Exactly How Multifactorial Is Childhood Obesity?

The full title of this study is “Unraveling Childhood Obesity: A Grounded Theory Approach” to Psychological, Social, Parental, and Biological Factors.” Its four authors are from three different universities and they look at seven major categories of interest: social factors; biological and genetic factors; psychological factors; family condition-related factors; feeding and health-related practices; parenting style factors; and consequences of obesity.

These are further broken down into a couple of dozen subcategories. In other words, there is very thorough coverage of everything that is known, or suspected, to affect the bodies of young humans. Why? Because…

Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration.

This work was done in order to come up with a “grounded theory” that includes them all. According to the study authors,

Grounded theory, as a qualitative research methodology, shows great potential for solving the complexities inherent in multifactorial issues. The aim […] is to construct a theoretical framework or a cohesive explanatory mechanism that explains the phenomena being studied. The application of grounded theory methodology includes analyzing and interpreting data that are mostly qualitative like observations, interviews, texts, and documents.

Needless to say, the numerous factors “interact in complex ways, highlighting the multifactorial nature of childhood obesity.” The authors begin by discussing BMI (body mass index) and other measurement tools, and note that “the absence of a universally agreed-upon definition” of childhood obesity makes every aspect of the search for knowledge more challenging. But it is more necessary than ever, because…

[…] obesity represents a significant component of the worldwide challenge of chronic illness and disability, carrying substantial social and psychological consequences that impact individuals of all ages and socioeconomic backgrounds.

In the realm of causation classification, which area holds the most sub-categories? Perhaps surprisingly to some interested parties, “social factors” includes an abundance of categories, five to be exact. One of them has to do with specific time periods, which in turn will surely be divided into even more sub-categories.

Three possibilities spring to mind. First, there is the historical era. When Americans plodded westward with covered wagons pulled by horses, very few cases of childhood obesity existed. Another place where time makes a difference is in the child’s lifespan. As one example, there appears to be a stage of infancy when trying to shovel solid food into a baby can cause lifelong damage to the digestive system.

Likewise, there is a specific time period during which a problem can be solved. Younger people are more likely to be able to lose weight through one means or another, while adults are more likely to stay fat. That is simply how things are and, as always, further research is needed on every front.

The “biological and genetic factors” category has four sub-categories, and so does “family condition-related factors.” Perhaps it is unfair, that what parents say, do, practice, preach, model, ignore, punish, reward, discuss, clam up about, encourage, discourage, and pay for (or don’t), makes so much difference. Family influence (and lack of it) is responsible for an awful lot, and there is no point in pretending.

One way or another, childhood obesity ends up being everybody’s problem. On the importance of starting early, agreement is universal. The need is felt to construct a theoretical framework that includes all the recognized factors and all the connections between them.

Your responses and feedback are welcome!

Source: “Unraveling Childhood Obesity: A Grounded Theory Approach,” ResearchGate.net, August 2024
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New Findings on Liraglutide for Younger Children

September is National Childhood Obesity Month, and we don’t need to tell you that obesity is a growing health crisis in the United States, affecting people of all ages. For children, the situation is particularly alarming: nearly 20% of all children in the U.S. have obesity, a number that has tripled since the 1970s.

This troubling rise has serious implications, not only for their immediate health but also for their future well-being. Children with obesity often become adults with obesity, facing a higher risk of developing long-term health problems like diabetes, heart disease, and even cancer. Despite these risks, weight loss for children — especially younger ones — has proven to be a significant challenge.

Doctors have long recognized how difficult it is for individuals with obesity to lose weight, regardless of age. While medications like GLP-1 receptor agonists, including the well-known drug liraglutide, offer promising results for adults and teens, younger children have been left with fewer options.

Until recently, children under the age of 12 could only rely on lifestyle changes like diet, exercise, and counseling to manage their weight. However, groundbreaking research on liraglutide is showing that this may be about to change.

Study details

A new study published in the New England Journal of Medicine explains how GLP-1 drugs could play a critical role in treating obesity in younger children. Dr. Claudia Fox, a pediatrician from the University of Minnesota, presented the findings at the European Association for the Study of Diabetes conference. The study focused on children between the ages of 6 and 12 who had high BMIs. Over the course of a year, 82 children participated, with 56 receiving daily injections of liraglutide while the rest received a placebo. Both groups were also provided with counseling to promote healthy diet and exercise habits.

Study findings

The results were impressive. Children who received liraglutide saw their BMI drop by 5.8%, compared to a 1.6% increase in the placebo group. This difference — 7.4 percentage points — was even more significant than the results seen in studies with teenagers. According to Dr. Fox, these outcomes suggest that early intervention with medications like liraglutide may yield better results, possibly even preventing the progression of obesity as children grow older.

