Teen Obesity Prevention: Strategies, Models & Interventions

Introduction to Obesity and Its Scope

Obesity refers to the accumulation of harmful body fat, characterized by excessive adipose tissue relative to lean body mass (Donatelle, 2002). One primary cause is high caloric consumption combined with an individual's inability to expend those consumed calories. Obesity is generally understood as the outcome of an imbalance between food consumed and energy expended (Venes, 2005). However, a considerable body of research also demonstrates genetic and metabolic deficiencies in cases of obesity — including an inactive mechanism by which the body signals satiety, as well as deficiencies in proteins that suppress hunger.

Obesity is currently the second leading cause of preventable deaths in the United States, after tobacco consumption (Flegal, Carroll, Orden, & Johnson, 2000). On a global scale, it is considered the leading cause of preventable deaths. According to the World Health Organization (WHO), obesity has reached epidemic proportions worldwide, with over one billion adults classified as overweight and no fewer than 300 million classified as obese (WHO, 2003). Beyond its cosmetic and social implications, obesity poses critical health risks including, but not limited to, hypertension, type 2 diabetes mellitus, periodontal disease, high cholesterol, stroke, heart disease, and certain cancers (Goldie & Risbeck, 2006).

Evidence from the United States indicates that childhood obesity has increased fourfold within a span of 20 years (Williams et al., 2002, as cited in Lazarou & Kouta, 2010). In the United Kingdom, the prevalence of obesity in children rose from 1.5% in 1984 to 6.3% in 2003 (Stamatakis et al., 2005). By 2008 estimates, 15.2% of girls and 16.8% of boys in the 2–15 age group were classified as obese (NHS, 2010). These figures are deeply concerning, given that the risk of obesity in adulthood is approximately 1.5 to 2 times greater for individuals who were overweight in childhood (Guillaume, 1999; Nicklas et al., 2001, as cited in Lazarou & Kouta, 2010). Roughly 50% of obese children are estimated to remain obese in adulthood (Krauss et al., 1998, as cited in Lazarou & Kouta, 2010). Several risk factors are associated with childhood obesity; notably, children from families with hereditary cardiovascular diseases tend to weigh more than those without such family medical history (Krauss et al., 1998).

Managing obesity can be broadly divided into two approaches: medical intervention and behavioral modification (Wilborn et al., 2005). Behavioral modification applies learning theories to the treatment of obesity and has been a standard therapy for both children and adults for over 25 years (Bray, 2003). Medical intervention focuses on reducing energy intake (caloric consumption) while simultaneously increasing energy output (Wilborn et al., 2005). It may also include pharmacological treatment when necessary and, in extreme cases, surgical weight-loss procedures.

The phrase "evidence-based medicine" was coined in the 1980s to describe an approach that employs scientific evidence to determine best practices. The term was later refined to "evidence-based practice" (EBP) when non-physician clinicians recognized the importance of scientific evidence in clinical decision-making (Beyea & Slattery, 2006). While multiple definitions of EBP exist, the most widely cited is "the explicit, judicious, and conscientious utilization of the best current evidence to make decisions regarding the care of each individual patient" (Sackett, Rosenberg, Gray, Hayes, & Richardson, 1996, as cited in Beyea & Slattery, 2006).