Should adolescent obesity prevention programs focus on calories?

Nutrition Research Newsletter, Oct, 2006

Childhood and adolescent obesity is a major public health concern as the prevalence has tripled in the past 20 years. It is obvious that healthful weight-management behaviors are needed for the prevention and treatment of obesity, there is concerns over the high prevalence of adolescents who are dieting or using unhealthful weight-control behaviors. These behaviors have been shown to be ineffective in long-term weight management and may inadvertently lead to a number of unfortunate consequences, including weight gain over time, inadequate intake of nutrients, and the onset of disordered eating and eating disorders. While it is important to develop interventions that provide adolescents with the knowledge, skills, and support for healthful weight-management behaviors, care needs to be taken in the development of messages that will not lead to behaviors that may be counterproductive and even harmful.

A school-based obesity prevention program, titled New Moves, was developed for girls at risk for overweight due to low levels of physical activity. In the development of this program, the research team debated whether nutrition messages should focus on weight control or take a more general approach toward health and healthful eating. On one hand, a focus on weight issues might be more interesting to the girls and more effective in achieving behavior change than a global focus on health. On the other hand, an overemphasis on weight issues could inadvertently increase the girls' risk for poorer self-images and unhealthful weight-control behaviors.

A pilot study was conducted, which included interviews with a sample of the New Moves population following the intervention to gather their perspectives on potentially sensitive topics related to weight management. Specifically, this exploratory study examined whether adolescent girls think the focus of nutrition messages should be on weight control or more generally on health, and if learning about calories would be helpful or harmful.

The New Moves study intervention group included 89 adolescent girls in grades 9 to 12 from three public high schools in Minnesota. For the current study, 10 girls from each of the three intervention schools were interviewed. Individual interviews were conducted by two interviewers during school hours within a private room and lasted an average of 35 minutes. Questions explored the girls' perceptions on how best to frame nutrition messages within obesity prevention programs. A semistructured open-ended interview style was used to elicit open-ended responses.

The subjects were mixed on whether nutrition-related information and messages would emphasize weight control or health. Although girls expressed interest in weight-related issues, some had concerns that overemphasizing weight control may lead to unhealthful and excessive weight preoccupation.

While many girls would like to receive information on weight and calories to help guide their decisions regarding food, care must be taken to avoid unintended harmful consequences in this sensitive population.

L. Shepherd, D. Neumark-Aztainer, K. Beyer, et al. Should we discuss weight and calories in adolescent obesity prevention and weight-management programs? Perspectives of adolescent girls. J Am Diet Assoc; 106:1454-1458 (September, 2006). [Correspondence: Linda M. Shepherd, MPH, RD, Assistant Professor, College of St Benedict/St John's University, Ardolf Science Center 158, 37 South College Ave, St Joseph, MN 56374. E-mail: lshepherd@csbju.edu].