Beyond BMI: The Next Chapter in Childhood Obesity Management

Abstract

Pediatric obesity treatment has traditionally focused on body mass index (BMI) and has had limited success. Recent research has suggested new ways to approach this topic that focuses more on holistic measures of health and inclusion of a larger population of children. This paper discusses new evidence in the prevention of chronic disease and treatment of obesity that has a body positive and mental health lens as well as integrating research from several areas of health, including the prevention of chronic disease. Practical medical and mental health assessments tools are suggested for clinical use. Implications for an individualized, positive treatment future are presented.

Continued attendance for paediatric weight management: A multicentre, qualitative study of parents' reasons and facilitators

“…Being able to observe tangible changes and having positive feedback from healthcare professionals on progress achieved led parents to perceive the programme as effective and enhanced families' motivation for treatment. Although “success” in PWM has been traditionally measured in terms of improvements in weight status, our data suggest that families hold a broader definition of success, which aligns with contemporary views of managing paediatric obesity and previous research on parental motivation (eg, help improve children's psychosocial health) for participating in programmes for PWM . Experiences of success may also enhance parents' and children's perceived capability to make lifestyle changes, which can lead to actual lifestyle changes and improved weight status …”

“…Parents' concerns about their children's weight and health can help to motivate enrolment in treatment for PWM. 19,20 Our study showed that these concerns are also important drivers of continued Although "success" in PWM has been traditionally measured in terms of improvements in weight status, [21][22][23] our data suggest that families hold a broader definition of success, which aligns with contemporary views of managing paediatric obesity 23,24 and previous research on parental motivation (eg, help improve children's psychosocial health)…”

The effects of resistance exercise on insulin sensitivity in adolescents

“…14,[26][27][28][29][30][31] Some research promotes the use of a 'body positive approach' when implementing a physical activity intervention to help manage chronic disease, as it focuses on long-term change of lifestyle behaviours. [32][33][34][35][36][37] However, the role of physical activity in the long-term management of insulin resistance has yet to be examined. In accordance with this observation, the systematic review and meta-analysis by Fedewa et al 17 stated that more research was required to determine which type of physical activity would produce sustainable change and promote lifestyle modification.…”

“…17,18 The second limitation is concerning recruitment of participants; in all published studies, participant selection was based on BMI and not on a diagnosis of insulin resistance. 18 It is known that not all adolescents with an elevated BMI are insulin resistant 33,54 ; therefore, not all participants recruited necessarily had insulin resistance. Thirdly, compliance to the intervention was not reported for most studies (in only four of nine RCTs); however, of the studies that reported compliance, the rate was high (80-100%).…”

“…Again, recruitment was not based on having a diagnosis of insulin resistance; all studies recruited participants based on BMI [26][27][28][29][30][31] , despite it being recognized in the literature that BMI is a poor predictor of insulin resistance in a pediatric population. 33,54 Thirdly, two of the four RCTs recruited only adolescents of Latino descent 26,29 and three of the four RCTs recruited only male participants 26,27,29 . Clinical generalizability of these results may be limited due to overrepresentation of Latino ethnicity and males.…”