Psychological Dimensions of Childhood Obesity


A web page titled “Confronting Childhood Obesity” asserts that diet modification and physical activity are “key,” and environmental conditions are important too. The page discusses food deserts, the dearth of exercise facilities in poor communities, the fear of crime, and the lack of physical education in underfunded schools. It urges parents to advocate for increased community policing and the removal of vending machines from schools.

On the home front, it advises parents to serve nutritious sit-down meals and to limit screen time. It mentions the harmful impact of food advertising.

That page originates with the American Psychological Association and, strangely, although the subject is confronting childhood obesity, it says nothing about the intersection between childhood obesity and psychological problems. A parent who seeks advice about what kind of psychological help might prevent or reverse childhood obesity will not find it here.

Moving on

As outlined by Medical Daily, a government guideline, in the process of being updated, advises treating child obesity with behavioral programs rather than drugs. This recommendation comes from the U.S. Preventive Services Task Force, an “independent panel of experts that guides nationwide screening practices.”

Two drugs are widely prescribed, the panel learned:

It found that metformin, a type 2 diabetes drug that doctors are increasingly using to treat obesity in children and adults, had a small degree of success, but that its long-term effects haven’t been adequately studied. Similarly, they concluded the drug orlistat, explicitly approved by the Food and Drug administration for treating obesity in people 12 or older in 2012, was lackluster and carried “moderate harms.”

Incidentally, the so-called moderate harms admitted to by orlistat include “abdominal pain or cramps, flatus with discharge, fecal incontinence, and fatty or oily stools.” Wow. As if an obese kid doesn’t have enough problems already, with this drug, she or he can worry about whether each new day’s school experience will include simply sharting, or perhaps dumping a full load in the pants. What a gift for the class bully!

The “intensive behavioral interventions” recommended by the USPSTF include bringing the whole family together for nutritional counseling sessions, better education on interpreting food labels, and supervised exercise. But as Dr. Pretlow has expressed time and time again, young people possess information that should be more than sufficient, if information were the essential factor.

Kids are knowledgeable about calories, and know why apples are better than chocolate-covered bacon, and have correctly answered questions about these topics and passed their tests in Health class. Yet the obesity rate remains impenetrable. Additionally, it seems that, in order to make a difference, at least 52 contact hours are needed per child. Fifty-two hours is the threshold that defines “intensive,” and represents a large investment to be undertaken by any cash-strapped school system.

Other behavioral interventions recommended by the USPSTF are the use of stimulus control, which translates as “limiting access to tempting foods and limiting screen time,” measures which are pretty much under parental control. Also recommended are goal-setting, self-monitoring, contingent rewards, and problem solving.

But here is the main problem to be solved. Motivation has to come from within, and something has to spark it. The drawback of behavioral interventions is that, unless the subjects are in a very restrictive environment like boot camp, people can’t be made to do things. The question of how to lead people to do things voluntarily, because they want to, is still very much a dilemma.

Your responses and feedback are welcome!

Source: “Confronting childhood obesity,”, undated
Source: “Treat Childhood Obesity With Behavioral Programs, Not Drugs, Says Updated
Government Guideline,”, 11/02/16
Source: “Draft Recommendation Statement,”, November 2016
Photo credit: Cariffiti via Visualhunt/CC BY-ND

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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