Paradoxically speaking about engagement in pediatric weight management

Consistent with previous research showing that childhood obesity is more prevalent in low-income children (1), a paper recently published in Pediatric Obesity reported a positive relationship between children’s BMI and social adversities including financial difficulties in families (2). In the present article, we argue that children representing ethnic minority populations and lower-income families are not only at greater risk of obesity but also at heightened risk of poor engagement and utilization of pediatric weight management services. Along with effective interventions, optimal engagement of children and families is required to address pediatric obesity and its adverse medical (e.g. risk of type 2 diabetes), emotional (e.g. depression) and social (e.g. isolation) consequences (3). Engagement in pediatric weight management, broadly defined as broadly defined as treatment-related decisions and actions that may or may not benefit patients, is characterized by low enrolment, high attrition and poor adherence (4–6). It is our view that three paradoxes related to engagement might help to explain why many children and families fail to achieve optimal outcomes in pediatric weight management.