When an obese adolescent lost 100 pounds, it was not cause for celebration.
To get there, he ate only one orange a day and often woke up in the middle of the night to go running to burn more calories. In the process, he developed a full-blown eating disorder.
This patient is not unique. There has been an increase in the number of young people who were overweight or obese who developed classic eating disorders when instructed to lose weight, said Neville Golden, M.D., FAAP, a member of the AAP Committee on Nutrition and Section on Adolescent Health.
To address this situation, the Academy recently released the clinical report Preventing Obesity and Eating Disorders in Adolescents, http://dx.doi.org/10.1542/peds.2016-1649.
“Pediatricians need to be cautious about the messaging we are giving our patients and the advice with regard to how to lose weight appropriately,” said Dr. Golden, lead author of the report.
Dr. Golden will discuss AAP recommendations outlined in the clinical report during a session titled “Talking to Your Patient About Weight: the Skinny on Strategies for Preventing Obesity and Eating Disorders.” The session will be held from 4-4:45 p.m. Monday (F3142) in Room 308 of Moscone South and again from 9:30-10:15 a.m. Tuesday (F4038) in Room 310 of Moscone South.
The report reviews the literature on behaviors that predispose to both obesity and eating disorders. For example, a large prospective study of healthy adolescents showed that dieting, defined as caloric restriction with a goal of weight loss, was associated with a two-fold increased risk of becoming overweight and a 1.5-fold increased risk of binge eating five years later ((Neumark-Sztainer DR, et al. Am J Prev Med. 2007;33:359-369).
Another study found that girls who dieted in ninth grade were three times more likely to be overweight in 12th grade compared to those who didn’t diet (Stice E, et al. J Consult Clin Psychol. 1999;67:967-974).
“Dieting tends to rebound and it’s not helpful, and in fact can predispose to both obesity and eating disorders,” said Dr. Golden, chief, Division of Adolescent Medicine, and professor of pediatrics, Stanford University School of Medicine.
Weight talk, or negative remarks made by a parent about his or her own body weight or to encourage a child to lose weight, tend to backfire as well. Young people who hear such comments are more likely to become overweight or to start using unhealthy weight-control methods such as self-induced vomiting, laxatives or diet pills.
Dr. Golden will review recommendations in the clinical report for how pediatricians can advise patients who are overweight or obese to lose weight safely. Among them are encouraging healthy eating and physical activity instead of dieting.
“The focus really needs to be on healthy living and healthy eating rather than on weight,” Dr. Golden said.
The pediatrician also can use motivational interviewing to help patients think about what they can do to control their weight and motivate them to make those changes.
When a pediatrician advises patients to lose weight, it’s important to monitor them closely. Extreme weight loss or losing weight too rapidly is associated with a number of medical conditions, including vital sign instability, Dr. Golden said.
“I think most pediatricians will say, ‘You need to lose weight, and I’ll see you in six months,’” he said, “and a lot can happen in six months.”
For more coverage of the AAP National Conference & Exhibition visit http://www.aappublications.org/collection/cme
