More on the Psychology of Fat

As we have noted more than once, there are oddities about how obesity has been regarded in different places and at various points in history. In some parts of the world, civilization has entered a phase where, rather than causing people to be emaciated, a shortage of money could (against all logic) make them fat. Today, low-income people are sold a plethora of products filled with more fattening ingredients than nutritious ones.

In the Middle Ages, to be fat and to have fat wives and heirs was way cool, a power move, a proud public assertion of worthiness, and a self-declaration of importance that was widely accepted as such, regardless of the thoughts of any lower members of society.

In the present day, a big waistline might mean either wealth or poverty. In circumstances where the wealthy are viewed as greedy parasites, to call such a person fat is an insult. At the same time, in any societal environment where the poor are viewed as undeserving sub-humans who eat up all the taxes that are unfairly extracted from the wealthy, to be called fat is an equally potent insult when hurled at them.

The vagaries of earthly life

Some people enter the world with blue eyes. Others are born deaf. Some emerge from the womb left-handed. And some arrive with a genetic predisposition to obesity — or are thrust into circumstances which (for them, anyway) will make it inescapable.

Skip ahead four decades. In which of those situations, after 40 years of existence, is a human most apt to be mocked, ridiculed, disrespected, scorned, rejected, vilified, blamed, or shamed? Which of those conditions is most likely to cause a grown adult — who may be successful, and even fulfilled, in one or more aspects of normal life — to seek help from a mental health professional? Obesity, of course.

Plus, the lack of choice

Another factor here is that while a person may quite readily have the freedom to choose between being left-handed and wealthy, or left-handed and impoverished, other situations are not so amenable, and obesity is one of them. In the past few years, advances have been made in this area of knowledge, to the point where more people realize that obesity can definitely influence a person’s prospects, and even lead them into a life of relative financial deprivation.

A typical citation comes from the journal BMJ Open:

Studies suggest that the obese are more likely to be perceived as lazy, unsuccessful, weak-willed and undisciplined. On basis of these negative stereotypes, the obese face various weight penalties in the labour market, which include higher job insecurity, lower chances for a job and general discrimination.

Along with many other sources, that one has noted the mutual disadvantages of being both fat and broke:

[L]ower income is associated with higher levels of psychosocial stressors which include decreased control over life, and higher insecurity, social isolation, stress and mental disorders.

[T]he stigmatization of the obese also correlates with material (ie, less income through weight penalty), behavioral (ie, change in health-promoting behavior through discrimination), as well as psychosocial factors (ie, self-stigma may inflict lower control over life, social isolation, stress, lower self-esteem) that may, again, lead to a higher risk of obesity.

One reason why such individuals seek counseling is to escape the curse of self-stigmatization, which all too readily transmogrifies into psychological malfunction. It’s bad enough to have other people metaphorically beating you up, but when you start doing it yourself, the situation really calls for intervention.

(To be continued…)

Your responses and feedback are welcome!

Source: “Income and obesity: what is the direction of the relationship?,” BMJ.com, January 2018
Image by Kaz_Graphics/Pixabay

CDC Updates Its Childhood Obesity Facts

Last week, the Centers for Disease Control and Prevention (CDC) released its childhood obesity facts, updated with some recent research data. While there are no shocking revelations to be glimpsed, especially by the readers of this blog, it’s always useful to try seeing the big picture backed up by reliable research. The numbers reveal a growing issue that touches nearly every part of society. No big surprise there, either. Here are some highlights (or, shall we say, lowlights).

Obesity in numbers

Between 2017 and March 2020, obesity affected 19.7% of children and adolescents in the United States. That translates to approximately 14.7 million young people between the ages of 2 and 19. For children, obesity is measured using Body Mass Index (BMI), with obesity defined as having a BMI at or above the 95th percentile for a child’s age and sex.

