Changing Times Call for Changing Methods: Introduction to the Special Issue on Innovative Treatments and Prevention Programs for Pediatric Obesity

According to recent survey results, approximately 17% of children and adolescents (ages 2 through 19) in the United States are obese (body mass index >95th percentile for sex and age) and about 32% are overweight (body mass index >85th percentile; Ogden, Carroll, Kit, & Flegal, 2012). Ogden et al., also reported that the prevalence of ‘‘high weight-for-recumbent length’’ among infants (ages 0–2) was just under 10%. These data taken from the 2009– 2010 National Health and Nutrition Evaluation Survey reflect increasing rates of obesity over the past 12 years in boys (ages 2 through 19) and relatively stable rates of obesity among girls over this span. Overall, the prevalence of obesity is approximately three times greater than it was in 1980. Although alarming, these summary statistics mask important differences in obesity across demographic categories, including racial/ethnic group, sex, income range, and urbanicity. For example, among both African American girls (ages 2–19) and Mexican American boys (ages 2–19), the prevalence of obesity approaches 25% and the prevalence of overweight exceeds 40%. Further, emerging evidence indicates that childhood obesity is more prevalent in households with lower income, lower education, and higher unemployment, as well as among those in rural (vs. urban) settings (Hearst, Biskborn, Christensen, & Cushing, 2013; Lutfiyya, Lipsky, Wisdom-Behounek, & Inpanbutr-Martinkus, 2007; Singh, Siahpush, & Kogan, 2010, Voss, Masuoka, Webber, Scher, & Atkinson, 2013). Internationally, childhood obesity prevalence rates vary widely, but appear to be increasing among economically advantaged countries as well as in developing countries (Gupta, Goel, Shs, & Misra, 2012; Jackson-Leach & Lobstein, 2006; Knai, Lobstein, Darmon, Rutter, & McKee, 2012). It is well-known that pediatric obesity is associated with numerous health and mental health conditions, including insulin resistance, hypertension, abnormal glucose intolerance, sleep apnea, peer victimization, decreased health-related quality of life, and increased risk for internalizing problems (see Jelalian & Hart, 2009; Vivier & Tomkins, 2008; Zeller & Modi, 2008 for reviews). Further, obesity in childhood is associated with increased likelihood for sustained obesity and overweight (and their attendant health risks) into adulthood (Singh, Mulder, Twisk, van Mechelen, & Chinapaw, 2008). Because of these health risks, pediatric weight-related health—including active living and healthy eating—remains a priority area for Healthy People 2020 (U.S. Department of Health and Human Services, 2010) as well as the National Prevention Council’s (2011) National Prevention Strategy. Recent reviews of the literature (Kitzmann et al., 2010; Oude Luttikhuis et al., 2009; Wilfley et al., 2007) indicate that behaviorally based individual and family interventions can be efficacious. Such therapies typically include behavior modification principles such as reinforcement for healthy behaviors, stimulus control, and modeling. However, effect sizes for such treatments remain relatively modest, and post-treatment outcome assessments frequently suggest poor maintenance of treatment effects over time (Epstein, Paluch, Roemmich, & Beecher, 2007). Further, issues such as nonor incomplete Defined as weight-for-recumbent length at or above the 95th percentile on the 2000 Centers for Disease Control and Prevention growth charts.