Childhood Obesity a Wide-Ranging Problem

fat logic meme

Mothers need to be sensitive, and toddlers need to feel emotionally secure. If these factors are not in place, the child is at risk of being obese by age 15. This was a conclusion reached in the Study of Early Child Care and Youth Development, which encompassed 977 subjects — all born in 1991 — from nine American states. From Ohio State University, lead author Sarah Anderson, Ph.D, told Psych Central News:

It is possible that childhood obesity could be influenced by interventions that try to improve the emotional bonds between mothers and children rather than focusing only on children’s food intake and activity…. Societally, we need to think about how we can support better-quality maternal-child relationships.

The researchers suggest that diet and exercise are not the only areas where attention is needed, and that parents need to be educated, not blamed. If there is money and energy for prevention initiatives, the constructive move would be to improve mother-child bonding. Such an intention could lead to many interesting dilemmas. In order to bond with their children, mothers first of all have to be present with their children. That is a wonderful ideal, but how can any government make that happen, short of requiring that mothers never work outside the home?

Or, a government might change conditions to where a family could get by with only one wage-earner, so that more mothers could afford to stay home and bond with their kids. In any case, huge changes take time, and their outcome is never guaranteed. When giant societal changes happen, even good ones, they often bring unintended consequences in their wake.

How can a government, or private or nonprofit agency, change people’s behavior without infringing on religious and cultural traditions, violating privacy, or creating a multitude of potential administrative difficulties? How does a society go about changing the quality of emotional relationships between mothers and toddlers? What an enormous and impossible task that seems.

The practical aspects

If the stress-response system is in a state of dysregulation, trouble ensues. Dr. Anderson explained how brain changes might be indirectly responsible for obesity, because of the limbic system, which runs hunger, thirst, the sleep cycle, our stress-response capability, and “a variety of metabolic processes”:

Sensitive parenting increases the likelihood that a child will have a secure pattern of attachment and develop a healthy response to stress. A well-regulated stress response could in turn influence how well children sleep and whether they eat in response to emotional distress — just two factors that affect the likelihood for obesity.

The case for sleep looks more solid every day, and the prevalence of eating in response to emotional distress is undeniable. The best thing parents can do is work on themselves so they can model healthy behavioral responses to stress, and just generally act to keep the stress level at home very low.

Your responses and feedback are welcome!

Source: “Teen Obesity Linked to Mom’s Relationship with Baby,” PsychCentralcom, 12/26/11
Image: unattributed Internet meme

A Pointless Childhood Obesity Controversy

Inline-Skating-ECPStacy-Ann Gooden, who writes for, told her readers about an Australian study, published in the journal PLOS ONE, indicating that overprotective mothers are “associated with a 13 percent increase in the odds of children being overweight or obese.” Gooden and her husband don’t let their child loose for free-range outside play. They doubt that she will ever spend an entire night at a sleepover, though they may drop her off and pick her up before bedtime. On the question at hand, however, Gooden feels that associating parental caution with obesity is “crazy.”

But she does quote people in disagreement, such as Canadian writer Douglas Robb, who believes that parental safety concerns and the time children spend with electronic screens are both major impediments to the sufficient-exercise ideal. He thinks children spend too much time in highly-controlled environments where they have no opportunity for the kind of free play  past generations enjoyed. Also quoted is pediatrician Ramon Resa, who told The Huffington Post,

I have come to the conclusion that we are doing our kids a disservice by being hyper aware of all the dangers in our society.

Criteria Questioned

Ultimately, it took an online commenter to put his finger on the problem: a poorly-designed experiment, and too little information to really draw a solid conclusion. The criterion for defining overprotectiveness consisted of the parents’ answers to only three questions. As with any study that depends on self-reporting, results may vary. “Jules” concedes that overprotectiveness might make a child prone to developing psychological issues that could show up as obesity. But the direct link, in his view, is very weak, at least if based on this one study.

The study took place over four years and, interestingly, found the correlation between overprotectiveness and obesity increasing with age. Does this mean that older children are more likely to become restless under excessively concerned parenting, and to rebel by letting themselves gain weight? Or does it only mean that the accumulation of extra fat requires some time? Also, Jules says:

The study did not address the mechanism for obesity. That is, it did not look at whether kids with overprotective parents were more or less active, nor did it address dietary factors, or any of the other known causes of obesity.

