Focus on Healthy Lifestyle, Not Weight, in Adolescents

An integrated approach to the prevention of obesity and eating disorders in adolescents is more effective than an adolescent-only focus, and should emphasize healthy lifestyle rather than looking solely at weight, according to the American Academy of Pediatrics (AAP).


"Pediatricians need to be aware of the co-existence of two seemingly opposite disorders, as they are not opposites at all," said Lustig, who was not involved in the report. "They should make sure that they don't contribute to the problem."

Although the majority of adolescents who develop an eating disorder were not previously overweight or obese, it is not unusual for an eating disorder to begin with a teen trying to eat healthy, according to the report authors.

"Some adolescents may misinterpret what 'healthy eating' is and engage in unhealthy behaviors, such as skipping meals or using fad diets in an attempt to 'be healthier,' the result of which could be the development of an ED," they stated.

In order to better understand how to prevent obesity and eating disorders in teens, Golden and colleagues used results from cross-sectional and longitudinal observational studies to identify five specific behaviors associated with both conditions.

• Dieting: Defined as caloric restriction with the goal of weight loss, dieting is a risk factor for obesity and eating disorders
• Family meals: Family meals have been linked to improved dietary intake and provide opportunities for modeling behavior by parents, even though family meals have not been shown to prevent obesity across ethnic groups
• Weight talk: Weight talk by family members refers to comments made by family members about their own weight or comments made to the child by parents to encourage weight loss. Even well-intended comments can be perceived as hurtful by the child or adolescent
• Weight teasing: Family weight teasing can lead to the development of overweight status, binge eating, and extreme weight-control behaviors in girls and overweight status in boys
• Healthy body image: Approximately half of teenage girls and one-quarter of teenage boys are dissatisfied with their bodies; these numbers are higher in overweight teenagers. Body dissatisfaction is a known risk factor for both eating disorders and disordered eating

The researchers also reviewed data from a study conducted through the AAP Pediatric Research in Office Settings network, which assessed the effect of motivational interviewing as a tool for facilitating weight loss in children.


Golden's group found that an integrated approach to obesity and eating disorders prevention that involves family members and pediatricians was more effective than an adolescent-only focus. Pediatricians can encourage parents to be healthy role models for their children by creating easy accessibility to healthy foods, encouraging physical activity, and limiting the amount of total entertainment screen time to less than 2 hours per day.

Golden's report also highlighted several tips for pediatricians in the role of preventing weight-related problems.

• "Discourage dieting, skipping of meals, or the use of diet pills; instead, encourage and support the implementation of healthy eating
• Promote a positive body image among adolescents
• Encourage more frequent family meals
• Encourage families not to talk about weight but rather to talk about healthy eating and being active to stay healthy. Do more at home to facilitate healthy eating and physical activity
• Inquire about a history of mistreatment or bullying in overweight and obese teenagers and address this issue with patients and their families
• Carefully monitor weight loss in an adolescent who needs to lose weight to ensure the adolescent does not develop the medical complications of semistarvation"