Q. I have a new patient, a teen who is obese but not particularly concerned about it. Isn’t she at greater risk of body dissatisfaction and excessive weight gain in the coming years? (A.G., Lubbock, TX)

A. New research from the University of Minnesota has shown that a high level of body satisfaction during adolescence is healthy, and may be beneficial for girls in terms of weight management over time. K.A. Loth et al.’s findings, as reported in the Journal of Adolescent Health (J Adolesc Health. 2015. 57:451) refute the common notion that overweight or obese teens have to be dissatisfied with their bodies to motivate positive change.

The study included 496 overweight or obese girls who as adolescents were drawn from Project Eating and Activity in Teens and Young Adults (Project EAT), a 10-year longitudinal study. Among overweight girls, a significant difference in 10-year BMI change across baseline body satisfaction quartiles was observed. Overweight girls with the lowest body satisfaction at baseline had a nearly three times greater increase in body mass index, or BMI, at follow-up, compared with overweight girls in the high body satisfaction quartile.

This difference has important clinical significance. Among overweight boys, no significant associations between body satisfaction quartile and change in BMI were observed. Lebow et al. reported that one-third of teens with restrictive eating disorders had a history of overweight or obesity (J Adolesc Health. 2015. 56:19). This factor was also underscored when the same group reported two examples of eating disorders that developed among obese youths in the context of efforts to reduce their weight.

In an editorial in the same journal, Dr. Kendrin R. Sonneville of the University of Michigan School of Public Health, notes that clinicians and researchers are guided by ethical principles that point to doing nothing over the risk of causing more harm than good. Such well-intended efforts to address obesity can cause unintended harm if not designed to protect against body image issues. One way to accomplish this is to weigh the risks and benefits of approaches designed to address obesity, particularly those that single out obese youths. At the least, clinicians should be aware of their own anti-fat attitudes and avoid using weight-related language generally viewed as stigmatizing.

— SC