Why are teens who are obese less likely to try losing weight?

Jian Zhang, MD, PhD

Fewer overweight teenagers are working to get the weight off, according to a new study that investigated the rise in overweight and obese adolescents and what is being done to reverse this trend.

The report, published in August in JAMA Pediatrics, revealed a significant jump in the number of teenagers considered overweight or obese-from 22.09% in a study period from 1988 to 1994, to 34.03% in a study period from 2009 to 2014.¹ During those same periods, researchers also noted a decline in the number of adolescents who tried to lose weight-from 33.68% in the 1988 to 1994 period to 27.24% in the 2009 to 2014 period. Weight-loss efforts varied by gender, according to the report, with the number of boys trying to lose weight decreasing from 36.36% to 23.41% and the number of girls trying to lose weight from 80.24% to 54.19%.

The study was conducted by researchers at Georgia Southern University, Statesboro, using data from the National Health and Nutrition Examination Survey. Researchers note that the data doesn’t provide insight as to whether the decrease in efforts to lose weight led to increases in prevalence of overweight and obese teenagers or vice versa.

Why fewer teenagers try weight loss

“There are several potential explanations for the declining trend among adolescents in trying to lose weight,” says Jian Zhang, MD, PhD, one of the co-authors of the study. Zhang discusses the role of the Social Comparison Theory, which states that individuals judge themselves in relation to those around them rather than on an absolute scale. In this study, this theory could explain that in the landscape of a dramatic increase in the population of overweight and obese teenagers, more adolescents compared themselves against peers with higher body weights, leading them to see a more positive body image of their own.

“When more than a third of adolescents are overweight or obese, it may be cognitively hard for adolescents to view overweight as abnormal,” Zhang says. “The numbers recommended by professional organizations are more remote than the friends surrounding them daily and are less likely to be used as references. Therefore, more overweight and obese adolescents are satisfied with their body weight and are not ready or motivated to engage in weight-loss efforts.”

A societal shift also may be to blame, Zhang notes. “In addition to the contribution from the shifting of socially accepted body weight, the failure to discuss weight issues with patients among health professionals may also contribute to the declining trend in trying to lose weight,” he says. “Previous studies have repeatedly demonstrated that physicians’ notification of body weight issues was strongly associated with an increased effort to lose weight. Healthcare providers in the primary care setting, however, frequently fail to acknowledge patients with overweight or obese or discuss weight issues with them.”

Encourage dialogue on weight

Pediatricians are missing an opportunity to prevent overweight teenagers from developing into obese adolescents, Zhang says, and new clinical practices need to be developed to open the dialogue on weight and obesity in a way that motivates teenagers and their parents to adopt healthier lifestyles. Although several professional organizations including the American Heart Association already recommend obesity screening for teenagers, Zhang suggests that it may be time to consider screening for adolescents who are overweight, as well.

“Discussion of body-weight concerns between pediatricians and adolescents might be an effective tool to empower adolescents to actively engage in obesity prevention,” Zhang says. “We all know that physicians’ advice regarding smoking cessation and immunizations increased likelihood that the patient would participate in these behaviors, and the commitments from primary healthcare providers are critical success factors of the antismoking crusade and population-wide vaccinations.”

Part of the problem, Zhang says, is that teenaged patients spend on average just 9 minutes with a physician during annual wellness exams, and there is a long list of topics to discuss in that timeframe already.

“It's easy to get lost in the shuffle,” Zhang says. “It might be a good idea to stick weight-related discussions on the top of the list since most of the health issues are directly or indirectly related to excess body weight.”

Zhang also acknowledges a fine line between addressing weight and obesity and stigmatizing these issues in a way that has a more negative effect.

“Studies have shown that conversations on body-weight issues among adolescents may impose psychological stress and are associated with an increased likelihood of engaging in risky behaviors, such as harmful weight-control behaviors, cigarette smoking, and suicide attempt,” Zhang says. “It is extremely important that the findings of the current study should be translated into clinical practices in a correct manner. We should discuss weight issues with youths from a healthy lifestyle perspective rather than stuck with the term of body weight. We are engaging in a prohealth-not an antiobesity-campaign.”

References:

1. Hawkins DR, Kazmierski K, Hansen A, et al. Trends in weight loss efforts among US adolescents with overweight and obesity. JAMA Pediatr. 2018;172(8):782-784.