at the reduced body weight. In moderately overweight young children, the goal may simply be to maintain body weight since future growth will normalize the body weight. While treatment combines dietary change, an increase in exercise and physical activity, and behavior modification, what is unique to childhood treatment programs is the inclusion of parent training.

Effect of Age

Because of the wide variation in developmental capabilities between the ages of 1 and 18, the age of the obese child must be considered when planning the treatment (Epstein, 1985). The child's capacity for understanding the disease is limited by his or her cognitive and motor abilities, which vary with age (Epstein, 1993a, b). In the very young child (1–5 years of age), parents have major control over the child's eating and activity and therefore represent an important focus of treatment in terms of food selection, preparation, and availability. In later years, the responsibility shifts from parents to the child, particularly as the adolescent strives to achieve autonomy. In fact, research among adolescents has shown that the outcome improves when parents and children are treated separately (Brownell et al., 1983). To date, little research has been devoted to age-appropriate intervention programs, though Epstein (1985) has developed a multistage model for the treatment of childhood obesity in which the responsibility for habit change is shifted from the parent to the child on the basis of the child's age and stage of development.

Most intervention studies have focused on treatment of preadolescent children (6–12 years of age) as compared to younger children (1–5 years) or adolescents (13–19 years) (Epstein, 1993b; Epstein and Wing, 1987). Future studies must focus on younger children and adolescents to fill in these gaps in our understanding of treatment and its outcome, to identify an optimal or preferred age to initiate treatment, and to develop treatment strategies that would be age appropriate.

Parent Training

Since obesity is a familial disorder (Garn and Clark, 1976), the family, particularly the parents, is important in the treatment of the disease. As previously discussed, family influence is both environmental (e.g., modeling, food availability, and food and activity habits) as well as genetic. Epstein and Wing (1987) have demonstrated in numerous investigations the importance of family involvement in the treatment of obesity. The most impressive of these studies showed that targeting both obese children and their parents during treatment results in lower body weights



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