The climbing rates

One of the most concerning trends is how obesity rates increase as children get older. Among children ages 2 to 5, the obesity rate was 12.7%. However, the percentage climbed significantly among older age groups, reaching 20.7% for children ages 6 to 11 and 22.2% for adolescents ages 12 to 19. These statistics suggest that unhealthy habits and lifestyle challenges may intensify as children grow older, making early intervention especially important.

Racial and ethnic disparities

The data also highlights major disparities among racial and ethnic groups. Hispanic children experienced the highest obesity prevalence at 26.2%, followed closely by non-Hispanic Black children at 24.8%. In comparison, obesity rates were 16.6% among non-Hispanic white children and 9.0% among non-Hispanic Asian children. These differences point to broader social and environmental factors that can influence access to nutritious food, safe places to exercise, healthcare resources, and education about healthy living.

Obesity by gender

Gender differences also appear within these statistics. Among girls, obesity rates were highest in non-Hispanic Black girls, with nearly one-third affected. Among boys, Hispanic boys experienced the highest obesity prevalence at 29.3%. These patterns demonstrate that childhood obesity does not affect all groups equally and that targeted community-based solutions may be necessary.

Family income

Family income plays a significant role as well. Children from lower-income households were more likely to experience obesity than those from higher-income families. Obesity affected 25.8% of children living at or below 130% of the Federal Poverty Level, compared to just 11.5% of children from families earning more than 350% of the poverty level. Financial limitations can make it harder for families to purchase healthier foods, participate in recreational activities, or access preventive healthcare services.

Healthcare costs

Beyond the physical health concerns, childhood obesity also creates a major financial burden. Healthcare costs related to obesity among U.S. children reached an estimated $1.3 billion annually in 2019 dollars. On average, children with obesity incurred $116 more in medical expenses each year compared to children with healthy weight. For children with severe obesity, those costs rose to $310 more per year. These expenses reflect increased medical visits, treatments, and long-term health risks associated with obesity-related conditions.

It takes a village

Addressing childhood obesity requires a collaborative effort from families, schools, healthcare systems, and policymakers. Encouraging healthy eating habits, increasing opportunities for physical activity, improving access to affordable nutritious foods, and supporting preventive healthcare can all play a role in reducing obesity rates. While the statistics are serious, they also provide an opportunity to focus on meaningful solutions that can improve the health and well-being of future generations.

Your responses and feedback are welcome!

Source: “Childhood Obesity Facts,” CDC, 5/6/26
Source: “National Health and Nutrition Examination Survey 2017–March 2020 prepandemic data files development of files and prevalence estimates for selected health outcomes,” National Health Statistics Report, 2021
Source: “Association of body mass index with health care expenditures in the United States by age and sex,” PLOS One, 3/24/21
Image by U.S. Centers for Disease Control and Prevention, via Wikimedia Commons/Public Domain

The Historical Psychology of Fat, Continued

As a previous post noted, to be called skinny used to be an insult. It implied that no one cared whether you lived or died, or that you were too stupid and inept to earn enough to feed yourself. Anyone who was that poor would be considered worthless and deserving of starvation.

Then some parts of the world grew a little softer, and a person who was skinny because of poverty might be pitied and even helped. Then, we got to where if someone is thin, it might only mean they can afford to belong to a fitness club.

At any rate, for thousands of years, the norm was for poverty to cause undernourishment and low weight. But now, because of some creepy ingredients being added to food, it appears quite possible that poverty can cause obesity.

Food on the brain

Moving on, here are a few more glimpses from the documented past. As in many other departments of human experience, a lot of the accepted wisdom doesn’t even make sense, or makes sense only within a limited repertoire of assumptions about life and the world.

There are some broad observable trends. For instance, along with what people eat and the amount they eat, the centuries have also seen the politicization and weaponization of other factors, like how, when, and where they eat.

Is there really such a thing as a great restaurant critic? Why should that person receive any sort of reward, or even a salary? Why does society tolerate the existence of a cult that fetishizes food? What if we simplified life by all just existing on a canned energy drink or an IV infusion?