Most importantly, Jules sees the key finding (and the most counterintuitive one) in a detail that most people seem to have missed. Parental behavior that might be considered hypervigilant was identified in the lower socioeconomic classes. In other words, as he says:

Maternal overprotectiveness is less a feature of the class that we think it is (upper- and middle-class) and more a feature of the lower classes.

Other readers mentioned the very excellent fact that this debate does not have to be an either/or proposition. Parents can most definitely get out there with their kids, in a park or at a health club, and take part in physical activities as a family, watching over and protecting the children to their hearts’ content.

Your responses and feedback are welcome!

Source: “Do Overprotective Parents Have Fatter Kids?”, July 19, 2014.
Image by Walter Lim.

Childhood Obesity: Where Moms Go Wrong

Some of the things mothers are blamed for may not, strictly speaking, be their fault. For instance, children of single mothers are more likely to develop obesity, but often, single motherhood is not a choice on the woman’s part. Another condition that a mother might experience, through no fault of her own, is PTSS or post-traumatic stress symptoms. PTSS is often used as shorthand for the distress felt by a parent whose child is damaged by a trauma that the parent did not personally experience.

It’s kind of like second-hand trauma, to which, historically and understandably, mothers are more susceptible than fathers. Naturally, even family members who did not experience an event are inextricably involved with its aftermath, and are filled with anxiety. For instance, when a child is an accident victim or undergoes a surgical procedure, parents are deeply affected. PTSS symptoms may include avoidance, hyperarousal, and re-experiencing. Kristi Wilsman writes,

PTSS in the parent is felt to impact a child through negative parental modeling, poor coping mechanisms and reactions to subsequent reminders of the trauma and stress.

Feeding Culture

A mother who is overweight or obese is more likely to have an obese child, and very often the mother’s weight is a function of her cultural background.

The University of North Carolina-Chapel Hill School of Medicine was the scene of a study whose lead author is Dr. Eliana Perrin, pediatrician, and professor. The team interviewed 963 parents, mostly mothers, about their infant-feeding practices.

They found that many mothers are not following the recommendation of the American Academy of Pediatricians to keep a baby exclusively on breast milk for the first six months, although there are indications that sticking to that limited diet can indeed reduce childhood obesity. Additional bad news:

More than one third of parents reported coaxing their babies to finish drinking bottles, and nearly a quarter propped bottles in their infants’ cribs or bassinets. Nearly half the parents reported watching television while feeding their infants, and 43% reported putting their babies to bed with a bottle.

All Ethnicities Affected

The researchers found no ethnic or racial group to be free of bad habits, and concluded that all families need early counseling, whatever their background. Among other things, this counseling would consist of advising parents to talk and play with babies, rather than zoning out with the television. Also, it’s a good idea to pay attention when a baby seems to have had enough, and not persuade the child to take more. And try to always hold the baby, rather than propping the bottle. Aside from overfeeding, the other potential dangers of that habit include choking, tooth decay, and ear infections.

A German university’s meta-study, involving 66 relevant studies that encompassed more than 640,000 individuals in 26 countries, shows that a birth weight of more than about 8.8 pounds will double a child’s risk of becoming overweight. A prospective mother is wise to avoid overnutrition, overweight, lack of exercise, and the metabolic disorders that accrue from those lifestyle choices. Professor Andreas Plagemann said:

Even more than before, the course of pregnancy is proving to be the key factor for the health of the child for its whole life.

Your responses and feedback are welcome!

Source: “Development of the Posttraumatic Stress Symptoms — Childhood Obesity Model,”, August 2012.
Source: “Cultural Practices May Cause Weight Gain in Babies,”, 03/19/14.
Source: “Yeah, That’s Right. Your Mom Is the Reason You Are Fat,”, 01/10/13.
Image by Karine.

Exercise, Motivation, and the Brain

A team at Seattle Children’s Research Institute, looking for answers about depression, learned something new that could make a difference to childhood obesity, specifically, an exciting revelation about motivation and mood regulation.