Safety and Side Effects

One of the key concerns about using weight-loss medications in younger children is safety. Fortunately, liraglutide proved to be safe for the participants in the study. While some children experienced side effects like nausea, diarrhea, and vomiting, these issues were generally mild and tended to subside as the trial progressed. Very few participants dropped out due to adverse reactions.

However, one major question remains unanswered: How long would children need to stay on these medications to maintain the benefits? Once the trial ended and children stopped taking liraglutide, their BMI started to increase again, though not as sharply as seen in older children. This suggests that while the drug may be effective, it might require ongoing use to sustain weight loss, similar to how other chronic conditions like diabetes or hypertension require long-term management.

Dr. Sarah Armstrong, a professor of pediatrics at Duke University and a co-author of the American Academy of Pediatrics guidelines, said that medication will probably be necessary for children with severe obesity; that is, a BMI of at least 35. She said:

It is pretty clear that without effective treatment, this does tend to get worse, not better, over time… If a child has severe obesity and maybe has developed some early life comorbidities, it’s probably the right thing to do.

Dr. Armstrong does have some concerns about the use of medications in young kids because of the long-term nature of treatment:

What happens to kids if you put them on medication that makes them less hungry while they’re still growing? Are they going to have delayed puberty? Are they going to have delayed growth? Will it somehow affect their bone density? Will it create disordered eating patterns that are going to cause other problems later in life?

A New Era of Treatment for Childhood Obesity?

The potential for GLP-1 drugs like liraglutide to revolutionize treatment for childhood obesity cannot be overstated. While lifestyle changes are crucial, they often aren’t enough on their own. Dr. Fox and other experts emphasize that obesity is a biological disease, not simply a matter of poor lifestyle choices. As such, more aggressive interventions — including medications and, in some cases, surgical procedures — may be necessary to provide meaningful results.

The implications of these findings could be enormous. Children with obesity face not only physical health challenges but also significant social stigma and emotional stress. Successfully treating obesity in childhood could lead to long-lasting health benefits, reducing the risk of complications like type 2 diabetes, heart disease, and even early puberty. This could also help ease the burden on healthcare systems in the long term.

However, more research is needed, and questions about long-term use, the cost, insurance coverage, potential effects on growth and puberty, and the best time to start treatment are still open.

Your responses and feedback are welcome!

Source: “Weight loss drug liraglutide shows promise for younger children with obesity, study finds,” CNN.com, 9/10/24
Source: “A Novo Nordisk weight loss drug lowers BMI in kids as young as 6,” NBC News, 9/10/24
Image by Lidya Nada on Unsplash

Childhood Obesity Awareness Month — Present and Accounted for

Without bringing up a single political point, it is still obvious that America thinks about childhood obesity a lot less than we used to when Michelle Obama was on the case. This seems like an appropriate time to mention a few current happenings that are intriguing, though difficult to categorize. Some ideas that appeared a while back might still have potential.

About six years ago, Dr. Liad Uziel of Bar-Ilan University discussed the belief that, despite a pile of contrary evidence, self-control might be a possible remedy for obesity. However, and sadly, it seems that a high capacity for self-control is a double-edged sword:

Not acknowledged enough are potential undesired personal and societal consequences associated with high self-control and the pursuit of higher self-control. Examples include inflexible behavioral patterns, over-emphasis on norm adherence at the expense of personal discretion, and strict emphasis on cold and rational thinking while overlooking intuition and emotional inputs.

Anyone can easily think of examples of “potentially problematic implications” accruing to an overabundance of self-control. For instance, the trait carries with it the possibility that a person’s information-processing ability might be negatively affected, as they wrongly assume that such a capability is universally distributed among the populace.

In this respect, all people are not created equal, but someone who can do it might unjustly blame others for not using the self-control they are assumed to possess. In the same way, someone with a knack for musical improvisation might assume that anyone can pick up an instrument and just jam… when they just can’t.

Such a mistaken assumption might blossom into a tendency to blame others for not making correct decisions that in reality they simply don’t have the capacity for. Blind faith in the idea that everyone should be able to exhibit extreme self-control can cause rough spots in social and interpersonal relationships.

It gets worse. Dr. Uziel’s research has revealed that “wanting to have more self-control can actually be an obstacle to achieving more self-control,” which is rather alarming:

Intensive self-regulatory efforts can lead to all sorts of problems, including health problems associated with intense stress. On that background, wanting to have more self-control contributes additional stress, and, in the short-run, demotivates one and reduces one’s belief that she or he can actually demonstrate good self-control.

After old notes were reviewed, an attempt was made to chase down a 2015 story headlined, “Childhood Obesity Rates Drop As A Result of Vegetable Spiral Slicer,” which was broadcast by a New York news program. Apparently, cooler editorial heads prevailed and all traces of that piece were removed from the internet.