And naturally, if humans insist on placing such importance on food, controversy will unavoidably stem from the inevitable results of eating, or not eating, that food. The most noticeable results in those cases are underweight people and overweight people.

End obesity before it ends you

In the 60s, the social movements that swept across the United States asked such questions as, “How dare anyone criticize what race I am, or what I smoke?” And, “Who is that politician, anyway, to tell me I have to go halfway around the world and kill some rice farmers?” Or, “If I want to sleep with a hundred different partners, whose business is that?”

Maybe the day will come when people rise up and march, carrying signs like “Fat As I Wanna Be!” How about, “Bigger Is Better!” “I’m Not Overweight, You’re Insubstantial!” Might it even be possible to legislate against discrimination and bring anti-fat bigots to justice through the law?

For some corpulent people, is their main problem a stubborn reluctance to do what a slew of busybodies see fit to demand? What part should the sciences of psychology and psychiatry play in the obesity issue?

One of the most influential Bible stories is about the original Christian using superhuman powers to share nutrition with a large crowd, no questions asked. The Prophet of Islam told his followers they should absolutely feed people who don’t have enough to eat. Among spiritually inclined humans, to have a bad attitude toward the hungry is pretty much universally frowned upon.

Other sides

According to some segments of pop culture, to become obese gives the world permission to make the accusation: “You don’t care what other people think about you!” — as if that were a bad thing.

But… Indifference to the opinions of others is a trait that has often moved humanity forward. As one example, people who choose lives of service, dedicating themselves to caring for the poor and the sick, are indifferent to the opinions of relatives and friends who ridicule them for bypassing the possibilities of wealth and privilege.

If Mother Teresa had cousins who criticized her for hanging out with beggars, she didn’t care. So maybe there is more to it than that.

Your responses and feedback are welcome!

Image by Boy-Employee and OpenClipart-Vectors/Pixabay

The Historical Psychology of Fat

Over the centuries of human life on Earth, obesity has always been a judgment magnet. Through a long chapter of European history, vast populations of serfs were ruled by a tiny minority of “nobles,” or people with inherited wealth. To the average peasant, a wealthy person’s obesity translated as a painful reminder that peasants were always expected to get along on almost nothing.

For a rich man to be fat was the classic example of adding insult to injury. For him to have a fat wife was what we today would call a “flex,” the cultural equivalent of owning a car that every man who saw it would envy. He was telling the world, “I can afford to support a human who does nothing but eat, and pop out a kid once in a while.”

An overweight member of the royal family was a man whose appearance publicly and proudly announced, “I spend half my day devouring rare, expensive, and fattening foods that you peasants can’t even dream of tasting. Furthermore, there is no such thing as an overweight duke, because however much a duke weighs is, by definition, the correct amount. And oh, by the way, I have never done a day’s actual work in my life.”

Times were hard

Long before money as we know it had arrived on the scene, there were many possible reasons for the lack of food. Maybe no seeds were available to plant because their storage space flooded, or rodents ate them. Maybe there was a drought, or an insect invasion. Or all the healthy men were taken from their fields and sent off to fight the king’s stupid war.

At a different stage of history, there might be no harvest because farm machinery parts were unavailable. Or the civilian population’s food resources might be limited because of rationing, necessary due to another king’s unnecessary war.

At any rate, if some people looked emaciated, the reasons for lack of nutrition were widely comprehended. Regular people understood that only the rich could afford to be well-nourished. Also, the rich could get away with insulting the poor for not carrying much body fat, and thus publicly announcing their low status in the class system, as if it wasn’t clear enough already. In various times and places, this attitude persisted through the centuries.

Bad attitudes

The sight of a skinny person could inspire such cruel reactions as, “You are not worthy of the expenditure of food required to keep you alive” (which would, of course, be verbalized in a much cruder and crueler way). On the most basic level, the obvious implication of pointing out someone’s thinness is “Your mother didn’t love you enough to feed you.” That universally applicable insult is a rude assertion that can be expressed in numerous ways and cause a literal gut reaction.