Principal investigator Dr. Eric Turner, who works with the Institute’s Center for Integrative Brain Research, is also a professor of Psychiatry and Behavioral Sciences at the University of Washington. The study’s lead author is Dr. Yun-Wei Hsu, and the publisher is the Journal of Neuroscience. The research was funded by the National Institute on Drug Abuse and the National Institute of Mental Health.

The area of interest is a part of the brain that seems to control the desire for physical activity, along with the ability to enjoy other activities that a well-functioning person recognizes as rewarding.

Depression Catch-22

A person suffering from major depression does not find enjoyment in much of anything, and the impulse to go out and run a few laps is definitely not operative in the midst of depression. This is particularly unfortunate because exercise can alleviate depression, and is in fact a recognized nonpharmacological therapy for the condition. The Catch-22 is that a person can’t benefit from physical activity if she or he is too depressed to engage in it. Dr. Turner is quoted as saying:

The brain pathways responsible for exercise motivation have not been well understood. Now, we can seek ways to manipulate activity within this specific area of the brain without impacting the rest of the brain’s activity.

What area of the brain is it? A tiny region called the the dorsal medial habenula. The hope is that by identifying it, a first step has been made toward developing more accurately targeted and thus more effective treatment for depression. Rodents and humans are similar in many ways, so knowing more about the habenula of a rodent is quite useful.

Two Stages

Normally, lab mice spend a lot of time running on their exercise wheels with every indication of enjoyment. They also relish drinking sweetened water when it is available. These traits are easily observable. But how do scientists know what kind of mood a rodent is in, and what motivates it to do what it does? A mouse that has no interest in running on the wheel or sipping sugar water obviously suffers from some impairment of its ability to have a good time. The first part of the study scrutinized mice that had been genetically engineered so that signals from the dorsal medial habenula were blocked, and their behavior was as lethargic, unmotivated, and couch-potatoish as that of depressed humans.

The second part of the elaborate experiment is best understood by reading the original report. The description of the very advanced technology employed to find these results is fascinating. The study convinced the researchers that the dorsal medial habenula is indeed intimately connected with rewarding behavior, and with mood regulation and motivation.

Benefits of Exercise

Hopefully at some point the knowledge gained here can be extrapolated and adapted to invent a new mode of therapy that can help morbidly obese young people turn their lives around. Childhood Obesity News has discussed the benefits of exercise before. On the most basic and obvious level, it burns calories, but this is just scratching the surface. For a refresher course in why physical activity is so essential, please review Neila Rey’s “50 Reasons to Exercise” poster. Shown in miniature on this page, it is available in full-size as a downloadable PDF file.

Your responses and feedback are welcome!

Source: “Area of brain responsible for exercise motivation discovered,”, 08/20/14.
Image by Neila Rey.

Childhood Obesity and Creative Lip-Zipping

The Mommy and Me Tea - U.S. Army Garrison Humphreys, South Korea - 14 July 2012

Registered dietitian Maryann Jacobsen runs a great website with consistently interesting and helpful articles, often in list format. One such list names 10 verbal mistakes that parents can make in the course of trying to prevent or change the course of childhood obesity. Yes, it matters what we say and how we say it. Our responsibility does not stop with bringing nourishing food into the home and preparing it and serving it at regular mealtimes in a pleasant atmosphere. The responsibility extends to words. To win the hearts and minds of children over to maximum health awareness, we need to avoid saying harmful and useless things.

Learning Grown-Up Skills

For instance, some kids seem to make a full-time hobby out of refusing to try any new food. Even if they deign to take a taste, they are likely to reject it and go back to the familiar territory of a few tried-and-true old faithfuls. Learning to appreciate different things sometimes requires a bit of time, and a few tries. A parent can help by acknowledging this. Widening the realm of acceptable foods is a grown-up skill, like the other grown-up skills that a child eventually learns. Planting this idea might facilitate the adoption of new foods into the hall of favorites.

The writer also urges explaining why requests are turned down. Most kids are good kids, and tend to cooperate better when they understand where a “no” is coming from. In addition, small children have a fuzzy concept of the future and what is likely to happen in the course of it. Maybe the child misunderstands, and thinks you mean “No licorice ever again.” Explaining that licorice time will be after supper might actually help.

