Psychosocial aspects of child and adolescent obesity

Question 1

What are the psychosocial contributors to obesity?

Answer 1

1. Bullying
2. Neglect or maltreatment
3. Living situation where consistency, limit-setting and supervision are lacking
4. Parental separation/divorce
5. Foster care with frequent placement changes
6. Inadequate sleep
7. Poverty
8. Generalized anxiety or depression
9. Increased screen time

Question 2

What is weight-bias?

Answer 2

Tendency to make unfair judgments based on a person’s weight

Question 3

What are the parent’s role in managing childhood/adolescent obesity?

Answer 3

1. Good role modelling
2. Setting limits
3. Purchasing healthy foods for family consumption
4. Keeping to healthy family routines (eating meals and exercising together)
5. Appropriate supervision
6. Effective time and money management
7. Ensuring divorce or separation remains as untraumatic as possible

Question 4

What are the effects of community on obesity?

Answer 4

1. Inadequate or expensive access to fresh produce in remote and northern regions
2. Direct marketing of foods high in fat and sugar to children
3. Children living in apartments, or public housing where outdoor play is curtailed by weather or a lack of safe facilities
4. Limited access to recreational opportunities
5. Elimination of daily physical education classes in schools

Question 5

What are the psychosocial consequences of obesity?

Answer 5

1. Depression
2. Poor body image
3. Disordered eating, binge eating, and bulimia nervosa
4. Poor self-esteem
5. Lower health-related quality of life

Question 6

What tools can be useful for clinicians working with children with obesity?

Answer 6

1. Motivational interviewing

2. Sizing them up score

Question 7

What are some concerns to educate/explore when working with parents?

Answer 7

1. Determine whether changing family behavior is a priority?
2. Determine how confident the parents are about achieving necessary changes
3. Positive role models for children
4. Reduce high fat/sugar foods in the home
5. Provide healthy snacks
6. Avoid casual snacking
7. Avoid using food as a reward or bribe
8. Discourage “food pushing”
9. Eat meals regularly as a family
10. Avoid skipping breakfast

Question 8

What are some effective public policy on obesity?

Answer 8

1. Education programs
2. Ensure food security
3. Promote farmer’s markets
4. Better nutritional regulation in child care settings and schools
5. Provision of age appropriate physical activity in child care settings and schools
6. Ensure safe sport and recreation for all age groups
7. Hospitals should implement healthier nutrition and PA guidelines
8. School based policies to prevent bullying
9. Policies and legislation that explicitly support mental health

Question 9

What are CPS recommendations for clinicians?

Answer 9

1. Counsel children, youth and families in their practices to accumulate the recommended level of daily physical activity, and to restrict sedentary behaviour as outlined in national guidelines.
2. Explore psychosocial issues when counselling overweight patients and their families.
3. Use motivational interviewing to help families adopt and maintain lifestyle changes, including:
   a) Encouraging all primary caregivers to be present for counselling sessions. A written summary of goals and action items should be provided to those unable to attend, to help maintain consistency.
   b) Identifying sources of stress within the patient’s family and making referrals to mental health professionals as needed, before or in tandem with lifestyle counselling.
   c) Recognizing stress in the patient, screening for anxiety, depression, low self-esteem and reduced quality of life, and making referrals to mental health professionals as indicated.
   d) Identifying patients who are being bullied and recommending appropriate resources and supports.
4. Advocate for national policies to achieve health equity for children and youth new to Canada, including the promotion of healthy active living.
5. Advocate for national strategies that seek to eliminate health disparities for First Nations, Inuit and Métis children and youth.
6. Work with other community leaders to improve nutrition and physical activity opportunities through community centres, child care facilities, schools and children’s hospitals.

Question 10

What are the CPS recommendations for government public policy-makers?

Answer 10

1. Collaborate to develop evidence-based, multisectoral, multidisciplinary healthy living strategies for each stage of life, including the prenatal period (eg, nutrition in pregnancy).
2. Increase access to and monitor affordable healthy food and recreation opportunities for low-income families and families living in remote communities.
3. Continue to develop and implement a national mental health strategy, with a particular focus on economically disadvantaged families.
4. Develop strategies specific to First Nations, Inuit and Métis children and youth—in collaboration with Aboriginal groups—with a particular focus on psychosocial and environmental contributors to obesity, such as poverty and lack of access to affordable healthy foods, community recreation and housing.
5. Legislate to prohibit advertizing that promotes unhealthy foods and physical inactivity during children’s television programming.
6. Mandate school-based health literacy, healthy eating and daily physical education, as well as school programs that promote an anti-bullying environment.