Psychologists at the forefront of weight management

Over the last few decades, the dramatic rise in paediatric obesity rates has emerged as a public health threat requiring urgent attention. The responsibility of identifying and treating eating and weight-related problems early in children and adolescents falls to health care providers and other professionals who work with the child, according to Professor Denise Wilfley and colleagues from the Department of Psychiatry at Washington University School of Medicine in the US. Furthermore, the key to successful treatment is a team effort involving providers and parents.

Wilfley's review of the causes, consequences, and early intervention of eating and weight-related problems in young people is published online in Springer's Journal of Clinical Psychology in Medical Settings. Wilfley and colleagues' paper highlights the important roles of mental health care providers in this effort.

The review examines the scope of the obesity problem, highlighting the dramatic increases in childhood obesity. The authors focus on the causes of eating- and weight-related problems in children and adolescents, attending to the complex interactions between environmental and biological factors, and dysregulated eating behaviours known as appetitive traits. In particular, the authors discuss binge eating and loss-of-control eating; satiety responsiveness or eating in the absence of hunger; motivation to eat; and impulsivity. For each trait, the authors identify screening approaches, as well as targeted intervention strategies that can be implemented by providers.

The authors find that, by far, the most effective strategies to combat childhood obesity are lifestyle behavioural interventions, and those involving the whole family in particular. Family-based behavioural interventions are considered the first-line of treatment for paediatric overweight, and weight maintenance interventions aimed at the socio-environmental context are indicated as well. These interventions promote small, successive changes in children's dietary and physical activity behaviours through the use of behaviour change strategies and familial support.

The authors conclude: 'Not only are there more obese children now than in the past, but the severity of overweight among these children is also much greater. The dramatic increase in paediatric obesity rates has created a mounting need for clinicians, psychologists, and other mental health care providers to play a significant role in the assessment and treatment of youth with eating- and weight-related problems.'