Alternative Wording

This item is very important. It starts with what a parent should not say, then translates what it means to the child, and offers a reason for changing our parental behavior, and even a better alternative set of words to send out into the world:

“You didn’t eat enough. Take a few more bites and then you can leave the table.”

Translation: “Mom/dad/empty plate (external signals) are a better judge of when I’m done eating than what I’m feeling inside.”

A better thing to say: “Make sure you got enough to eat because the next meal won’t be until (breakfast, lunch, dinner, snack time).”

Rationale: When children are in charge of how much to eat, they learn how to effectively manage hunger (hint: sometimes, mistakes have to be made).

Jacobsen urges parents to understand that pickiness about food is a normal stage of development, and then to expunge the word “picky,” and any synonyms, from their vocabulary. Once a label is applied to a person, it may do various kinds of harm, and will definitely not lead to any type of beneficial result.

We won’t give away all of Jacobsen’s secrets here, but, speaking of labels, Childhood Obesity News offers a reminder about how truly counterproductive it can be to label a food “bad.” The word implies a judgmental attitude, which is never helpful in any situation — especially with kids who often delight in being “bad,” for myriad reasons beyond the scope of this post.

Your responses and feedback are welcome!

Source: “10 Things You Should Never Say to Your Child About Food,”, 09/07/12.
Image by USAG-Humphreys.


Cookie Monster Must Go!

The Cookie Monster and the Milky Monster.

Not long ago, Erica Palan found it troubling that “America is waging a war on Krimpets.” This is a brand of snack cake, and the Disney empire had decided no longer to carry advertising for it. But Palan believes that such an attitude will backfire and cause more trouble in the long run. The psychological effect on parents is not helpful. Palan says:

By banning junk food commercials, Disney is letting parents off the hook when it comes to educating their children about healthy eating. Shielding kids from the available options doesn’t help them understand why they shouldn’t guzzle a gallon of Pepsi — teaching by example and conversation does. In short, commercials aren’t causing childhood obesity.

The last statement is a bold one because many authorities disagree vehemently with that position, and believe that advertising is massively destructive.

As for the “letting parents off the hook” part, she is right. Parents do need to teach by example, and have conversations with their children.

Tongue in Cheek?

The subtitle of Palan’s Philadelphia essay is, “Don’t just stop with banning junk food advertising. Birthday cakes and Cookie Monster must go!” This is a hint that perhaps the writer is not entirely in earnest. Only the first part of her essay is serious. The rest is devoted to some tongue-in-cheek ideas about reducing childhood obesity.

Except … exactly how serious is this woman? Because her first suggestion is “Just say no to Halloween,” which is a totally legit idea shared by many adults in the helping professions, and by even more parents. It need not be completely abandoned, but Halloween could stand a vigorous reinvention. Palan is very funny and we won’t spoil her humor by paraphrasing it, but this part must be quoted verbatim:

Cookie Monster should be rechristened as Veggie Monster. He currently reminds children that cookies are ‘a sometimes snack.’ But no more! Parents and their offspring don’t have the self-control to understand the word ‘sometimes.’

What is this? Satirical humor, or a straight-up 100% accurate diagnosis? She appears to mean it, and it does seem self-evident that obesity is rampant in our society. Grownups don’t have self-control. Kids don’t have self-control. So, what’s the joke?

Truth Is Subjective

But then, the writer turns around and makes a clearly absurd suggestion. Or maybe not. What one person recognizes as absurd may be another person’s gospel truth. For instance, the politician Sarah Palin has expressed thoughts about child nutrition that caused many people to say, “She’s got to be kidding.” Yet her many supporters are quite convinced that she is correct.

The last time Childhood Obesity News caught up with Cookie Monster, he was a reformed character. The blue puppet had changed his public image from insatiable consumer of cookies, to reasonable fellow who tamed his appetite for cookies and broadened his diet to include other, more nutritious foods.

Cookie Monster’s video is still on YouTube.

Source: “7 Ways to End Childhood Obesity,”, 06/14/12
Image by Anthony J.

