Weight gain also has many adverse side effects on a person's psychological well-being. For instance, a study by Rumpel and Harris12 looked at a nonobese population of women and found that of those women who gained 11 pounds or more, a greater number were likely to have decreased feelings of well-being and higher negative affect.13 In addition, self-esteem and body image is a predominant struggle in obese children. Self-esteem is closely linked to weight and body image: the more severe a child's obesity, the lower his self-esteem. Two studies found that when body image was controlled for, self-reported self-esteem levels were not significantly lower in the obese population compared with healthy controls8,14; however, that is not to say that there is no link between obesity and body image.
Often obese children are criticized and teased by their peers. This negative stigma creates lower self-esteem and is thought to be a contributor to body dissatisfaction in later life.3 In addition, self-esteem tends to vary based on gender. It has been reported that females are at greater risk for self-esteem problems since body image has more important social implications for young girls than for young boys.3 More important, constant dieting may lead to lower self-esteem in both adolescent and younger girls because of the cyclic nature of losing and regaining weight.3 In terms of treatment, the succession of gaining and losing weight is particularly problematic since the fluctuations can be emotionally draining.
The most important factor for the successful treatment of obesity is a person's willingness to change his lifestyle. Family support, especially in children, tends to facilitate a successful weight loss program. Parental lack of concern that their child is overweight and parental belief that the child will never be able to shed the excess weight are clear indications that a weight-management program will be unsuccessful.4 Parental involvement and support are essential when treating obese children.
Current research suggests that children with active parents are 6 times more likely to be physically active themselves.15 According to the Expert Committee on Obesity Evaluation and Treatment, healthy eating and physical activity are essential for any weight-management program to be successful. It is imperative to understand that being physically active and eating wholesome foods may be learned behaviors and that eating and exercise patterns can therefore be changed. As previously stated, family influence and support, whether it is optimal motivation or the entire family changing eat-ing habits and activity levels, is critical to weight loss success.4 Additional behavioral treatments include goal setting, self-monitoring, and the development of skills for managing high-risk situations.3
The study by Barlow and colleagues1 designed to recognize different types of obesity treatments used by health care providers reported a large variety of intervention methods. Most commonly reported in children was the use of a minimally restrictive intervention, in which specific foods were limited. Many of the physicians who responded to the questionnaire reported frequently referring their young patients to registered dietitians. These professionals may be useful in treating obesity in children; they provide an additional resource to primary care physicians and possess the counseling skills and time necessary to establish a unique dietary program based on the individual needs of the child.1
An FDA-approved pharmacologic approach for sustained weight loss in children is still needed. Studies suggest that more weight is lost with pharmacologic agents than with behavioral treatments, but the weight is gained back once treatment is discontinued.3 Serotonin and norepinephrine(Drug information on norepinephrine) reuptake inhibitors, as well as medicines that affect the dopamine(Drug information on dopamine) system, are being investigated. As reported by Zametkin and colleagues,3 "topiramate, zonisamide(Drug information on zonisamide), felbamate(Drug information on felbamate), and bupropion have been [found] to cause weight loss in adults," but further research on the effects of these drugs needs to be done before they can be administered to children.
Adults who underwent gastric bypass surgery for obesity have demonstrated enhanced self-esteem, improved social relationships, and more confidence in their appearance. However, many reported poor acquiescence with dietary and exercise instructions after the surgery. Although research suggests a decrease in weight, gastric bypass surgery for obesity is a risky procedure marked by a high complication rate.16
There is an abundance of literature on the treatments for pediatric obesity that goes well beyond the latitude of this article. Two additional pediatric reviews that expand on treatments for obesity are articles by Epstein and colleagues17 and Jelalian and Saelens.18