Kindliches Übergewicht psychotherapeutisch behandeln?

Abstract

Overweight and obesity are considered a worldwide epidemic, and also Swiss children are at an increased risk to develop this illness with its associated somatic and mental comorbidities. Besides genetic factors, environmental influences are held responsible for its development. Not only food intake and physical activity is mediated by family habits, eating behaviour, the establishment of food cues, food as a reward, body image and emotional meaning of food are all formed by the parents. Overweight children are exposed to multifarious psychosocial stressors and somatic health risks. A detailed review about the literature underlines the increased psychological strain of obese children. Overweight children experience stigmatisation and bullying among peers, which is associated with the development of emotional and depressive symptoms in a third of the bullied youths. A large subgroup of obese children has mental disorders and behaviour problems; this counts for clinical groups especially, but also for non-clinical subgroups in the norm population. The direction of this association may go both ways: there are mental disorders like depression and oppositional disorders that predicted obesity in adolescents in longitudinal studies. Externalising disorders like attention-deficit and hyperactivity disorders (ADHD) and binge-eating symptoms were found in many cross-sectional studies. There is evidence for the transmission of psychopathology from mothers to their obese children, as it is for normal-weight children, but a child's competences constitute important protective factors for the child's psychological well-being. These findings demand a change in treatment and prevention of childhood obesity: from a mere change of eating and activity behaviours to a thorough prevention of emergence and chronification of comorbid mental disorders and their psychotherapeutic treatment. Cognitive behavioural treatments have shown superior to mere dietician counselling or family therapy. Including the parents in the treatment is more effective than treating the children alone. The comparison of parents-only treatments vs parents-children treatments showed that both are equally effective, leading to the conclusion that treating the parents only may also be the more cost-effective alternative. The inclusion of parents is therefore crucial for the support of change in eating and physical activity behaviour and the increase of resilience factors like social competence and fostering self-esteem. Psychological factors like emotional regulation, social competence and body image have to be addressed with psychotherapeutic methods.