While the need for obesity prevention is clear, intervention will be necessary for the millions of children and adolescents who are already overweight and the millions more who will develop weight problems in the coming years.  Fortunately,  the treatment of pediatric obesity is a growing area of research, and much important work has already been done (Black & Young-Hyman, 2007). Interventions often employ behavioral or cognitive-behavioral approaches to bring about behavior change with a specific focus on changing diet and exercise habits. Recognizing the role of the family in children’s and adolescents’ habit formation, many intervention programs incorporate family elements and attempt to use parents as role models for positive behavior change (Germann,  Kirschenbaum,  &  Rich,  2007; Johnston & Steele, 2007).

A plethora of laboratory-based (i.e., efficacy) studies have been conducted,  identifying promising intervention strategies for addressing weight problems in children (Becque,  Katch,  Rocchini,  Marks,  &  Moorhead, 1988; Epstein, Valoski, Kalarchian & McCurley, 1995; Holtz, Smith & Winters, 1999).

Fewer examinations of such treatments in “real-world” settings (i.e., effectiveness studies) have been completed (Jelalian, Wember, Bungeroth & Birmaher, 2007); however, such investigations are beginning to emerge in the literature (Johnston & Steele, 2007). Similar to other areas of child treatment, the next step for pediatric obesity intervention research will be to demonstrate effectiveness in typical clinical settings and disseminate effective programs widely (see Clinical Treatment and Services Research Workgroup, 1999 for discussion of efficacy, effectiveness, and dissemination research).

EARLY RECOGNITION
Routine assessments of eating and activity patterns in children and recognition of excessive weight gain relative to linear growth are essential throughout childhood. At any age, an excessive rate of weight gain relative to linear growth should be recognized, and underlying predisposing factors should be addressed with parents and other caregivers. The Centers for Disease Control and Prevention percentile grids for BMI are important tools for anticipatory guidance and discussion of longitudinal tracking of a child’s BMI. Significant changes on growth patterns (eg, upward crossing of weight for age or BMI percentiles) can be recognized and addressed before children are severely overweight. An increase in BMI percentiles should be discussed with parents, some of whom may be overly concerned and some of whom may not recognize or accept potential risk.

Although data are extremely limited, it is likely that anticipatory guidance or treatment intervention before obesity has become severe will be more successful. Discussions to raise parental awareness should be conducted in a nonjudgmental, blame-free manner so that unintended negative impact on the child’s self-concept is avoided. Data from adult patient surveys indicate that those who were asked by their physician about diet were more likely to report positive changes. Similarly, the efficacy of physicians discussing physical activity, breastfeeding, and smoking prevention is well documented. Thus, pediatricians are strongly encouraged to incorporate assessment and anticipatory guidance about diet, weight, and physical activity into routine clinical practice, being careful to discuss habits rather than focusing on habitus to avoid stigmatizing the child, adolescent, or family.

About This Volume

While the statistics describing the pediatric obesity epidemic are sobering, they do not fully convey the costs—physical, psychological, and economic—associated with this problem. Likewise, estimates of prevalence fail to capture the challenges of attempting to reverse these alarming trends.

The problem, however, has not gone unnoticed and important research into the causes, correlates, and treatment of pediatric obesity is available.

This manual aims to concisely present relevant parts of that literature and contribute to the discussion about weight problems in children.

Furthermore, we hope this section will encourage further research aimed at addressing the rising pediatric obesity epidemic.

Toward this end, the section is divided into six sections. The first provides an overview of the prevalence, correlates, and consequences of pediatric obesity, including current and long-term secondary health conditions and associated mental health conditions.  Of particular use to policy-makers, administrators,  and public health professionals,  this section lays the foundation for the scope of the problem as well as the areas of functioning that obesity affects.

The second section focuses on assessment issues related to the onset and maintenance of pediatric obesity. The sections specifically address definitions and measurement of obesity in children (with particular attention to how these differ from those of adults) as well as assessment of children’s and adolescents’ dietary practices and eating attitudes and behaviors.  We see these sections as being of particular practical importance to health care providers, educators, and prevention specialists.

However, in addition to the practical aspects of this section, the sections speak to measurement issues that will facilitate further research on evidence-based therapies for children and youths with weight management issues.

Building on appropriate assessment techniques,  the third section examines factors that pose specific risks for the development of obesity in children. Of particular interest are sections that focus on the interaction of physiological and genetic factors with environmental components.

Because children from lower-income groups tend to be at increased risk for obesity,  Chapter 9 (Goodman)  specifically addresses socioeconomic risks for childhood obesity.

Getting to the heart of efforts to curb the growing epidemic,  the fourth and fifth sections specifically address issues related to prevention and intervention. They cover practices and programs that have demonstrated efficacy/effectiveness in addressing pediatric overweight.  Of particular note,  sections in these sections highlight specific variables that may affect the degree to which interventions are accepted by diverse samples as well as intervention and prevention efforts aimed at various levels of implementation (e.g., home, school, community).

The manual concludes with a section on future directions in pediatric obesity research and practice. Chapters examining innovative or emerging treatment techniques will provide clinicians with novel approaches for their clients and will provide researchers with directions for further study.

Overall, the section provides a comprehensive overview of the multidimensional and complex nature of pediatric obesity, with attention to evaluation, psychosocial and medical correlates,  prevention,  and intervention strategies; it has information relevant for clinicians, policy-makers, and researchers alike.  Specifically,  we anticipate that the section will provide an up-to-date and concise synthesis of rapidly growing prevention and intervention literatures, allowing clinicians to place their practices on a strong research base and policy-makers to move beyond rhetoric and toward evidence-informed decisions in the larger socioecological systems. Further, we expect that the section will be useful to researchers in identifying important directions for future study while placing new investigations within the context of what we already know about pediatric obesity.

CONCLUSION
The prevalence of pediatric obesity has increased tremendously over the past two decades across all demographic groups and ages. As a result, health-related conditions once thought of as “adult diseases” are becoming more prevalent in children and adolescents, and psychosocial sequelae for children and youths continue to be identified. As detailed throughout this volume, no single factor is responsible for the growing epidemic and the resulting health and mental health consequences; a number of factors at a variety of socioecological levels have contributed independently and in concert with other factors. Solutions to the nation’s pediatric obesity epidemic must be similarly multifaceted. This volume is offered with the hope of bringing together clinicians, educators, researchers, administrators,  and policy-makers to create such solutions.

REFERENCES

Elissa Jelalian, Ph.D.
Warren Alpert Medical School of Brown   University
Providence, RI USA
Elissa_Jelalian {at}brown.edu