However, it was possible to find another article about the device, which contains no mention of a decrease in the rate of childhood obesity but does tout the virtues of the Very Healthy Spiral Slicer, saying:

[I]t provides an excellent way to get children excited about fruit and vegetables… It is widely believed that the fun and colourful results produced by the spiral slicer will appeal to children. It is essentially a subtle way to introduce vegetables into a meal in a form that won’t immediately be recognised as a vegetable… Through creating long spirals of vegetables similar to spaghetti, it makes it easy to replace pasta in meals.

It appears that this tool is still available, although whether it is capable of reducing childhood obesity rates is yet to be determined.

Your responses and feedback are welcome!

Source: “Intricacies of the pursuit of higher self-control,” ScienceDaily.com, 03/26/18
Source: “Varietyland Launches New Vegetable Slicer To Revolutionise Healthy Dieting,” PRWeb.com, 04/21/15
Image by Jonas Zeschke/Attribution-ShareAlike 2.0 Generic

Anything Goes? The Epigenetics Challenge

The whole field known as epigenetics is like a wild and wooly frontier. A Harvard University publication calls it an emerging area of research. Basically,

[…] the DNA that make up our genes accumulates chemical marks that determine how much or little of the genes is expressed… The different experiences children have rearrange those chemical marks…

Which explains the mystery of why identical twins can have quite diverse skills and personalities, and different levels of health and achievement. One consequence of this malleability is that arguing “Nature versus Nurture” is a waste of breath. The parental genes a person receives are not the final word on anything, and because developmental experiences “rearrange the epigenetic marks that govern gene expression, they can change whether and how genes release the information they carry.”

A child’s early experiences alter gene expression and affect long-term development whether we like it or not, and whether or not we believe it. Events and circumstances can influence how easily a gene may be switched off or on, and may leave a temporary or permanent mark. To express the concept in a more colloquial way, pretty much everything is up for grabs.

Outcomes depend on such variables as learning opportunities, supportive or destructive family relationships, and the general stressfulness of the surroundings, which may be anything from an odious intellectual environment of stultifying boredom to a catastrophic war zone:

The “biological memories” associated with these epigenetic changes can affect multiple organ systems and increase the risk not only for poor physical and mental health outcomes but also for impairments in future learning capacity and behavior.

The realization that nothing is “set in stone” can be crushing or exhilarating, and the exciting challenge of working with the concept that change may be just within our reach surely fuels the souls of many scientists.

It gets crazier

Things really changed in this area of knowledge with such events as wartime famine in the Netherlands which indicated the possibility of traits that were not genetic, yet nevertheless were heritable. A study showed that men who were still in the womb when their mothers experienced malnutrition tended to have children with a tendency to become overweight adults.

Just when everything already seems complicated enough, the pipeline delivers more baffling information. According to a brand new Northwestern University/University of Texas report, explained by its originators in advance of official publication, “Temporary stress can cause heritable changes without altering the genetics…”

What now? Some of us have just become used to a packet of new ideas about how things work, and already we have to revise them? What exactly is going on here anyway? Well, it seems that…

Bacterial cells can “remember” brief, temporary changes to their bodies and immediate surroundings… And, although these changes are not encoded in the cell’s genetics, the cell still passes memories of them to its offspring — for multiple generations.

Human have entertained a lot of notions about how simple little bacteria inherit and pass along their physical characteristics, and it now appears that this understanding was incomplete. The need for revisionist thinking began to be suspected as far back as 2001, with the Human Genome Project.

Adilson Motter, the new study’s senior author, explained to interviewers that among bacterial biologists, it has long been assumed that DNA is the chief determiner of physical characteristics. However, as it turns out, “information also can be stored at the level of the network of regulatory relationships among genes.”

Scientists wondered whether characteristics can be transmitted from one generation of bacteria to the next by some means other than DNA encoding. Could the cause be the regulatory network itself? Because “the echoes of changes affecting their parents persist in the regulatory network while the DNA remains unchanged.”

Genes interact not only with each other, but with elements of the environment like temperature, available nutrients, and acidity. Excitement is in the air, for it appears that a lot of big discoveries are on the horizon:

For example, researchers could circumvent antibiotic resistance by subtly tweaking a pathogenic bacterium to render its offspring more sensitive to treatment for generations. Image the repercussions of harnessing that sort of knowledge.

Your responses and feedback are welcome!

Source: “What is Epigenetics?,” Harvard.edu, undated
Source: “Bacterial cells transmit memories to offspring,” ScienceDaily.com, 08/29/24
Image by Bernd Thaller/Attribution 2.0 Generic