AAP National Conference: In quest to lose weight, teens with obesity can develop eating
CarlaKemp, Senior Editor
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
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.
“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 12thgrade 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.”