A Bouquet of Tips for Parents

Registered dietician Maryann Jacobsen has gathered a generous selection of excellent suggestions for parents, and backs them all up with references. She places a great deal of importance on communal meals served at stated times, and discourages snacking and grazing. Even if a family’s schedule is impossible during the week, one big major shared meal on the weekend should be doable. For any meals, she recommends family-style serving. In other words, pass the bowl around and let kids help themselves to the amounts they feel comfortable with. This recommendation is based on the teachings of Ellyn Satter, whose official biography describes her as:

Registered Dietitian Nutritionist and Family Therapist and internationally recognized authority on eating and feeding, who pioneered the Satter Feeding Dynamics Model and the Satter Eating Competence Model. She is the author of the Division of Responsibility in Feeding, which is the gold standard for feeding children.

Regulating Food Intake

The Division of Responsibility doctrine aims to build trust and competency, and help children work out their ability to regulate food intake by learning to recognize physiological cues. Evidence shows that 85% of young parents have made efforts to feed their children more at meals. On the other hand, other parents try restricting portions. According to Satter’s philosophy, no bribery or coaxing is to be done by parents, and no portion restriction, either.

The rule for babies is slightly different than for older kids. With infants, the parent is responsible for the what, obviously, since little babies can’t get their own food. But the child is responsible for how much of it to accept, and when, and where. For everybody else, toddlers through teenagers, the parent is responsible for what, when, and where — for providing food of the parents’ choice, at a certain time and place. But the child decides whether to eat, and how much.

Making Mealtime Pleasant

This works better if parents also provide a pleasant atmosphere for sharing sustenance. The emotional ambiance of a meal influences people in ways that can be very destructive. Whatever else is going on in the household, mealtime should be a truce with no snarking or sniping. This is the place to demonstrate good manners and good eating habits. Jacobsen advises parents to make use of everyday moments to pass along the tenets of healthful eating:

Children learn about nutrition simply by seeing which foods are served and how often. The foods you have in your house should be in line with your beliefs about food and nutrition. They will go out into the world and notice the difference and this is where you can gradually teach them about nutrition.

Another recommendation is to expose kids to a variety of nutritious foods, and a very patient parent will not give up, but will try again, and perhaps look into different cooking or presentation methods that might inspire a child to finally try a particular item. Kids who help with the preparation and cooking processes are apparently more willing to eat the resulting food, so the answer might be as simple as enticing them to join the kitchen crew.

This fits in with another piece of advice Jacobsen offers to parents: Embrace cooking. To do a good job of obtaining food and of getting it ready and serving it is an enormous commitment of time and energy. As she says, “We can hate every minute of it or embrace our role as provider.”

Your responses and feedback are welcome!

Source: “15 of the All-Time Best Strategies for Raising Healthy Eaters,”, 02/07/14.
Source: “Ellyn Satter, MS, RDN, LCSW, BCD,”
Source: “Ellyn Satter’s Division of Responsibility in Feeding,”
Image by kelly.

Childhood Obesity, Mothers, and Blame

Every mom cooks like this no

Last time, Childhood Obesity News talked about a controversial public service announcement that Dr. Pretlow discussed in an interview. Many people interpreted the PSA as zeroing in on mothers as the root of the childhood obesity problem. For simplicity’s sake, it’s easier to address mothers as the main nurturers, but of course almost all advice for moms is also for dads, extended family members, day-care workers, and anyone else responsible for putting food into the face of a young human.

Even when mothers are not overtly blamed, they are made to feel like failures. Writing for, Lisen Stromberg describes the thought process:

You tell me my kid is obese and two things happen, a) I get defensive because the subtext is I’m not a good mother, and b) I ignore your advice because I don’t want to consider that, as the gate-keeper to my children’s health, I may actually be harming them.

Women have all kinds of complicated feelings about weight and body image, both their own and their children’s. For some women, the modern fitness-conscious mom is a paradigm of self-involvement and narcissism that they don’t want to sign onto. Stromberg says:

For these women, being the mother who provides food and sacrifices herself for her family is more important than her own weight. She doesn’t have time to exercise because what little time she does have, she wants to devote to her children.

Such super-focused mothers may even be aware that example is the best way to teach. But the example they are trying to set for their children is of a mother who stays home, generally in the kitchen, and it doesn’t matter what kind of figure she has because it’s covered up with an apron anyway. The underlying idea is that a true mother is willing to sacrifice herself by “letting herself go,” without realizing that it’s not an either-or proposition. Received wisdom and unquestioned attitudes are what make up a culture, and a culture often prides itself on resistance to change. Stromberg says:

It isn’t as simple as rich vs. poor or white vs. ‘other’. We are hitting women at the heart of their roles as mothers when we tell them their children are obese. We need to find a way to work within their own value system as mothers and women.

