The updated expert recommendations for the treatment of child and adolescent overweight and obesity provide specific and detailed guidance for a staged approach to address childhood weight concerns in primary practice. During 6 years as the clinical director of the FitMatters Weight Control Program, a comprehensive multidisciplinary intervention (such as would be recommended in Stage 3 of the expert recommendations), in which the average child BMI was 45, it became evident that earlier interventions were needed to truly address the obesity epidemic. FitMatters implemented empirically supported behavioral approaches (problem solving, contingency management, environmental control), including child and parental self-monitoring. Many of the participants joined the program without prior basic interventions, and thus lacked basic knowledge about healthy habits and the risks of obesity. Because the program served primarily a low-income, minority population, additional barriers included numerous psychosocial stressors, which often impeded participation in the program and implementation of specific weight management strategies on a day-to-day basis. The combination of already being severely overweight for many years, the lack of a foundation of health knowledge, and numerous psychosocial barriers made it difficult for many participants to manage their weight successfully, despite the intensive intervention, although some were successful despite these barriers.
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