Childhood Obesity (Holistic)

Excessive weight in children and adolescents is becoming an increasingly serious problem.^{1, 2} In the United States, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years are overweight, and among adolescents the percentage is three times higher than it was 20 years ago.³ Major contributors to childhood obesity include genetics, unhealthy diets, and sedentary lifestyles.^{4, 5} Overweight children often become adults with weight problems that contribute to a wide variety of health problems,^{6, 7} but even during childhood and adolescence, overweight can contribute to such disorders as type 2 diabetes, high cholesterol, high blood pressure, insulin resistance, and liver disease.^{8, 9, 10} Being overweight also has social and psychological consequences for children in terms of social discrimination, poor self-esteem, and depression.^{11, 12}

Parents, family members, and others who are important people in a child’s life can either help or harm an obese child’s situation. As with all children, those with weight problems need acceptance, support, and encouragement from their family, and the eating, exercising, and other health habits of family members play important roles in influencing the same behaviors in children.^{13, 14}

The proper weight for a growing child or adolescent should be determined with the help of a doctor or other qualified health professional, who can also determine whether any unusual medical problems might be contributing to weight gain, whether any current health problems exist that are related to overweight, and appropriate weight control methods. Treating obesity should not include overly restrictive or fad diets that are missing essential nutrients. In fact, weight loss is not necessarily appropriate for a growing child. Often the best goal for an overweight child is to maintain their current weight as they grow taller.

Lack of physical activity is considered a significant contributing factor in childhood obesity.¹⁵ However, while the results of treatment of overweight children are usually enhanced by strategies to increase physical activity or decrease inactivity, attempts to improve physical activity levels have not been very successful in preventing childhood obesity according to most controlled research.¹⁶ Nonetheless, watching television and playing computer or video games contributes to the sedentary lifestyle of many children, and controlled research has shown that weight control is more successful when these activities are controlled and healthier alternatives provided.^{17, 18, 19} Children are recommended to get at least an hour of moderate physical activity most days of the week, and more may be necessary to offset genetic and other influences. Fun activities that involve other family members or other children will help make getting more exercise a positive experience.²⁰

Weight-loss efforts that involve excessive restriction of calories or protein can inhibit a child’s ability to gain lean body mass (such as muscle) during the normal growth process. Consequently, weight-loss diets for children should not be excessively restrictive. In addition, an appropriate exercise program can be a useful addition to a low-calorie diet for overweight children. A controlled trial found that strength training, when added to a low-calorie diet, resulted in a greater gain of lean body mass (while still promoting weight loss), compared with diet alone in obese children.²¹ Another study of obese adolescents found that a physical exercise program combined with normal calorie intake resulted in reductions in body weight and body fat while allowing for normal growth and preservation of lean body mass.²²

Behavior-change techniques are considered useful for helping people break old habits and form more healthful habits. These techniques may be learned from counseling professionals, support groups, educational programs, or books. Many controlled studies have investigated various methods for using behavior-change techniques to prevent or treat childhood obesity, with several reporting success at reducing overweight compared with either no treatment or with conventional weight-loss approaches.^{23, 24, 25}

Parental involvement in the treatment of childhood obesity is considered important for success, especially when parents are given adequate training in a wide range of behavior-change techniques that can be applied to the entire family.²⁶ Limited research suggests that training parents alone is superior to training either children alone or training both parents and children.^{27, 28, 29} Some authorities suggest that training parents alone produces the best results because this avoids affecting the child’s self-esteem and willingness to change, which might result from labeling him or her as “the patient.”^{30, 31}

Problem-solving techniques are used in some types of counseling to help people maintain changes in their behavior. In one controlled study, teaching problem-solving techniques to parents in addition to behavior-change techniques improved weight loss results in obese children compared with a group learning only behavior-change techniques.³² However, another controlled study found no additional benefit when problem-solving training was given to either the child or to both child and parent.³³

For support and information, parents can also try the following resources:

• The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents (www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm)
• How Parents Can Fight the Obesity Epidemic (www.med.umich.edu/1libr/yourchild/fightobesity.htm)
• Shapedown for Parents, Kids & Teens (www.shapedown.com/page2.htm)