The number of children and adolescents struggling with significant weight problems and obesity is growing at an alarming rate. In the past thirty years, the number of obese children and adolescents has more than tripled as nearly 22 million children around the world are classified as either overweight or obese. This dramatic increase has resulted in serious medical consequences with 45% of all newly diagnosed type-2 diabetes cases being children or adolescents and ever-increasing numbers of children being diagnosed with hypertension, cardiovascular problems, and sleep apnea due to overweight and obesity
The causes of Obesity
Despite ongoing efforts among health professionals to address this epidemic, the number of children who are obese continues to rise with no indication of improvement. While some researchers stick to only one theory, most insist that obesity is multidimensional and involves physical aspects, such as genetics and metabolism, as well as psychological issues and environmental conditions. Childhood obesity may be best conceptualized as a combination of family, social, and individual experiences that interact and impact one another.
The family environment is where children first experience the social world: the place and time where they develop a sense of self and explore their prospects for the future. Subsequently, these early years is a critical period for the developing child, and the messages that the family provides surely shape and direct that child. Some developmental theories argue that obesity begins in infancy where food is used to reduce stress, which ultimately becomes a learned coping behavior used in childhood. For children overwhelmed by chaotic family dynamics and lacking resilience, food consumption becomes a means of emotional survival, which results in disturbed eating patterns throughout a child’s life.
Divert of attention
Some theories explore the possibilities of why the family came to need and then maintain the overweight member. They believe an obese child is psychosomatic for deeper lying problems in the family and the child unconsciously takes on the role of diverting attention away from any dysfunctions in the interaction thereby protecting the family. The family members are then trapped into an inflexible way of interacting with one another and have difficulty resolving conflict. In this model, the family is as responsible as the individual for obesity because the family is where basic development occurs and understanding of society begins.
The family scapegoat
Family dynamics may be made considerably more complex by the presence of an obese child. Families with an obese child may be perceived as dysfunctional or emotionally detached. Parents may be exceptionally stressed with time and financial factors specifically related to having an obese child, such as numerous doctors’ appointments and requisite medications. How the family copes with the emotional realities and possible psychological disorders of the obese child can also alter how the family functions. Obese children may even be assigned the role of the family scapegoat and receive a disproportionate amount of undeserved blame.
The consequences of critique and negative attention
The comments that parents make related to weight may further enhance the problems of the obese child. When one parent is overweight and that condition is focused on and repeatedly addressed by the other parent, it creates an environment that can negatively affect the child. The child may identify strongly with the parent who is being criticized and feel attacked as well. The child may also believe that he or she is also at risk of being confronted if he or she does not conform to the verbalized norm. Parents who cling to stereotypical social standards of appearance may promote dieting for themselves and their children, which may result in increased body dissatisfaction in adolescence. Furthermore, studies has shown that overweight and obese children are nearly 300% more likely to consider suicide as an option in homes where family members tease their children about weight, regardless if they are also teased by peers.
Weight problems runs in the family
Children struggling with obesity and weight problems frequently come from homes where one or both parents are struggling with significant weight problems. In research with obese mothers, though nearly all of the mothers acknowledged their own obesity, only 20% correctly recognized that their children were obese, and of the mothers that did consider their children overweight, only 67% expressed a concern about it.
Less educated obese mothers had the biggest difficulty identifying their children as being overweight and were less aware of the health risks associated with excess weight. In a recent study, mothers of obese preschoolers did not measure their child’s size by growth charts. Instead, they believed that if their child was bullied for his or her size at school then he or she was overweight; however, as long as the child’s size did not impact his or her activity, then the mother was not concerned about the child’s weight. These mothers also reported having difficulty adhering to and continuing a healthy food plan for themselves and their children.
Culture and environment
Children and adolescents struggling with excess body weight are often captives of environmental factors beyond their control that support an unhealthy lifestyle and foster inappropriate messages about food consumption and body image. Sociocultural factors such as ethnic identity may promote overeating. In some cultures being overweight is not viewed as a negative body characteristic, and shopping within the local community despite the lack of healthy food is seen as an obligation, as well as gratifying children with food is considered a characteristic of responsible and good parenting.
Psychosocial consequences of obesity
Overweight children and adolescents face problems related to stigma, including depression, teasing, social isolation and discrimination, diminished self-esteem, behavioral problems, dissatisfaction with body image, and reduced quality of life. It is not always clear whether depression is the cause or the result of obesity; both relationships may be true. Prospective studies have revealed that obese adolescents are at risk for major anxiety and depressive disorders later in life. When obesity becomes chronic, the failure to control weight gain over an extended period may predispose affected children to depression. The longer a child is overweight, the greater the risk for depression and other mental health disorders and the less is the motivation to change.
There are several different family-based treatments designed to address weight problems and obesity. Behavior modification programs focusing on the family dynamics have shown to be effective in terms of weight loss and maintenance. Behavioral interventions are based on the principle that the overeating is a learned behavior and can, subsequently, be modified. Research has indicated that “pressuring” the child is particularly ineffective and can initiate overeating, and that children respond more favorably to positive reinforcement strategies, which emphasize healthy eating that results in “feeling and looking good”.
Enhancing the community feeling
Family-based interventions that promote the parent as the regulator of food and exercise have some advantages. This approach requires involvement of the family as a whole and particular initiative on the part of the parent. While intensive family behavior treatment may not be feasible for some obese children and adolescents, further education for parents in the reduction of inactive behaviors and the importance of balanced nutrition may be utilized. When we create a positive communal eating experience, valued by the family, it helps to decrease depressive symptoms in overweight adolescents.
Parenting plays a pivotal role in promoting healthy active living and in managing childhood/adolescent obesity. The following parental responsibilities are particularly important: good role-modeling, setting limits, purchasing healthy food, keeping healthy family routines (e.g. eating meals and exercising together), effective time and money management, and ensuring that a divorce or separation remains as non-traumatic as possible.
So while the design and implementation of family-based treatments vary, family involvement and positive support remain a viable form of intervention.