Early intervention of eating- and weight-related problems

Abstract

Obesity and other eating-related problems are widespread and are associated with harmful physical, psychological, and social problems. The dramatic increases in rates of pediatric obesity has created a mounting need for 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. Therefore, it is imperative for providers to be aware of the causes and consequences of eating- and weight-related problems and to be familiar with evidence-based assessment and intervention approaches. Currently, the most well-established intervention approaches are family-based behavioral treatments, and weight loss maintenance treatments with a socio-ecological focus are promising. This paper provides a comprehensive review of these topics and highlights the important roles that mental health care providers can have. Medical settings are often the patient's first point of contact within the healthcare system, making mental health care providers in such settings uniquely suited to assess for a broad range of eating- and weight-related problems and associated comorbidities, to deliver relevant evidence-based interventions, and to make appropriate referrals. Moving forward, providers and researchers must work together to address key questions related to the nature of eating- and weight-related problems in youth and to achieve breakthroughs in the prevention and treatment of such problems in this vulnerable population.

Fig. 1

Behavioral susceptibility theory of obesity. An individual’s weight status is determined by the overall energy balance between energy intake and energy expenditure. Individual and environmental factors influence energy-balance behaviors through direct channels (e.g., individuals who binge eating consume excess energy) and through complex interactions (e.g., individuals who have a high motivation to eat may seek out environments with easy access to unhealthy foods). The figure depicted is adapted from Carnell and Wardle (2008), Proceedings of the Nutrition Society

Fig. 2

Interplay among appetitive traits. Appetitive traits are similar in that they are associated with dysregulated eating behaviors that make it more difficult to for individuals to initiate eating only when they are hungry and/or terminate eating when they are full. Studies reveal overlaps in appetitive traits, which likely increase risk for excess weight gain and obesity. The figure indicates the relative prevalence rates of each appetitive trait found in children. Further work is warranted to elucidate the precise rates of each trait in youth. The figure depicted is adapted from Carnell and Wardle (2008), Proceedings of the Nutrition Society, (c) Cambridge Journals, reproduced with permission

Fig. 3

Socio-ecological model of weight regain. Reprinted with permissions from Wilfley et al., 2010

Fig. 4

Enhanced social facilitation maintenance treatment: A social-ecological model. Reprinted with permissions from Wilfley et al., in press