Karen Nelson, PhD, Associate Clinical Professor of Psychiatry,  
University of Iowa College of Medicine

Obesity has been identified as one of the leading public health concerns of the 21st century; pediatric and adolescent obesity in the US has reached epidemic proportions: 

Culprits: Inactivity, emotional eating
Why are so many teens overweight? Adolescents who take in more calories than they burn will gain weight. Though overeating is by far the biggest contributor to weight gain, lack of activity also contributes. 

Children, like adults, overeat for many reasons -- depression, anxiety, low self-esteem, stress, boredom. Children imitate parents who relieve emotional pressures with a snack. Research shows that overweight children experience peer teasing and rejection, and this can also play a role in a cycle of seeking emotional relief by overeating.

Setting realistic goals
Most adults remember all too well their own sensitivity to perceived physical deficits during adolescence. Teens, bombarded with images of ultra thin models and movie stars, can find it hard to reject the notion that a perfect body exists. Parents and health providers can help adolescents set reasonable goals for health and body image.  

Teens often become defensive when parents broach concerns about weight. It can be useful for parents to affirm that the teen is in charge of his or her body. At the same time, it is appropriate to say, “I can help you make healthy decisions about what you eat and how much you exercise.”  

Parents should avoid language like “fat” and “skinny.” Instead, focus on incorporating physical activity and healthful eating into daily life. A physician or dietician can help a teen set reasonable goals for weight and body mass index that reflect the teen’s individual build, height, and age.  

Fad diets, fast food

A 2003 Youth Risk Behavior Survey found that, in the 30-day period under review:

• 43.8% of teens reported they were trying to lose weight   

• 42.2% reported eating less food, fewer calories, and focusing on low fat foods

• 13.3% had gone without eating for 24 or more hours

• 9.2% had taken diet pills, powders, or liquids without doctor’s advice

• 6.0% reported vomiting or taking laxatives to lose weight

Teens are especially attracted to fad diets that promise fast results, but these diets are often nutrient poor and fail to address emotional eating. Point out realistically that no one will go through the rest of life without eating bread, or existing on frozen diet meals and celery. Teens who follow fad diets often experience rapid weight loss, then regain all they lost -- and more. They need to understand that losing weight and then maintaining a healthy weight require permanent changes in how you eat and exercise.  

Fast food is also a concern. In 2003, Pediatrics presented research showing that one of every three American children age 4-19 eats fast food daily. While the average bagel used to have a 3" diameter and 140 calories, today it's about 6" across and has 350 calories.

Many overweight teens are reluctant to join sports teams, and that is OK. Instead, encourage them to walk or cycle to school, use stairs, walk the dog. Parents -- key role models for eating and physical activity -- can encourage activity by accompanying teens on walks, praising them when they exercise, even giving small rewards. While Iowa winters can pose a challenge to being active, many schools, malls, and local recreation centers offer winter walking programs and other indoor activities.  

Healthy lifestyle: A family affair
The most important factor in teen diet is to encourage the whole family to adopt healthier habits. Instead of singling out the overweight teen, it is more effective to help the entire family choose nutritious meals and to increase everyone’s activity level. Some basic guidelines to share with families:

• Don’t skip meals

• Decrease total calories

• Eat appropriately sized portions (to learn more about portion size, see A Parent's Guide to Healthy Eating).

• Without restricting any specific foods, eat more “light” foods, like fruits and vegetables, and fewer “heavy” foods that are high in saturated fats and calories

• Exercise as a family – walk, hike, run, swim, bike -- together

SHAPEDOWN: Just for teens
In 2007, the University of Iowa Children’s Hospital piloted a weight management program called SHAPEDOWN: Just for Teens. The 10-week program targeted 7-12th graders with BMI > 85th%ile for age. Teens and parents attended weekly psycho-educational groups that focused on nutrition, self-esteem, and understanding emotional eating. Teens and parents exercised together during each meeting, and were also encouraged to increase overall physical activity at home. Most of the teens who completed the SHAPEDOWN program lost weight.  All reported satisfaction with the program.  

For more information about upcoming teen weight management opportunities through UIHC, visit www.uihealthcare.com/healthyweight, or contact Karen Nelson, 319-353-6040, karen-nelson@uiowa.edu.

Resources

Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Peds 2003: 111, 112-8.

Iowa Medical Society white paper: Key messages physicians should use to prevent early childhood obesity

SHAPEDOWN: Just for Teens. Balboa Publishing: San Anselmo, CA: 2007.

Youth Risk Behavior Surveillance Report (Centers for Disease Control).