At the level of least ugliness, the hidden meaning behind insulting someone’s thinness is, “Obviously, you are too lazy to work for your daily bread.” (Otherwise, there would be some meat on your bones.) Some societies do try to feed people.

And of course, there are always a certain number of citizens who hate to be taxed just for the sake of feeding children. Such folks may not even recognize why they feel so strongly about it. But the subconscious mind of this person may be putting up an objection like, “Why should I care about, and be financially responsible for, babies whose own parents don’t even care enough to nourish them?” The thought process here is, “People are required to deserve every bite of food, and if they can’t manage to do that, too bad for them; it’s not my problem.”

There is plenty of blame to go around. A well-fed person might look at a starveling and think, “You don’t work, so why should you eat?” In other contexts, no such resentment has occurred. In India, over the centuries, millions of people have earned spiritual merit by filling the rice bowls of monks who give up everything to spend their whole lives praying for the world and every creature in it.

Nowadays

Recent history has shown us that, counterintuitively, poverty can cause obesity because of the weird ingredients added to hundreds of food products. When it comes to emotions about body size, a lot of deep subconscious material is involved. In recent history, it has been relatively easy to understand why a low income has so readily caused people to be underweight. Quite obviously, the main cause of malnourishment is: not enough money for groceries.

During what is called the Great Depression, for instance, Americans understood this equation all too well. By and large, on the whole, it was a pretty well-settled and comprehensible fact that poor people tended to be thin and rich people tended to be obese.

There seems to be an overwhelming number of reasons to scorn people who are visibly obese. It used to make more sense when it meant, “I hate you because you obviously are rich, and probably keep all the food for yourself, and don’t share.” Except now, that instinct misses the mark, and it is actually more probable that an obese person is not rich. Of course, in some quarters, it is considered okay to hate skinny people.

According to one study,

[I]ncome […] is linked to higher health literacy which, in turn, is positively related to health-promoting behaviors (ie, healthy nutrition, physical activity).

(To be continued…)

Your responses and feedback are welcome!

Source: “Income and obesity: what is the direction of the relationship? A systematic review and meta-analysis,” NIH.gov, January 2018
Image by jcoope12/Pixabay

GLP-1 Coverage Cuts by Medicaid

As demand for GLP-1 medications continues to surge across the United States, a growing number of states are reevaluating whether they can afford to cover these drugs for obesity treatment under Medicaid. Recent proposals in Massachusetts and Rhode Island highlight a broader national trend: balancing access to innovative but expensive therapies with the realities of state budgets.

A shrinking list of states offering coverage

Just a year ago, 16 state Medicaid programs covered GLP-1 medications specifically for weight loss. That number has now dropped to 13. States like California, New Hampshire, Pennsylvania, and South Carolina have already eliminated this benefit, citing unsustainable costs.

GLP-1 drugs, originally developed for diabetes management, have gained widespread attention for their effectiveness in promoting weight loss. However, their high price tag has made them a significant financial burden for publicly funded programs like Medicaid.

Proposed changes in Massachusetts and Rhode Island

In Massachusetts, Governor Maura Healey’s proposed fiscal 2028 budget would remove coverage of GLP-1 drugs for weight loss under MassHealth, the state’s Medicaid program. Importantly, coverage would remain intact for patients using these medications to treat diabetes or other medical conditions. The proposal is still under legislative review, leaving room for potential revisions.

Similarly, Rhode Island’s governor has proposed eliminating Medicaid coverage for GLP-1 medications when prescribed solely for obesity treatment. These decisions reflect a growing concern among policymakers: how to prioritize limited healthcare dollars while still addressing widespread chronic conditions.

Despite these cutbacks, several states continue to provide coverage for GLP-1 drugs for obesity. These include Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, Tennessee, Utah, Virginia, and Wisconsin.