The culture in which a mother has been brought up might encourage her, at feeding time, to watch TV rather than concentrate on the baby, and even such small and seemingly unimportant actions make a difference. “Propping” a bottle and leaving an infant alone to drink its milk or formula is seen as harmless in some cultures, while many experts would rather see this practice abandoned. The bottom line is that families of all ethnic backgrounds and races could use a little help in one way or another.

A metastudy conducted by Dr. Tristin D. Brisbois and a team from the University of Alberta looked at 135 relevant studies, comparing 42 variables suspected to be associated with adult obesity. They narrowed it down to seven main early markers. Mothers who smoked and gained too much weight during pregnancy were noted as likely causes, and maternal BMI appears to be a definite cause. Again, rather than being neglectful or uncaring, these mothers might have been operating out of what they considered more important motives than keeping themselves healthy.

Class, or more bluntly, economic status, seems to play a part, and brings to mind an interesting footnote from a previous Childhood Obesity News topic. In this study, the economic difference was confusingly split. Speaking of the effect on unborn babies of electromagnetic fields from cellphones and appliances, Dr. De-Kun Li’s team observed that:

…there was no consistent pattern of MF exposure with family income: women with either low or high family income had lower MF exposure level than women with medium family income.

There are so many ways in which parents can sabotage their children’s heath — using food as a reward for good behavior; being overprotective, negligent, or authoritarian; reacting to stress in unhealthy ways; and many more — and Childhood Obesity News will look at them more deeply.

Your responses and feedback are welcome!

Source: “The Answer To Childhood Obesity? Mothers,”, 06/25/12
Source: “Early Childhood Factors ID’d for Predicting Adult Obesity,”, 12/29/11
Source: “A Prospective Study of In-utero Exposure to Magnetic Fields and the Risk of Childhood Obesity,”, 07/27/12
Image by Brian and Mia Elizardi

Dr. Pretlow Interviewed About Controversial PSA

Atlanta Panorama

A couple of years back, Childhood Obesity News discussed the Georgia anti-childhood obesity billboards. Created by the Strong4Life program founded by Children’s Healthcare of Atlanta, they were criticized as tasteless and too judgmental.

So much attention was focused on the billboard/poster campaign that few people remarked on a 1-minute, 41-second video PSA the group released around the same time. “Rewind the Future” didn’t garner much attention at first, but recently it suddenly did. It starts with a patient being readied for surgery. He weighs about 300 pounds and just had a heart attack. We are shown scenes from his earlier life, going farther into the past each time. Here is how Cristina Goyanes of describes it:

As the flashback continues, Jim’s mom enters the picture. At first, she seems caring, gifting him an at-home treadmill to help him lose weight. Rewind a little more, and the story shifts. Rather than encouraging her son to be healthy, as she does later, Mom is doing the opposite, picking up fast food for him, buying him candy from a vending machine, letting him eat sugary cereals for breakfast, and feeding him French fries.

Now everybody’s talking about the video’s shock value and alleged fat-shaming. It is a factor worth being sensitive to. The Rudd Center for Food Policy and Obesity has determined that behavior change is not effectively motivated by stigmatizing people. More to the point, the short film is parent-blaming. Still, not everyone is upset. Its proponents describe “Rewind the Future” as bold, and the topic deserves boldness. Writer Beth Greenfield quotes an online comment from an unnamed doctor:

Obesity is perhaps one of the worst comorbidities to have for a hospital patient. It complicates everything. Every. Single. Thing.

“Rewind the Future” just wants to raise awareness and encourage people to make some changes, even small ones. And by people, they mean parents. An honest parent will admit there are times when you will do just about anything to get a child to stop fussing. Some parents have even found themselves struggling to appease a difficult child as if offering sacrifices to a raging monster from a horror movie.

