Innovative interventions in pediatric obesity: commentary and future directions.

As described in the manuscripts in this special issue, pediatric obesity is an epidemic that challenges the health of children in the United States and globally, and places considerable burden on all levels of our health care system. During the past decade, pediatric psychologists have actively pursued an understanding of the psychosocial correlates of pediatric obesity and developed effective interventions based on this knowledge. This special issue is a reflection of the considerable progress that has been made in this arena, while simultaneously paving the way for the work that remains to be done. Treatment Models Several of the manuscripts in this special issue outline novel approaches for intervening with obese children and adolescents. Overweight/obese adolescents present a particular challenge for intervention stemming from developmentally normative striving for autonomy, the ambiguous role of parents in initiating and supporting weight control, and decreased body satisfaction (Jelalian et al., 2010). Walpole, Dettmer, Morrongiello, McCrindle, and Hamilton (2013) randomized youth with a mean age of 13.9 years to six sessions of motivational interviewing (MI) or social skills training combined with standard care. There was no advantage to MI over social skills training with regard to change in body mass index z-score (zBMI) or self-efficacy. When groups were combined, adolescents demonstrated significant increases in self-efficacy related to weight-control behaviors and a trend toward decrease in weight status. Of interest, attendance at MI sessions was superior to that for social skills sessions, suggesting that MI may be an effective strategy for engaging adolescents. MI may serve as an initial engagement strategy or an adjunctive treatment to support weight control in adolescents. In a study with adults (West, DiLillo, Bursac, Gore, & Greene, 2007), participants randomized to standard group-based behavioral obesity treatment combined with adjunctive motivational sessions demonstrated superior weight loss compared with those randomized to behavioral weight loss treatment and attention control sessions. In the area of weight control for adolescents, we may need to combine MI with more intensive lifestyle interventions to see incremental benefits in body mass index (BMI) decrease. A second strategy for enhancing motivation to facilitate weight change is seen in the study by Saelens, Lozano, and Scholz (2013). This study, which was conducted with school-age children rather than adolescents, presents another model for incorporating motivational factors into intervention development. These investigators randomized children between the ages of 7 and 11 years to a 20-week behavioral weight-control intervention with a standard untailored prescription of weekly goals by the interventionist or a ‘‘self-directed’’ approach in which parent–child dyads were encouraged to increase autonomy in selection of weekly goals based on their own motivation. Interestingly, children and parents in both treatment conditions showed significant reductions in zBMI and BMI, respectively, with no added benefit associated with the enhanced motivational approach. As noted by the authors, there may be alternative models for more explicitly enhancing motivation that would result in stronger outcomes for