However, even among these states, access is often limited. For example, Michigan has restricted eligibility to patients with morbid obesity, excluding those who are overweight or moderately obese. This policy adjustment alone is projected to save the state an estimated $240 million, illustrating the scale of financial pressure these medications create.

Louisiana’s ongoing debate

In Louisiana, lawmakers are considering a middle-ground approach. Rather than offering broad coverage, the state may allow Medicaid to cover GLP-1 medications for obesity only when patients also have a related chronic condition, such as prediabetes, hypertension, or cardiovascular disease.

This strategy aims to target patients at the highest risk while controlling costs, but it also raises questions about equity and early intervention. Should treatment be limited to those already experiencing complications, or should it be expanded to prevent them?

The cost challenge

The financial strain driving these decisions is substantial. Medicaid spending on GLP-1 prescriptions (covering both diabetes and weight loss) has skyrocketed from about $1 billion in 2019 to nearly $9 billion in 2024, according to KFF.

For those without insurance, affordability remains a major barrier. In response, Novo Nordisk announced plans to lower the list price of its GLP-1 medications to $675 per month by 2027. While this reduction may improve access, it is still a significant expense for many patients and for state-funded programs.

High need, limited access

The debate over GLP-1 coverage comes at a time when obesity rates remain high. Nearly 40% of adults and about 25% of children enrolled in Medicaid have obesity, suggesting a large population could potentially benefit from these medications. Yet, as states tighten coverage, a pattern emerges: Innovative treatments are becoming more effective and more popular, but not necessarily more accessible.

The kids are also affected

As Philadelphia’s WHYY reported, the Children’s Hospital of Philadelphia (CHOP) did some research about the coverage specifically for children:

CHOP researchers found that only a fraction of eligible kids ultimately get a GLP-1 prescription. Even after they do, families struggle with cost and insurance coverage issues that make it hard for their children to stay on the medication.

Side effects and gaps in follow-up care are also causing disruptions in medication use, according to CHOP’s findings, recently published in the journal Pediatrics.

Looking ahead

The future of GLP-1 coverage under Medicaid is far from settled. As more states weigh the costs and benefits, policies will likely continue to evolve, creating a patchwork system where access depends heavily on geography.

For patients, providers, and policymakers alike, the challenge is clear: how to expand access to life-changing treatments without overwhelming already stretched healthcare budgets. Whether through pricing reforms, eligibility adjustments, or alternative treatment strategies, the decisions made today will shape obesity care for years to come.

Your responses and feedback are welcome!

Source: “Philly pediatricians are using GLP-1 drugs to treat childhood obesity, but cost can be a major barrier, CHOP doctors find,” WHYY, 5/4/26
Source: “Only 13 States’s Medicaid Still Cover GLP-1 Drugs to Treat Obesity, and More Are Dropping Out,” FlaglerLive.com, 4/30/26
Source: “Rhode Island considers ending Medicaid coverage of GLP-1 drugs for weight loss,” Rhode Island Current, 6/10/25
Source: “Louisiana Medicaid might add coverage for popular obesity treatment drugs,” Louisiana Illuminator, 4/16/26
Source: “Medicaid Coverage of and Spending on GLP-1s,” KFF, 1/16/26
Image by SHVETS production/Pexels

That Reciprocal Causation Trap

Journalists in the obesity field have written about why poor people become overweight, and also about how overweight people can become economically disadvantaged. Between those two inconvenient facts, a mutual causative relationship exists, which has been mentioned previously by Childhood Obesity News.

To say “mentioned” is an understatement, because the issue has many facets, and to effectively illustrate them all requires more than a few words.

Brief generalization: People on the lower end of the economic scale are vulnerable to obesity because financial conditions often restrict their access to health-inducing foods, and also preclude many sorts of healthcare, both preventive and curative.

