CBT for Weight Management & Eating Disorders
Eating Disorders in Children and Adolescents
Eating disorders and obesity in children and adolescents require clinical attention, as distorted understandings of eating and weight as well as problematic behavior cycles create maladaptive patterns. Treatment of eating disorders and obesity requires a comprehensive approach regarding the individual, their home, and their social environments.1 Deemed an appropriate treatment for all weight control issues, cognitive-behavioral therapy (CBT) provides an emphasis on the process of changing the individual’s habits and attitudes that seek to maintain the issue at hand.1 Through cognitive restructuring, the harmful patterns that invade daily functioning are replaced with healthy habits that allow children and adolescents to lead healthier lives.1 Professor of Psychiatry, Medicine, Pediatrics, and Psychology at Washington University School of Medicine, Denise E. Wilfley and colleagues discuss weight control issues and the corresponding treatments in their article “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents.”1
The spectrum of weight control issues reaches many different types of individuals, and problems often begin in childhood and adolescence.1 According to Wilfley and colleagues, weight problems are often difficult to treat as they permeate each aspect of daily life.1 These individuals place too much emphasis upon food, eating, body weight and body shape, leading it to significantly impact their quality of life.1 The DSM-IV-TR includes the following diagnoses for eating disorders: anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), which includes binge eating disorder (BED). The other end of the spectrum includes obesity. Rates of childhood obesity have tripled over the past 30 years, making it a national epidemic.
Eating Disorders and Medical and Psychological Complications
Weight control issues are associated with a wide range of medical and psychological complications.1 Wilfley and colleagues state that children and adolescents who struggle with eating disorders often suffer from distorted cognition and unhealthy eating behaviors.1 They also tend to experience psychosocial problems, such as social isolation, low self-esteem, and secretive eating. Other psychological disorders often appear comorbid with eating disorders, including depression, anxiety, and impulse control disorders. Children and adolescents with eating disorders also face several medical complications, such as metabolic changes, osteoporosis, dental abnormalities, gastric abnormalities, dysregulated body temperature, irregular or loss of menses, and weight fluctuation. Also, excessive weight gain is associated with a multitude of problems.1 Depression, feelings of worthlessness, low self-esteem, and victimization are all associated with childhood obesity. The excess weight also causes cardiovascular problems, diabetes, joint and bone pain, cancer, and sleep apnea. As there are several serious problems stemming from both eating disorders and obesity, Wilfley and colleagues state that early intervention is key to reduce risk of current and future medical and psychological problems.1
There are multiple factors that take part in the development of weight control issues. First, there is body dissatisfaction, dietary restriction, overvaluation of weight, negative affect, and low self-esteem. However, Wilfley and colleagues state that there are also appetitive traits that lead to weight gain, such as satiety responsiveness (the failure to recognize hunger cues), impulsivity (the inability to postpose immediate rewards), and high motivation to eat. Also, interpersonal problems, such as sensitivity and teasing, can lead to an individual turning to food to cope. However, a child’s environment will further complicate the risk for weight gain and unhealthy eating behaviors.1 For instance, negative parental role modeling of unhealthy eating and physical activity can influence children’s behavior.1 Also, the recent trend of increased sedentary behavior due to increased technology have hindered healthy physical activity.
Treatment of Eating Disorders
According to Wilfley and colleagues, CBT is an effective treatment for eating disorders.1 Specifically, BN and BED benefit from this treatment, as it identifies, monitors, and concentrates on the cognitions and behaviors that lead to the maintenance of the disorder, all while providing motivation for change. However, interpersonal psychotherapy (IPT) is comparable to CBT for BN and BED. IPT connects individuals’ unhealthy behaviors to interpersonal difficulties and guides them through dealing with such issues.1 Treatments for AN are not as plentiful.1 In fact, only family-based therapy has been shown effective in treating adolescents with AN. The treatment empowers the family to serve as “agents of change” in the adolescent’s recovery process.1 The therapist teaches the family how to help their adolescent gain weight, regulate eating behaviors, and promote healthy development and independence.1
Regarding obesity, lifestyle interventions show the most promise for treatment success. A multi-component approach is needed to modify the child or adolescent’s practice of healthy habits.16 Interventions may include behavioral and cognitive skills components targeting weight-related behavior.1 Some strategies focus on stimulus control and self-monitoring, while family-based interventions focus on parents acting as role models for their children.1 Reward systems are encouraged, according to Wilfley and colleagues, as they reinforce and promote healthy behavior.
Wilfley and colleagues state that there are several parallels between eating disorders and obesity, allowing them to be discussed along a weight control continuum.1 For eating disorders, psychotherapies such as CBT and IPT are the most effective treatments, while obesity treatment relies on family-based programs and lifestyle interventions.1 Wilfley and colleagues state that the most successful treatment encourage family, peers, and the community to work together to create a supportive and healthy environment for development.1 Intervening early is also key, as it may allow many to avoid medical and psychological problems in the future.1
 Wilfley, D.E.; Kolko, R.P.; and Kass, A.E. (2011, April). Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 20(2): 271-285.
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