Overweight teens shouldn’t be told to diet, says new guidance for pediatric docs

When teenagers are obese or overweight, pediatric physicians should steer clear of encouraging them to diet, and family members should do the same, according to new guidance from the American Academy of Pediatrics.

Published in the journal Pediatrics, the guidance recommends physicians and family members adopt what it calls a “motivational interviewing” strategy, rather than focusing on a teen’s weight or daily caloric intake which could cause the patient to develop an eating disorder (ED).

"At first, weight loss is praised and reinforced by family members, friends and health care providers, but ongoing excessive preoccupation with weight loss can lead to social isolation, irritability, difficulty concentrating, profound fear of gaining the lost weight back and body image distortion,” wrote Neville Golden, MD, chief of the adolescent medicine division at Lucile Packard Children’s Hospital and co-authors. “If the pediatrician only focuses on weight loss without identifying the associated concerning symptoms and signs, an underlying ED may be missed.”

The guidance says dieting may be counterproductive to managing weight in teens. In its place, physicians should recommend the following steps:

• Families should eat together as often as possible, as a higher frequency of family meals has been associated with a better diet: “Eating family meals together seven or more times per week resulted in families consuming one serving more of fruits and vegetables per day compared with families who had no meals together.”
• Family members shouldn’t make comments about a teen’s weight. Even well-intentioned conversations could hurt, according to the guidance. When parents talked about their child’s weight, the patient is more likely to try unhealthy weight control behaviors or binge eat. Talking about healthy eating and staying active, however, is encouraged.
• Don’t tease a teen about their weight. “For both males and females, hurtful weight-related comments from family members and significant others were associated with the use of unhealthy weight-control behaviors and binge eating in both males and females.”
• Monitor weight loss so teens don’t attempt to semi-starve themselves.
• Physicians should ask overweight teens about bullying or mistreatment, then try to address those instances with patients and their families.
• Promote a positive body image. Teenagers can already have issues with their bodies, with the guidance saying more than half of teenage girls and 25 percent of boys saying they don’t like how they look, which can increase the risk for developing an eating disorder. Teens who are more satisfied with their bodies more often say their parents encourage healthy eating and exercise.

In a separate blog post, Golden writes that going over these strategies shouldn’t be too time-consuming for pediatricians, even given the sensitivity of discussing a patient’s weight, saying the guidance could be implemented in “relatively brief encounters.”