A Review of the Psychological and Familial Perspectives of Childhood Obesity

By Latzer, Yael; Stein, Daniel | Journal of Eating Disorders, February 25, 2013 | Go to article overview

A Review of the Psychological and Familial Perspectives of Childhood Obesity


Latzer, Yael, Stein, Daniel, Journal of Eating Disorders


Author(s): Yael Latzer[sup.1,2] and Daniel Stein[sup.3]

Review

The investigation of the psychological and familial aspects of childhood obesity has been the focus of long-standing theoretical and empirical effort [1, 2]. In this review paper we aim to describe the main psychosocial dimensions of childhood obesity: overall psychosocial functioning, cognitive performance, self and body esteem and psychopathology in overweight youngsters, the influence of children's perception of overweight on their well being, and the influence of parental attitudes about weight and eating on the psychological condition of the obese child.

The current review focuses on an updated analysis of the most relevant psychiatric and psychosocial issues in childhood overweight. In order to identify the relevant articles on this topic, we conducted a comprehensive systematic computerized literature search of the Cochrane, PUBMED, PSYCHLIT, PSYCHINFO, and ERIC databases from 1991-2012 using the following terms: "childhood obesity," "childhood overweight" "pediatric obesity" "pediatric overweight" "overweight and obesity in youngsters and in adolescents,". We also combined the terms: "overweight" and "obesity' with "family", "familial", "prevalence", "psychoeducation", "psychiatric", "psychopathology", "psychosocial", and "sociocultural". Lastly, in order to provide a more clinically oriented review, we included in our analysis not only controlled and randomized controlled trails (RCTs), but also findings of open studies.

Definitions

Obesity is a well-defined term in adults but in children and adolescents its definition is less consistent. The US Center for Disease Control (CDC) growth charts include gender-specific body mass index (BMI)-for age growth charts for ages 2 to 19 years [3]. Obesity among individuals 2-19 years old is defined as the 95th percentile or greater of BMI-for age, and overweight is defined as the 85th percentile or greater, but less than the 95th percentile of BMI-for age [3]. Because of the likelihood of stigmatization associated with the term "obesity", several leading authorities in the field have suggested to define a "risk for overweight" as BMI between 85-95%, and overweight as a BMI > 95% (see for example [4, 5]. An international forum of consensus development, the International Obesity Task Force (IOTF) [6], has recently recommended adopting the risk-related cut-off concept of Cole et al. [7], who developed age and sex specific cut-off points using the BMI. These charts extrapolate risk from the adult experience to children. The IOTF defines childhood overweight as a BMI of approximately 91% or greater and obesity as a BMI of approximately 99% or greater [6].

Prevalence

Childhood obesity is epidemic around the globe, and has increased in prevalence over the past 2 decades in both industrialized and developing countries. Thus, whereas the prevalence of child and adolescent obesity has been relatively stable during the 1960th and early 1970th, it has begun to accelerate since the late 1970th [8, 9]. Accordingly, in the US, the prevalence of overweight has doubled among youngsters 6 to 11 years of age and tripled among those 12 to 17 years of age between 1976-1980 and 1999-2002, respectively [8]. The prevalence of overweight in the United States around the end of the 1990th has been estimated around 10.4%, 15.3% and 15.5% for children 5-10, 6-11, and 12-19 years old, respectively [10]. In 2007-2008, 9.5% of American infants and toddlers have been at or above the 95th percentile of the weight-for-recumbent-length growth charts. Among American children and adolescents aged 2 through 19 years, 11.9% have been at or above the 97th percentile of the BMI-for-age growth charts; 16.9% have been at or above the 95th percentile; and 31.7% at or above the 85th percentile of BMI for age [11].

In the UK, the rate of overweight, including obesity, has risen from 17 to 22% and from 20 to 25% in 2-5 years old boys and girls, respectively, between the early 1990th and early 2000th [12]. …

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