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Conclusion

Pediatric obesity is a public health issue of major concern to mental health providers. Currently, nearly one third of youths in the United States are overweight or obese, putting them at higher risk for various serious health problems (Ogden et al., 2010), emotional and psychological issues (Stern et al., 2006), and social stigmatization (Latner & Stunkard, 2003). Moreover, overweight youths are more likely to become obese adults, increasing their risk for obesity-related health concerns later in life (Ballard-Barbash et al., 2010; Eckel & Krauss, 1998). In addition, significant racial and ethnic disparities exist in pediatric obesity rates, necessitating the development of culturally relevant prevention efforts (Freedman et al., 2006). Given the prevalence of pediatric obesity in the United States, along with the associated negative health and psychosocial consequences, prevention efforts are greatly needed, and counselors must play an integral role in these efforts for prevention to be effective.

Prevention of pediatric obesity is clearly complex because a number of factors influence youths' eating and weight-related behaviors, including the environment, individual differences, cultural factors, and familial patterns. Therefore, singular approaches that focus only on one aspect of obesity or address only one system in which a child functions (e.g., school, family) might not be successful. Indeed, educational approaches alone, which may not have the flexibility to integrate barriers and motivational factors that prohibit change, are generally ineffective (Wilfley et al., 2007). Moreover, obesity prevention is complicated by the toxic societal environment that can derail even the most motivated youth or family (Brownell & Horgen, 2004; Brownell, Schwartz, et al., 2009). Therefore, given the complexity of pediatric obesity prevention, an integrative, multisystem approach will likely provide the best outcome. At the individual, group, family, or school level, this approach could involve an interdisciplinary prevention plan involving a registered dietician, exercise physiologist, medical physician, and counselor. At the societal level, it might involve government regulations improving the nutrition of school meals and increasing opportunities for physical activity, subsidies on fresh produce, or restrictions on food marketing to youths.

Moving forward, we offer recommendations to counselors that we believe can enhance pediatric obesity prevention efforts. First, it is imperative that prevention be culturally adapted to fit the needs of youths and their families. Examples of cultural adaptations could include creating healthier versions of culturally traditional foods, maintaining awareness of cultural variations in ideal body types and perceptions of health, incorporating culturally relevant forms of exercise, and including members of extended family or salient community institutions. Prevention programming should also be tailored to meet the needs of lower socioeconomic status youths and families because this group is not only disproportionately affected by obesity (Singh, Kogan, Van Dyck, & Siahpush, 2008) but is also more likely to face co-occurring barriers such as unsafe neighborhoods and a dearth of easily accessible fruit and vegetable retailers. Second, we recommend that counselors incorporate parents into pediatric obesity prevention whenever possible, particularly with younger children. Parental support and role modeling of healthy behaviors can have a powerful impact on youths' eating and weight-related behaviors. In addition, targeting parents helps improve the entire family's health behaviors and avoids stigmatizing children as the identified patient. Finally, we want to highlight the importance of behavioral support. We believe that consulting regularly with individuals and families to set goals, identify and problem solve barriers, and build on existing skills can enhance the odds that prevention efforts will be successful.

Highlights

• Primary prevention takes the perspective that pediatric obesity is a societal public health concern, and all youths would benefit from prevention programming.

• Primary prevention can reduce barriers to healthy eating and physical activity through information and access.

• An interdisciplinary approach to pediatric obesity prevention is recommended; teams should include nutrition, exercise, and medical experts, as well as counselors.

• Education alone does not produce sustainable change; counselors address the gap between expert recommendations and patient engagement in these health behaviors.

• MI assesses youths' and families' readiness to change and joins with them through collaboration and empathy to increase motivation and self-efficacy.

• Family approaches seek to change the family environment and behaviors rather than identify the overweight youth as the patient, which can be damaging to self-esteem and willingness to change.

• Parental role modeling of healthy eating and physical activity encourages children to engage in similar behaviors and increases self-efficacy for those behaviors as they get older.

 
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