An assessment of the child’s/adolescent’s and family’s readiness to make lifestyle changes is an
important barometer of whether weight-management interventions will be effective. Several studies
in adults and adolescents have shown that stage of change can influence behavioral change [14,15].
An adolescent who is ambivalent about modifying his or her lifestyle may exhibit opposition and
poor adherence to weight-management interventions, leading to subsequent program failure and
weight gain. A family who is not ready to make lifestyle changes will not provide a supportive
environment for their child. By identifying the older child’s/adolescent’s and family’s readiness to
change, the practitioner can integrate specific counseling strategies related to their stage of change
into the weight management intervention. A tool for addressing these stages of change and developing
appropriate intervention strategies can be found in the tool section of Bright Futures in
Practice: Physical Activity [16].
Overweight children and adolescents can present psychological manifestations that include low
self-esteem, poor peer socialization, and depression. Overweight children and adolescents may also
have eating disorders such as bulimia and binge-eating disorders. Screening children and adolescents
for psychological issues and eating disorders is an important component of the nutritional assessment.
Several screening tools are available [17–19]. If any of these psychological disorders is
suspected, referral for a comprehensive psychological evaluation is warranted. In the case of a
suspected eating disorder, an evaluation by a multidisciplinary team that specializes in pediatric
eating disorders is recommended.
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