udall, J. N., Suskind, R. M., Vargas, A., & Blecker, U. (2000). Weight loss and growth velocity in obese children after very low calorie diet, exercise, and behavior modification.Acta Paediatric,89, 1036–1043CrossRefGoogle Scholar
  57. United States Department of Agriculture. (2005).Dietary Guidelines for Americans,2005(6th ed.). Washington, DC: U.S. Government Printing OfficeGoogle Scholar
  58. United States Department of Agriculture. (1996). The food guide pyramid.Home and Garden Bulletin,252. Washington, DC: AuthorGoogle Scholar
  59. Valoski, A., & Epstein, L. H. (1990). Nutrient intake of obese children in a family-based behavioral weight control program.International Journal of Obesity,14, 667–677PubMedGoogle Scholar
  60. Wansink, B., & Cheney, M. M. (2005). Super bowls: Serving bowl size and food consumption.Journal of the American Medical Association,293, 1727–1728PubMedCrossRefGoogle Scholar
  61. Wansink, B., & Van Ittersum, K. (2003). Bottoms up! The influence of elongation on pouring and consumption volume.Journal of Consumer Research,30, 455–463CrossRefGoogle Scholar
  62. Whitaker, R. C., Wright, J. A., Pepe, M. S., Seidel, K. D., & Dietz, W. H. (1997). Predicting obesity in young adulthood from childhood and parental obesity. The New England Journal of Medicine,25, 869–873CrossRefGoogle Scholar
  63. Wing, R. R. (2002). Behavioral weight control. In T. A. Wadden & A. J. Stunkard (Eds.),Handbook of Obesity Treatment(pp. 301–316). New York: Guilford PressGoogle Scholar
  64. Wing, R. R., & Jeffery, R. W. (2001). Food provision as a strategy to promote weight loss.Obesity Research,9(Suppl.), 271–275CrossRefGoogle Scholar
  65. Wrotniak, B. H., Epstein, L. H., Paluch, R. A., & Roemmich, J. N. (2004). Parent weight change as a predictor of child weight change in family-based behavioral obsity treatment.Archives of Pediatrics and Adolescent Medicine,158, 342–347PubMedCrossRefGoogle Scholar
  66. Wrotniak, B. H., Epstein, L. H., Paluch, R. A., & Roemmich, J. N. (2005). The relationship between parent and child self-reported adherence and weight loss.Obesity Research,13, 1089–1096PubMedCrossRefGoogle Scholar
  67. Yin, T. J. C., Wu, F. L., Liu, Y. L., & Yu, S. (2005). Effects of a weight-loss program for obese children: A “mix of attributes” approach.Journal of Nursing Research,13, 21–29PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Hollie A. Raynor
    • 1
  1. 1.University of TennesseeKnoxville

Personalised recommendations