up, we had more opportunities for free play. Our neighborhoods tended to be safer, and usually someone
was at home, supervising our activities. These activities typically did not include the increasing
sedentary activities we have today (multiple television stations, computers, Internet, and video games).
We spent more of our time engaging in activities that burned more calories — bike riding, playing
chase, climbing trees. Most families ate a home-cooked meal every night. The rate of childhood obesity
was 5 to 10%. Now, about 15% of children are considered overweight or at risk for overweight.
Environmental factors may contribute as much as 80% to the causes of childhood obesity.
These factors include increased caloric and fat intake (e.g., energy-dense foods and beverages,
irregular meal patterns, snacking and dining out, and sedentary behaviors, such as television viewing
[1,2]) and absence of regular physical activity [3]. Research indicates that obese children demonstrate
decreased levels of physical activity and increased psychosocial problems.
It is well accepted that the environment of the family plays a key role in the development of
obesity in young children at risk for adult obesity and related diseases such as diabetes [4–7].
Research shows that parent inactivity strongly predicts child inactivity [6]. Moreover, the exercise
patterns of parents have a strong influence on the frequency of exercise in their children [8].
Research also shows that parental influences are early determinants of food attitudes and practices
in young children [9]. Furthermore, food preferences greatly influence the consumption patterns
of young children [10]. Therefore, strategies that positively alter the behaviors and environment of
the family may reduce the risk of adult obesity and diabetes by improving physical activity and
nutrition. This may prevent the onset of pediatric obesity and the risk of metabolic disease later in
life, especially in those children with primary risk factors (at risk). Efforts to halt and reverse
obesity and related metabolic disease, therefore, should begin with young children. More important,
educational interventions that target the parents of children at risk for obesity should be an integral
part of standard pediatric and family medical care.
The health consequences of children’s being obese are significant. Obese children are more
likely to develop cardiovascular disease (high cholesterol, hypertension), glucose intolerance (which
may lead to diabetes), gallstones, and psychological problems, to name a few. The most serious
and prevalent long-term consequence of childhood obesity is psychosocial. Obese children are
targets of early and systematic discrimination by peers, family members, and others. Obese children
frequently have low self-esteem and social isolation and can become depressed. One of the best
reasons to treat childhood obesity is to reduce the psychosocial consequences.
The most successful approach to treating childhood obesity is through a multidisciplinary (medical,
nutritional, psychological, physical activity), family-based approach [11]. Such approaches teach
both the overweight child and his or her family how to lead a healthier lifestyle to promote the
achievement of a healthier weight. Interventions are best delivered in a group family setting.
However, the combination of medical supervision, dietary guidance, promoting increased physical
activity, and behavioral counseling should be promoted in the individual medical care of overweight
youth, as well. Unfortunately, although the number of obese pediatric patients seen by physicians
each year is continuously increasing, knowledge of effective treatment techniques is lagging.
Recently, Story and others identified a lack of parent involvement and motivation and lack of
support services as the most frequent barriers to treatment of pediatric obesity in clinical settings [12].
Even though obesity is recognized by the majority of health care professionals as a serious,
chronic disease, they feel unprepared to address the multidimensional aspects of the obesity
problem. Studies indicate that health care professionals believe that childhood obesity requires
immediate medical attention and treatment [12]. However, many of their treatment practices are
not in accordance with current expert recommendations [13]. This was evidenced when a survey
of providers identified perceived low proficiency in the use of behavioral management strategies,
guidance in parenting techniques, and addressing family conflicts [12]. Moreover, providers feel
they lack expertise in motivational skills to promote change in dietary and physical activity patterns
[14]. Despite these findings, behavioral therapy has been shown to be effective, even when done
briefly. The Worcester Area Trial for Counseling in Hyperlipidemia study is an example of how
brief counseling in adults can provide positive results in weight loss [15]. During the study,
physicians were given 8 minutes with each patient. Study patients either received counseling alone
(control) or counseling combined with handouts and questionnaires concerning dieting (treatment)
while in the waiting rooms. A year later, treatment patients were found to have lost 2.3 kg more
than the control and, as a benefit of that loss, lowered their cholesterol by 3.8 mg. Still, physicians
rarely feel that a great difference can be made in the behavior of the families through the use of
individual counseling [15]. This is caused by a lack of both training and experience of physicians
in the area of counseling interventions. Another factor affecting this lack of enthusiasm in physicians
is that many feel “ill-equipped” to handle behavioral issues [15,16], and that such issues are out
of their area of interest [15]. Moreover, because of time constraints, physicians in primary care
especially are conflicted, with heavy workloads combining with a strong work ethic to give the
best care to their patients. Finally, a lack of incentives offered to physicians is another factor that
reduces physician counseling in weight management [15]. However, physicians play a vital role to
the safety and effectiveness of weight loss and maintenance interventions in children.
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