It is important to involve the entire family when working towards the goals of weight loss or obesity in children. Studies have illuminated that there exists a familial aggregation of risk factors for obesity, and the family provides the child's major social learning environment. Studies have further demonstrated that the long-term (10-year) effectiveness of a weight control program is significantly improved when the intervention is directed at the parents as well as the child, rather than aimed at the child alone.
Patience and perseverance in dealing with overweight children
If a child fails to lose weight despite what appears to be adequate treatment, it is important to refrain from disparaging remarks or accusing the child of cheating on the diet or misreporting physical activity. Many of these children have already experienced several perceived failures in their lives, and an unsuccessful attempt to lose weight should not be added to their emotional burden. Remember that children and adolescents require a great deal of encouragement in general, and obese children require even more encouragement.
The treatment of obesity in children, like the treatment of obesity in adults, is expensive, lengthy and generally only effective if the whole family is involved, and even then it is not curative. Weight awareness is essential. Obesity, determined partially by genetics and partially by the environment, may best be considered a chronic disease. The increase in overweight problems and obesity in the United States (and a similar increase in other countries as their economies develop) is not caused by a change in the gene pool of the population, but rather by changes in the environment that have caused genetically susceptible people to develop the obesity problem in increasing numbers.
A nationwide population-based approach to weight awareness and the prevention of childhood obesity is becoming critical. Increasing physical activity and practical nutritional knowledge through weight awareness is paramount. This knowledge or education should be available at home, in schools and through extracurricular programs. This should be an obvious first step that may require legislative action.
A public service campaign is needed to combat the overwhelming messages of caloric and fat intake bombarding children at every turn; during one hour of watching cartoons, a young child might see advertisements for more than enough calories, fat and sodium than is appropriate for an average adult male to consume in 24 hours. Advertisements for children to resist inappropriate food choices and for their parents to avoid pressure from their children to buy this undesirable food could be modeled after the successful antismoking campaigns targeted at young persons.
With no safe, effective pharmacologic agent on the horizon, there is no easy answer to the treatment of childhood obesity. The prevention of this condition is a daunting task, but we cannot remain complacent and expect all overweight children to "outgrow it," or we might find ourselves facing even more alarming statistics in 20 years as we look back to the "good old days" at the end of the 20th century when the incidence of childhood obesity was only 22 percent.
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