Review article
The Need for Bold Action to Prevent Adolescent Obesity

https://doi.org/10.1016/j.jadohealth.2009.03.004Get rights and content

Abstract

Record levels of obesity in children and adolescents are predictable in light of powerful conditions that promote high consumption of calorie-dense, nutrient-poor foods and discourage physical activity. Default conditions for youth are dangerous, and include multiple and relentless forms of marketing, poor foods promoted in schools, and a variety of other conditions that undermine personal resources, individual responsibility, and parental authority. This article discusses how optimal defaults can be created using five issues as examples: framing of the obesity issue, treating versus preventing obesity, nutrition in schools, marketing, and addressing weight bias and discrimination. By adopting a public health approach that addresses the conditions causing obesity, there is hope of reversing troubling trends in prevalence.

Section snippets

At the heart of change: optimal defaults

Many approaches have been proposed to deal with child and adolescent obesity, but there is little agreement about how to establish priorities among them. Consensus is likely only if the field can rally behind an organizing conceptual scheme. One such scheme involves the concept of optimal defaults.

Behavior and health are affected by environmental conditions that surround people as their default. For instance, poverty and social inequality have very negative effects on health through default

Framing the obesity issue

People default to certain assumptions about what causes obesity, what it means for society, whether and how the issue should be addressed by the individuals who have it, and how institutions such as schools, insurers, and government should respond. These assumptions are influenced by prevailing societal frames and influence how people interact with overweight individuals and the degree to which policies to change the environment will be supported.

Changing the frames may be one necessary step in

Treatment versus prevention of obesity in youth

Treatment has been the prevailing default to dealing with obesity, in both adults and youth. With adults, cognitive–behavioral therapy, medication, and surgery are the empirically validated treatments [17], [18] with cognitive behavior therapy the foundation for most programs. This approach teaches individuals to self-monitor, identify, and challenge dysfunctional thoughts, use problem solving skills, and address interpersonal stressors that lead to overeating. The approach had been refined

Schools as an important starting point

Schools can be an important piece of the obesity prevention picture, and can be instrumental in supporting parents in their efforts to raise healthy children by setting exemplary nutrition and physical activity standards, educating children and families, and shifting social norms. However, schools often create a negative food and activity environment, which at the very least sets poor defaults for parts of a child's diet but also fails to realize the opportunity schools provide. National survey

Food marketing to youth

A key environmental contributor to obesity among youth, perhaps one of the most suboptimal defaults, is food marketing [14], [61]. Children and adolescents are exposed to massive amounts of marketing that promotes consumption of calorie-dense, nutrient-poor foods [61], [62], [63]. Compared to the research on children, however, far fewer studies have examined adolescent exposure to food advertising or the effects of that exposure [61], [62]. Perhaps as a result, most proposed curbs on food

Weight stigma

A key to changing the environment to better encourage healthy behavior is support for such changes among the public and those who establish policy. Weight bias, stigma, and discrimination erode support for policy changes when individuals are blamed for their weight and felt to “get what they deserve.” Addressing weight stigma could be an important part of the puzzle for changing defaults, but one must also consider the very real impact it has on the everyday life of those affected.

Weight stigma

Conclusions

Adolescents are exposed to conditions that exploit their developmental vulnerabilities, promote excess food intake, and discourage physical activity. These conditions are the default for most Americans, but adolescents may be especially susceptible. Counting on discipline, personal responsibility, and restraint to hold up under such powerful conditions is wishful thinking, thus making it imperative for the nation to change default conditions.

Suboptimal defaults begin with social attitudes about

Acknowledgments

This work was supported in part by grants from the Rudd Foundation and the Robert Wood Johnson Foundation.

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