A parent can take a very positive and useful step toward avoiding that situation. Parent Effectiveness Training and other courses can teach parents how to cope in those moments of temptation. Feeding a child is not the only way to get some peace and quiet. The Strong4Life website offers parenting tips from a page that also says:

As parents (and humans), we’ve all made decisions that didn’t look too good in hindsight. But today, right now, we have an opportunity for a life changing do-over…. if your children are still children, it’s not too late.

The writer Cristina Goyanes also interviewed Dr. Pretlow, who confirmed that parents often play a role in enabling a child’s obesity. Please do visit and enjoy “Are Parents to Blame for Obesity?”

Your responses and feedback are welcome!

Source: “Shocking Anti-Obesity PSA Sparks Debate,”, 08/12/14
Source: “5 Tips for Powerful Parenting,”, undated
Source: “Are Parents to Blame for Obesity?”, 08/15/14
Image by Tim Dorr

The Closing Childhood Obesity Window

Fat Boy

The journal Childhood Obesity (Volume: 10 Issue 4: August 1, 2014) published an editorial by Dr. Stephen R. Daniels (University of Colorado School of Medicine) and Dr. Aaron S. Kelly (University of Minnesota Medical School). “Pediatric Severe Obesity: Time to Establish Serious Treatments for a Serious Disease” makes the case that the prevalence of severe obesity among teenagers is accelerating, and the need is obvious for more intensive interventions. The authors very strongly urge more drugs and more bariatric surgery for America’s youth.

How did we get to this point? What makes these health professionals advocate such extreme measures? Nearly 6% of children and teenagers in the U.S. qualify as severely obese. Extrapolation from longitudinal studies predicts that 90% of these obese kids will be obese adults, with all the comorbidities that come along with severe obesity. The authors spell out the consequences:

Children and teens with severe obesity … have higher levels of blood pressure, triglycerides, inflammation, oxidative stress, lower levels of high-density lipoprotein cholesterol, signs of subclinical atherosclerosis, and a higher prevalence of impaired glucose tolerance and prediabetes. Severe pediatric obesity is also associated with obstructive sleep apnea, nonalcoholic fatty liver disease, musculoskeletal problems, and reduced quality of life.

However, while diet and healthy lifestyle changes have a chance when implemented during childhood, the window of opportunity closes fast. Prevention is the best approach, and failing that, early identification of the problem and early intervention are crucial. Severely obese teenagers are another story. Although lifestyle modification therapy should be included in their program, the authors feel that lifestyle changes alone cannot be enough, and anything short of surgical treatment is “virtually ineffective.” They write:

The current state of evidence suggests that more intensive interventions, potentially including pharmacotherapy and weight loss surgery, may be required to elicit meaningful reductions in adiposity and the comorbidities associated with severe obesity in this lifestyle treatment resistant adolescent population.

The reason for this dictum is that even if lifestyle modification alone may seem to working the short term, by the time a teenager has become severely obese, the body has already made far-reaching adaptations. The hormones that manage appetite and satiety may be so out of whack that it will be impossible to maintain weight loss over the long term. According to the authors, better access to specialty medical weight management programs, pharmacotherapy, and weight-loss surgery are all important components of a more comprehensive strategy to combat severe obesity among teens. But they pin their best hopes on pharmacotherapy and bariatric surgery.

The additional bad news is, when it comes to pharmacotherapy those hopes at present are slim. Only one weight-loss drug has been approved for adolescents, but it doesn’t work very well and the side effects are considerable. Consequently, a segment of the teenage population experiences obesity so serious that surgery appears to be the only answer. Dr. Daniels and Dr. Kelly feel that surgery is underutilized. They hope that the widespread resistance to it will fall away, and also that more effective drugs will enter the market.

Meanwhile Dr. Pretlow asks, what else could this be, other than addiction? As Childhood Obesity News has discussed, Dr. Pretlow has developed a smartphone app known as W8Loss2Go, which is based on an addiction model of staged withdrawal in small increments from problem foods, snacking between meals, and excessive food amounts at meals. He says:

Intensive treatment using addiction medicine methods is showing potential for such young people, as evidenced by results from our three pilot studies involving 142 obese youth.

Your responses and feedback are welcome!

Source: “Pediatric Severe Obesity: Time to Establish Serious Treatments for a Serious Disease,”, 07/01/14
Image by Yun Huang Yong

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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