Limits and caution

When some thought is invested in the issue, it is easy to pinpoint specifics. For example, people with low or no income are unlikely to travel across town for more reasonable food prices. Volume discounts are tempting, but even if all three of the kids wear backpacks, there is a limit to how many cans of beans can be transported home on the bus.

Vegetables can last a long time in a freezer, if a family is fortunate enough to have one. If the opportunity arises to get hold of multiple large bags of peas or corn on sale, a supply of low-calorie veggies is a wonderful asset for a health-conscious family. But first… You need to have a freezer.

Low-income people often have no choice other than to live in a dangerous neighborhood. A walk after supper, to burn a few calories, sounds like a swell idea, until you get mugged. Low-income people generally can’t afford gym memberships, and while there is no guarantee that a person with that opportunity will make the best use of it, the odds are certainly better than when they are not even allowed through the door.

Official documentation

Let’s look at a typical, fairly recent government-published report on a systematic review and meta-analysis that explored the phenomenon in depth, pointing out that obesity can be a causative factor of poverty, as “obese people drift into lower-income jobs due to labor–market discrimination and public stigmatization.” It was by no means the first document to highlight this reciprocal effect, and will certainly not be the last.

That meta-analysis encompassed 21 studies: two from Canada, three from the United Kingdom, and 16 originating in the United States. Its conclusions did not cause worldwide headlines, but indicated that persistent examination of the topic could potentially lead to a meaningful increase in attention, especially when a growing awareness of what goes into food products does not correlate with any serious efforts to change the habits of food manufacturers.

Society’s ability to ignore signs of corporate malfeasance is only one roadblock. Individuals are acutely aware of inequities in their everyday lives. Even when other factors are equal, obese people tend to be passed over for job opportunities. Clothes that fit may be prohibitively expensive. Even if people can afford gym memberships, the embarrassment factor may prevent them from doing so.

Thousands of individuals, if asked, could add thousands of examples of how body weight and size can turn everyday life into an ordeal:

Findings suggest that there is more consistent evidence for reverse causality. Therefore, there is a need to examine reverse causality processes in more detail to understand the relation between income and obesity… Obesity is a major risk factor for all-cause mortality, a number of non-communicable diseases and reduced quality of life.

Why does this even matter? Because in general, all the associated numbers are going up, with no indication of reversal any time soon. A very specific possibility on the horizon is the shadow of a reinstated military draft, along with hints of war that are more than subtle. Once America wakes up to the reality of how few conscription-ready individuals are suitable to be trained as soldiers, there might be a problem.

Your responses and feedback are welcome!

Source: “Income and obesity: what is the direction of the relationship? A systematic review and meta-analysis,” NIH.gov, January 2018
Images by hellbergstina and Mohamed_hassan/Pixabay

Salt of the Earth, and the Ocean

Is any other natural substance so encrusted by myth and practical observations? The number of informal borrowings of the word to imply humanly recognized concepts is staggering. For example,

“To capture unwary investors, they salted the mine.”
“She salted away most of her fortune.”
“He’s not worth his salt.”

Salt is fundamentally sweat, whether generated by brutal forced labor or pleasant voluntary exercise. Everyone has heard salt used as a figure of speech. (A-Z Quotes offers close to 700 sayings by the famous and the obscure.)

All over the world, in many times and places, salt has been an international currency accepted with no questions asked. Despite being an eminently pragmatic commodity, it has been valued like gold or jewels. Even in an era like this one, when salt seems common as dirt and is given away for free in little paper packages, it is universally recognized as having value.

How naughty is it?

On the topic of unwise food choices, the role of salt as accomplice and enabler is paralleled by no other substance. Consider the delightful movie-theater snack combo of salted popcorn and chilled cola drink, so loved, yet only available during recent history. This culinary masterpiece packs such an extraordinary one-two punch that the people who lived before its time can only be pitied.

