Mental health professionals – psychiatrists, psychologists, clinical social workers, psychiatric nurses and licensed mental health counselors – play a vital role in the treatment of childhood obesity. Psychosocial problems among obese youth are increasingly recognized as significant consequences of childhood obesity and may require clinical attention. Difficulties include: emotional distress and social rejection due to weight bias, pervasive low self-esteem, specific psychiatric disorders and overall diminished quality of life. Learn more here.
Screening
It is recommended that practitioners screen overweight and obese children for any psychosocial, educational or family problems, as well as experiences with weight bias. The Brief Screening Questionnaire is part of a 3 phase screening at our clinic and can be administered in approximately 5 minutes and will highlight any emotional, behavioral, social, academic or family concerns. There is also a separate item to assess experiences with weight bias. A positive response to any of these items is followed by administering the Child Behavior Checklist to the child’s parent. The CBCL is one of the most widely used and researched measures of general child functioning and provides extensive evaluative information including specific DSM-based diagnoses. The screening is completed with a clinical interview, which reviews and further explores areas of concern.
Referrals
Practitioners should refer patients to a mental health obesity specialist or program when:
- BMI ≥ 40 (increased risk for mental health problems)
- Rapid weight increase
- Lack of motivation for treatment
- Non-compliant with treatment regimen
- Child emotionally distressed during examination
- Parent-child conflict during examination
- Severe or persistent weight bias situation
- Suspected or documented co-morbid mental health, family or educational problem
- Weight Bias
Already evident among pre-schoolers, weight bias includes teasing, rejection, exclusion, physical abuse and cyber attacks. [LINK: Yale Rudd Weight Bias] Recent research suggests that weight bias occurs in families, schools, and among health care professionals and may be a major factor in the development of psychological problems in obese youth. Practitioners should become familiar with a range of strategies to help obese children cope with mistreatment [LINK to Easing the Teasing]
Dual Diagnoses
While any childhood psychiatric disorder can accompany obesity, our research confirms other data citing a high prevalence of depressive disorders and ADHD among obese youth. In these and other dual diagnoses, progress in the child’s weight management may require concurrent treatment of both problems. Our staff has prepared a brief guide to the clinical varieties of these co-morbidities. [LINK: Child Psychiatric Disorders and Childhood Obesity]
Intervention
Intervention research has consistently demonstrated that family based behavior modification combined with diet and exercise is the most effective treatment for childhood obesity. Cognitive Therapy methods have also been applied successfully. The most commonly used techniques are:
Behavior Therapy
- Stimulus control
- Modeling
- Contingency contracting
- Monitoring
- Parent training
- Social skills training
- Role playing
Cognitive Therapy
- Direct instruction
- Problem solving
- Rational analysis
- Self-instruction
- Time projection
- Cognitive restructuring
Relevant Readings
LLLR has weekly journal club sessions to advance their knowledge on the new research in the treatment of obesity.
S254.full journal article on recommnedation for treat of obesity