Pediatric Obesity: Parallels with Addiction and Treatment Recommendations

Abstract

Rates of pediatric obesity have increased dramatically over the past decade. This trend is particularly alarming as obesity is associated with significant medical and psychosocial consequences. Obesity may contribute to cardiovascular, metabolic, and hepatic complications, as well as psychiatric difficulties. The development of obesity appears to be influenced by a complex array of genetic, metabolic, and neural frameworks, as well as behavior, eating habits, and physical activity. Numerous parallels exist between obesity and addictive behaviors, including genetic predisposition, personality, environmental risk factors, and common neurobiological pathways in the brain. Typical treatments for pediatric obesity include behavioral interventions targeting diet and/or exercise. Treatments focusing on diet and exercise have yielded mixed results, and typically have been examined in specialty clinic populations, limiting their generalizability. There are limited medication options for overweight children and adolescents, and no approved medical intervention in children younger than 16. Bariatric surgery may be an option for some adolescents, but due to the risks of surgery it is often seen as a last resort. The parallels between addiction and obesity aid in the development of novel interventions for pediatric obesity. Motivational enhancement and cognitive-behavioral strategies used in addiction treatment may serve to be beneficial. KeywordsPediatric obesity; medical co-morbidity; addiction; treatment; review Pediatric obesity has reached epidemic proportions, with a 200-400% increase in the past 10 years [1][2][3] . Alarmingly, routine screening for obesity in children is very low (0.5% in a recent review of 600 pediatric cases), treatment is only provided to a fraction of children identified as overweight, and the most frequently used treatment (general advice) is known to be ineffective 4 . The current article will review some of the correlates of obesity, examine parallels with addictive behaviors, and review treatment recommendations.Due to concerns about stigma, the CDC recommends the term "overweight", rather than obese, when referring to youth 5 . Overweight is a condition where one has excess adipose tissue 6 . Body Mass Index (BMI) is the most accepted parameter for measuring total body fat. A BMI of > 85 th percentile indicates mild to moderate overweight, and a BMI > 95 th percentile indicates a need for intervention. Based on these criteria, more than 20% of US Medical and psychosocial consequences of overweight in children and adolescentsBeing overweight during childhood and adolescence is associated with a myriad of concurrent medical and psychosocial consequences, as well as placing children and teens at higher risk for medical comorbidity and mortality as adults. One of the most widely documented health consequences of overweight is a metabolic syndrome that includes insulin resistance, type 2 diabetes mellitus, polycystic ovary syndrome, dyslipidemia, and hypertension 13 . This syndrome has b...

A Systematic Review of Pediatric Obesity and Family Communication Through the Lens of Addiction Literature

“…4,25,28 These suggestions are largely based on the parallels in neural pathways that exist between obesity and addictive behaviors. 4 Such parallels provide evidence to support development of new pediatric obesity treatments by employing addiction therapies. Similarly, another study called for parent-child communication training as an intervention for maladaptive eating patterns.…”

“…Three reviews, two survey studies, and two observational studies were reviewed, all of which were published after 2003 (see Table 2). 4,[25][26][27][28][29][30] The extant literature about family communication, pediatric obesity, and addiction focused largely on how parental behaviors, parenting styles, and family communication may contribute to maladaptive eating behaviors in children. Four articles focused on family characteristics related to adverse eating behaviors, where parental control and food restriction were related to overeating behaviors in children.…”

“…This study by Acosta and colleagues found that higher family conflict and more dysfunctional family communication were related to decreased retention in treatment, whereas higher levels of family support were related with successful child weight loss. 4 Three articles suggested the use of therapies common in family treatment of addiction to counsel families affected by pediatric obesity. 4,25,28 These suggestions are largely based on the parallels in neural pathways that exist between obesity and addictive behaviors.…”

“…4 Three articles suggested the use of therapies common in family treatment of addiction to counsel families affected by pediatric obesity. 4,25,28 These suggestions are largely based on the parallels in neural pathways that exist between obesity and addictive behaviors. 4 Such parallels provide evidence to support development of new pediatric obesity treatments by employing addiction therapies.…”

“…For example, motivational interviewing, 3 originally developed for use in alcohol abuse therapies, has shown promise for, and is now a commonly used approach, in treating obesity among adolescents. 4,5 Causes and contributors to obesity are varied and diverse, 6 and approaches to treatment must be tailored to the needs of the individual. Researchers have begun to explore the possible addictive properties of hyperpalatable foods in the US food environment.…”