overweight and obese children and young adults may be at increased risk for subsequent development of eating disorders (Hsu, 1990), including body weight dissatisfaction, anorexia and bulimia, and binge eating disorder.

Body weight dissatisfaction, which is common among adolescent girls, is more severe in obese girls (Wadden and Stunkard, 1993). Many report that their bodies are "ugly and despicable and that others view them with hostility and contempt" (Stunkard and Mendelson, 1967). Further, histories obtained from persons with bulimia nervosa indicate that their first binge usually occurred when they were dieting, while anorexia is often defined as a diet that never ends (Wadden and Stunkard, 1993). Binge eating disorder, defined by the occurrence of eating binges with the absence of vomiting or other purging behavior, is common among obese persons entering weight-reduction programs (30 percent) but less common among obese persons in the community at large (5 percent). Although little is known about the specific incidence in children and adolescents, one study reported that 30 percent of obese adolescent girls seeking treatment for obesity engaged in binge eating (Berkowitz et al., 1993).

The effect of dieting on the development of eating disorders among obese children and adolescents is largely unknown. One study reported six children (3.8 percent) developing eating disorders (all with bulimia) following participation in a weight-control program (Epstein, 1993a). Thus, while eating disorders are a recognizable risk of obesity treatment, more research is clearly needed to improve our understanding of the relationship between dieting and the psychosocial consequences of obesity treatment, particularly in the pediatric population.

TREATMENT

Despite the rising prevalence of obesity in the United States and the fact that childhood obesity is an important public health problem, few obesity treatment programs are available for children and adolescents (Dietz, 1994b). Research on the treatment of childhood obesity has been quite limited, particularly when compared with treatment for adults. As yet, no consensus exists on what constitutes the most effective treatment strategy for children and adolescents. Current programs for children are similar to adult treatment programs and are generally multidisciplinary in nature. This section reviews the literature on the basic components for treatment of childhood and adolescent obesity in both clinics and school settings.

Simply stated, the goals of the treatment of childhood obesity are weight loss without adverse health effects, followed by weight maintenance



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