New AAP Guidance on Avoiding Teen Obesity, Eating Disorders

Veronica Hackethal, MD

August 23, 2016

The American Academy of Pediatrics (AAP) has issued new evidence-based guidance for healthcare providers on how to help teenagers avoid obesity and eating disorders. The report focuses on parental involvement in promoting healthy eating and exercise, rather than unhealthy weight control efforts.

"Family involvement in the treatment of both adolescent obesity and EDs has been determined to be more effective than an adolescent-only focus. An integrated approach to the prevention of obesity and EDs focuses less on weight and more on healthy family-based lifestyle modification that can be sustained," write co–lead author Neville Golden, MD, from Stanford University in California, and colleagues.

The new guidance was published online August 22 in Pediatrics.

During the last 3 decades, teenage obesity has quadrupled. About 35% of teenagers may currently be overweight or obese, with Hispanic, American Indian, and African-American youth disproportionately affected, according to the authors. Although recent data suggest these rates may be stabilizing, they remain concerning, as obesity is associated with increased risk for later health problems, including diabetes and heart disease.

At the same time, eating disorders represent the third most common chronic problem in teenagers, after obesity and asthma.

The AAP report addresses recent concerns about a link between weight control efforts and disordered eating in teenagers and stresses that properly conducted obesity prevention does not promote eating disorders in teenagers.

It describes behaviors associated with both obesity and eating disorders in teenagers, including:

  • Dieting: A risk factor for both obesity and eating disorders.

  • Family Meals: Linked to improved diet quality, family meals provide an opportunity for parents to model healthy eating behavior.

  • Weight Talk: Comments by family members about their own weight or their child's weight have been linked to eating disorders; focusing on healthy eating rather than weight may improve unhealthy eating behaviors.

  • Weight Teasing: Linked to unhealthy weight control behaviors and binge eating.

  • Healthy Body Image: Body image dissatisfaction is a risk factor for eating disorders, whereas a positive body image has been linked to fewer weight control behaviors.

A sustainable approach to the prevention of obesity and eating disorders may include focusing less on weight and more on healthy lifestyle modification within the family, according to the report.

Healthcare providers can help teenagers by including constructive advice about weight management during clinic visits, discouraging unhealthy eating behaviors like skipping meals, and supporting healthy living. They can promote a positive body image by avoiding weight-based language. Providers should also enquire about mistreatment and bullying. They can involve the family by encouraging family meals and advising families to focus on healthy eating and exercise.

Finally, the report recommends motivational interviewing, a collaborative communication style aimed at increasing personal motivation to change, to improve outcomes when counseling about weight management.

"Time constraints in a busy pediatric practice are significant. Weight issues can be a topic of sensitivity and therefore can be time consuming. The evidence-based suggestions in this report can be implemented in relatively brief encounters and can be an excellent first step for teenagers and families to promote a healthy lifestyle," the authors conclude.

The report provides a table of high-risk eating activity behaviors and concerning clinical findings, as well as a table listing the principles of family-based therapy in eating disorders. Providers can use the AAP Web and mobile app "Change Talk" to train on motivational interviewing.

The report received no external funding. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 22, 2016. Full text

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