Evidence-Based Treatments for Childhood Obesity

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.).