Although most teens who develop an eating disorder (ED) did not have obesity first, any attempt to treat obesity in this vulnerable population is likely to instigate an eating disorder. Pediatricians need an evidence-based set of guidelines to follow, so that teen obesity is treated with standardized guidelines while limiting negative outcomes.
Having obesity in your teen years puts you at risk for a number of “adult diseases,” including prediabetes, diabetes, hypertension, heart disease, and more. Getting a teen with obesity to lose excess weight is a health imperative, but teens can easily misconstrue what a “healthy diet or fitness habit” means. The messaging that parents, teachers, mentors, and especially pediatricians use as they navigate a discussion with a teenager managing obesity is quite a delicate matter.
Cultural issues also need to be addressed, as teen obesity rates among the Hispanic, American Indian, and African-American groups are trending even higher than Whites or other groups.
Teens are especially vulnerable to food messages. Hearing that certain foods are bad or unhealthy may lead to a teen cutting out entire food groups. A teen who begins to exercise and sees positive changes in his or her body, may start to exercise obsessively. Dietary restrictions can lead to fasting, starvation diets, and the use (and abuse) of laxatives and energy supplements (caffeine in particular). This can progress even further to self-induced vomiting, heavy use of diet pills and other extreme measures. (Anorexia and bulimia, incidentally, are incredibly resistant to treatment.)
Given these challenges, new Evidence-Based Management Strategies were issued to help healthcare providers, pediatricians, and teen-medicine specialists treat obesity while minimizing the risk of a sparking a eating disorder. The guidelines focus on a number of key areas.
Dieting typically addresses the concept of limiting calories. Most teens are still growing and developing, however, so dieting needs to take that physiological reality into consideration. Project EAT, an instructional eating program coupled with an observational study that followed over 2,500 teens for five years, showed a two-fold risk of teens becoming overweight after two years in the program and a 1.5 risk of the teen developing a binge-eating disorder after five years. Another published study showed that 9th grade teen girls who started dieting, without obesity present, were three times more likely to be overweight by the 12th grade, compared to non-dieters.
Family meals The positive benefits of family meals on children and teens’ weight, dietary choices and mental health is clear. There is not, however, clear scientific evidence that it can prevent obesity across all ethnic groups. Some studies show that more frequent family meals appear to encourage greater consumption of fruits and vegetables and may help to limit eating disorders among teens. Family meals also can allow parents to observe their teen’s eating habits.
Many teens already struggle with body image issues, as well as sudden growth spurts, pimples, and other bodily changes. Choose the wrong words when discussing obesity or weight issues and you can send a vulnerable teen spiraling out of control into serious overeating or undereating behaviors.
Any weight teasing that occurs can be devastating to a teen. Weight teasing can instigate further body dissatisfaction, a significant risk factor for disordered eating.
Ask a teenage boy or girl how they feel about their body and you are likely to hear a series of self-deprecating comments. One study showed that about half of teen girls and a quarter of teen boys are dissatisfied with their body image, and these numbers skew higher among overweight teens.
One technique that has been identified as a tool for doctors to use when treating patients with addiction and eating disorders, and now obesity, is motivational interviewing (MI), which helps to engage teens appropriately; focuses on specific, healthy changes; encourages discussion of the need for change; and helps teens plan for the change. Involving parents and focusing on lifestyle changes (more family meals, less TV time, family menu planning, etc.) are also key to helping teens navigate a balanced and safe treatment program.
The new guideline recommendations to the pediatrician treating a teen diagnosed with obesity include:
Discourage dieting, skipping meals and other unhealthy behaviors in favor of healthy eating and physical activity. "Live healthy" is the message
Encourage positive body image by selecting messaging carefully and thoughtfully
Make family meals a priority
Spend time with parents to make them understand that "weight talk" is not beneficial
Investigate any history of mistreatment or bullying
Make sure to monitor teen weight so any dramatic changes in weight can be discussed. This will help to limit the likelihood of an eating disorder developing