Reframing interventions for optimal child nutrition and childhood obesity: the importance of considering psychological factors

Abstract

This review aims to emphasise the impact of poor nutrition on children’s health and psychological wellbeing, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, wellbeing and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological wellbeing, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.

Editorial: nutrition at key stages of the lifecycle

“…These include childhood stress and the negative effects of low self-esteem on emotions, mental health and eating behaviours, which are associated with weight discrimination and stigma (19) . A more holistic approach, that addresses psychosocial and emotional needs, may positively influence engagement with and long-term sustainability of health behaviour change interventions (19,20) .…”

The psychosocial beliefs, experiences and expectations of children living with obesity

“…Noteworthy, however, that only 20% of the studies systematically reported psychosocial outcomes, with the most common being quality of life, and only 5% of the studies recorded mental health outcomes (such as depression). 16 Despite the relationship between obesity and psychological variables and the increased risk of psychological comorbidities in individuals living with obesity, 20 there is a lack of attention given to psychological variables as part of obesity treatment, 21 especially within UK guidelines. 22 , 23 , 24 This lack of focus on psychological variables is partly due to insufficient research on interventions that systematically assess psychological factors.…”