An Action Plan to Combat Adolescent Obesity

Weight Watchers® set off a furor early this year when it announced plans to launch a free program for teens.

As we are in the midst of a childhood obesity epidemic, critics pounced: Is a company named “Weight Watchers” that encourages weekly weigh-ins the proper vehicle for helping teens improve their health? Will the company trigger the development of an eating disorder in some teens? Is this just a ploy to lure new lifelong customers?

Of course, Weight Watchers is not alone in going after the teen market. Weight loss companies like Medifast® and OPTIFAST® have developed teen-focused programs with calorie-controlled meal plans that require purchases of shakes and other processed foods. Weight loss camps—generally costing $5,000–$10,000 for programs of 2–12 weeks—promise teens rapid weight loss, often with little medical oversight or evidence of long-term effectiveness.

Desperate for help, many teens and their families will try anything to lose weight. Their feelings are justified: Without intensive intervention, 90% of teens with obesity will have overweight or obesity as adults. They also face in­creased risk for type 2 diabetes and insulin resistance, sleep apnea, fatty-liver disease, high cholesterol, hypertension, hip dysfunction, and poly­cystic ovarian syndrome (in females) (Steinbeck et al. 2018).

Adolescent obesity has been linked, moreover, to depression, anxiety, suicidal thoughts, poor self-esteem, attention deficit hyperactivity disorder, aggressive and destructive behavior, internet addiction, binging and purging, and other severe emotional outcomes (Reinehr 2018). Emotional issues are often attributed to bullying and weight stigma, which frequently stem from peer and media influence (Van Geel, Vedder & Tanilon 2014).

Health and fitness professionals can help teens gain the confidence, desire and ability to establish lasting healthy habits and avert the damage of obesity. One thing to bear in mind, however, is that adolescence is a vulnerable life stage with unique new social norms and pressures. Teens’ impulsive behavior, quick-fix outlook, growing independence and potential defiance can make any attempt to influence their health seem overwhelming and even perilous. As some Weight Watchers critics wondered, how do we help teens without triggering disordered eating or a preoccupation with weight?

With 17% of teens affected by obesity and 6% of teens by extreme obesity—rates having doubled in the past decade—this population needs quality programs to improve health (Reinehr 2018). While researchers are exploring the effectiveness of intensive lifestyle interventions, medications and bariatric surgery, we’re still unsure of the most effective weight loss interventions for teens. Nevertheless, health and fitness professionals who work with adolescents can drive positive outcomes and minimize the risk of harm by following these five “rules” for coaching teens to better health:

1. Focus on Behavior, Not Weight

Zeroing in on healthy habits takes the emphasis off weight loss and/or restricting calories. Encourage teens to adopt these behaviors:

  • Eat “real foods” like vegetables, fruits and whole grains rather than packaged or highly processed foods.
  • Incorporate enjoyable activity into each day.
  • Get adequate sleep.
  • “Unplug” from screens and devices for part of the day.
  • Cope with stress more effectively.

The goal is to help teens learn about healthy food options and ways to improve habits pertaining to sleep, stress management and physical activity, all of which affect weight. Focusing on healthy habits helps teens set goals based on things they can control. Moreover, teens who do not feel confined to a strict diet are less likely to yo-yo between weight loss and gain, which often occurs when people start and stop a new diet or restrictive nutrition plan. Evidence also suggests that focusing on dieting increases the risk of disordered eating and low self-esteem (Golden et al. 2016).

Remember, though, that adolescents tend to focus on the present and not so much on improving health for their future. Thus, a focus on health should include goals with immediate benefits—such as increased energy and mood, or the ability to play a favorite sport or go a set distance by walking, biking or jogging.

2. Choose Words Carefully

Adults must be careful to avoid stigmatizing language. The American Academy of Pediatrics (AAP) advises using neutral words like “increased weight” and “elevated body mass index” versus “obese” or “overweight.” This includes, as discussed, de-emphasizing weight loss altogether to focus on developing healthy habits before addressing weight.

According to the AAP, “Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight” (Pont et al. 2017). However, there is no evidence that shaming a person motivates them to lose weight. Indeed, shaming is more likely to result in more weight gain, less physical activity, binge eating, social isolation and avoidance of health care (Pont et al. 2017; Brewis & Bruening 2018).

Health and fitness professionals can improve a teen’s adherence to a program by showing a positive attitude, avoiding blame and focusing on the teen’s strengths,
as opposed to failures (Reinehr 2018).

3. Encourage Adults to Model Healthy Behaviors

In addition to following this guidance themselves, health and fitness professionals can encourage parents to model healthy habits. See “Modeling Dos and Don’ts: Tips for Parents” on page 47 for some practical ideas.

Research has found that parents who urge a child to diet may do more harm than good: “Experiencing parent encouragement to diet as an adolescent was significantly associated with a higher risk of overweight or obesity, dieting, binge eating, engaging in unhealthy weight-control behaviors, and lower body satisfaction 15 years later” (Berge et al. 2018). Instead, parents can help by modeling healthy habits and a healthy relationship with food for the whole family.

4. Empower Teens to Make Better Choices

Giving teens autonomy and the tools to make healthy choices is powerful. Teach SMART (Specific, Measurable, Attainable, Relevant and Time-bound) goal-setting and create habit-based goals (e.g., “I will eat a fruit or vegetable with each meal or snack”) rather than weight loss goals. These tactics set teens up for the quick wins that will keep them motivated.

Once teens develop SMART goals, encourage them to learn new skills like reading nutrition labels, understanding serving sizes, noting hunger and fullness cues, and helping with meal planning. These skills can keep teens involved, empowered and likely to achieve their goals.

Another way to empower teens is to let them attend health or fitness appointments on their own, without a parent. As a health or fitness professional, make sure you tell a teen’s parents about any action plan you and the teen agree on. That helps nurture a home environment that encourages the teen to achieve goals.

5. Use a Multidisciplinary Approach

There is strong evidence to suggest teens who succeed the most at improving weight and health do it by engaging their families, an extended support network and a multidisciplinary team. This is especially important for teens with severe obesity or with “red flags” such as

  • excessive exercise, weight loss or use of dieting pills or laxatives;
  • induced vomiting, bingeing or severe diet restriction;
  • social isolation;
  • clinical problems such as severe headaches or hip pain; and
  • comorbidities such as diabetes, depression or an eating disorder.

While not every community has easy access to a robust adolescent weight management program, you can develop a professional network so you can refer a
client to a pediatrician, mental health professional and/or registered dietitian, for example, if needed.

Teens Are Not Like the Rest of Us

Adolescents are not young versions of adults. Thus, optimizing health and treating obesity in teens means tailoring programs to their age, developmental stage, personal preferences and aspirations. Moreover, this work must be done by a caring team of medical and health professionals who understand adolescents.

We desperately need health and fitness professionals who meet these requisites so we can help teens eat better, move more, sleep longer, spend less time on screens and devices, and better manage stress. Teens must be able to experience the rewards, including improved mental and physical health and well-being, that result from these behavior changes.

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Natalie Digate Muth, MD, MPH, RD

Natalie Digate Muth, MD, MPH, RD, is a registered dietitian and a recent graduate of the UNC School of Medicine. She has made several appearances as a nutrition expert on CW's San Diego 6, been quoted as a fitness expert in the New York Times, and is an ACE master trainer and award-winning author. She is currently pursuing a residency in pediatrics.
Certifications: ACE, ACSM and NSCA

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