Overweight youth: Changing behaviors that are barriers to health

My child doesn’t have a weight problem. We’re a family of big eaters, that’s all.” If you’ve heard this explanation or ones like it after raising a concern about a child’s weight, chances are you will encounter barriers to recognizing obesity and to changing the behavior that encourages it.

Even when parents and a significantly overweight child or adolescent acknowledge the problem, they may not achieve goals for good nutrition or activity. Treating childhood obesity requires identifying and removing the barriers to change.

In this paper, we identify 3 domains of weight management barriers—family, personal, and sociocultural—and offer possible solutions for dismantling the barriers.

Barriers to weight loss

Family: When parents make poor choices

Ideally parents would model a healthy lifestyle, provide a supportive home atmosphere, and reduce family stressors to facilitate weight reduction. However, parental behavior—even when well intentioned—often interferes with what’s best for the child.

For more original research on weight problems in children, see “Detecting overweight children in primary care: Do national data reflect the typical urban practice?”

If parents make inadequate nutritional choices and have a sedentary lifestyle, their children will mimic them. In fact, parent self-report of activity accounted for some of the variance in overweight youth’s physical activity.¹

Parents’ food choices and purchasing behaviors may affect how their children purchase both healthy and unhealthy foods.² Regular family mealtimes with nutritious foods will help adolescents learn to make more positive dietary choices and adopt healthy behaviors.³

In addition, the weight of mothers and fathers influences the weight of their children,^4-6 and parent obesity is associated with less physical activity among children.^7,8

Parental disciplinary strategies also affect children’s behavior. Authoritarian parents tend to engage in a battle of wills with children, creating standoffs—eg, when children are forced to sit at the table for hours to try fruits and vegetables or other new items.⁹

Authoritarian parenting was associated with the highest risk of overweight among young children.¹⁰ However, parental control of food intake and structured planning of healthy behaviors is not always negative.^11,12

Parents often do not see their children as overweight even when they are. Parents may actually view heavy children as being healthy and a sign of successful parenting.^4,13 They may use terms such as “thick” or “solid” rather than “overweight.” Some parents acknowledge weight problems only if their child is the object of teasing or exhibits physical limitations.¹⁴

Deflected responsibility. Furthermore, parents often attribute weight difficulties to an inherited propensity, citing multiple overweight family members while disregarding the influence of the home environment on weight status.¹⁵

Personal barriers: A need for empowerment

In a behaviorally oriented weight-control program for youth, significant predictors of weight loss were the child’s beliefs regarding personal control over weight, perceived difficulty of losing weight, attribution of obesity to their medical problems or family problems, and perceived willingness of family members to diet.¹⁶

Sometimes motivation is lacking. The importance of motivation in getting obese children to exercise is well established.^7,17 Inaction may be due to a lack of information or to insufficient maturity to see that change is needed to protect health.

Psychosocial problems are more prevalent among overweight youth than among their peers at normal weight.¹⁸ In the past 10 years, published research on the psychiatric aspects of pediatric obesity shows increased rates of depression, anxiety, and low self-esteem,¹⁹ which can be significant barriers to change.²⁰ Emotional difficulties can increase distress that contributes to binging and overeating,¹⁹ limit physical activity, and impair motivation to change by increasing helplessness and hopelessness.^20,21

Comorbid physical conditions can affect activity goals (juvenile arthritis, hemophilia, asthma, etc) or dietary goals (diabetes, food allergies, etc).

Limited knowledge about nutrition and exercise can hinder behavioral change. Weight management goals, for instance, are often too broad or vague to be of help to children and their families. They need specific details. Much of the public misunderstands important nutritional concepts—portion size, balanced meal, metabolism, healthy eating, and low fat. For example, children believed a food product labeled “diet” was healthy.