Salt is probably the single greatest cause for the rise of the soda industry. The unique experience of switching from salty to cold-fizzy-sweet, and then back to the salted potato chips (or salted any sort of chips), and then to the chilled beverage, on and on, interminably… ad infinitum… Is any sensation more heavenly? The poignant contrast can bewitch a person for hours.

Just a side note, but the second-largest accomplice to the insidious rise of cola drinks has to be the refrigerated vending machine. The genius who figured out how to keep bottled beverages cold until some poor sucker came along and dropped a quarter into the slot may be responsible for just as much obesity as salt itself.

A slice of history

Many of us who are middle-aged and beyond grew up very familiar with the experience of sitting at a table where each adult thoughtlessly grabbed a salt shaker and automatically covered everything on their plate with salt, barely pausing to glance, and knowing exactly how much of it should be distributed per square inch of food surface. In every case, it was too much.

Today, a sane person, if one can be found, draws the line at about a level teaspoon (about six grams) of salt per day. But, considering how much sodium is already injected into packaged food items, even that is probably excessive. And, 2,000 mg of salt per day is about the outer limit a conscientious adult should go with.

It was tempting to include here a compendium of examples from this very website, to prove the overwhelming presence of salt in the human diet and consciousness. One alternative would have been a comprehensive list of each Childhood Obesity News post that has thus far mentioned the word “salt,” totaling at least 360 of them. This would be somewhere close to the neighborhood of one out of every 10 posts ever created for this venue.

The likelihood that any American suffers from insufficient sodium intake is vanishingly small.
Okay, someone who sweats a lot may be an exception to that broad generalization. These include competitive athletes and workers exposed to major heat stress, such as foundry workers and firefighters.

But for pretty much everybody else, on the scale of Things to Worry About, a sodium deficiency is way down the list, registering less than a whisper of a dream. This same American Heart Association information source, by the way, warns that sodium can be sneaky, and offers a printable version of its one-page infographic, “7 Salty Myths Busted.”

Additionally, and especially appreciated here at Childhood Obesity News, is a printable poster geared for kids, explaining the myths and the facts of sodium.

P.S. A note: While no doubt full of many virtuous qualities, green salt does not taste salty. Sorry, it just doesn’t.

Your responses and feedback are welcome!

Source: “Isak-Dinesen-The-cure-for-anything-is-salt-water-sweat-tears-or-the-sea,” QuoteFancy.com
Image by Isak Dinesen/QuoteFancy.com

What New Research Says About Childhood Growth and BMI

For decades, pediatric health experts have relied on a concept known as “adiposity rebound” to help assess a child’s future risk of obesity. Traditionally, this stage, when body mass index (BMI) begins to rise again after early childhood, has been viewed as a potential warning sign. But new research published in The Journal of Nutrition is challenging that long-held belief and offering a more nuanced understanding of how children grow.

A look at childhood growth patterns

The study analyzed data from 2,410 children and adolescents ages 2 to 19 who participated in the National Health and Nutrition Examination Survey (NHANES) between 2021 and 2023. Researchers observed a familiar trend: BMI decreases in early childhood, then begins to rise again around age 6 — the classic “adiposity rebound.”

However, there was a surprising twist. While BMI increased, another important measurement, the waist-to-height ratio, continued to decline. This metric is considered a more accurate indicator of body fat, particularly abdominal fat.

The implication? The rise in BMI during this stage may not signal increased fat at all. Instead, it may reflect healthy growth in lean tissues like muscle and bone.

Why BMI alone may be misleading

BMI has long been used as a simple screening tool because it relies on such basic measurements as height and weight. But it has a significant limitation, as it cannot distinguish between fat mass and fat-free mass. This distinction is especially important in children, whose bodies are constantly changing.

Lead researcher Andrew Agbaje emphasized this concern, saying:

Recent global consensus statements on redefining and diagnosing obesity have recommended that obesity should not be diagnosed with BMI alone but confirmed with non-invasive measures such as waist-to-height ratio.

He also said:

This new study buttresses the misleading use of BMI in children whose body composition rapidly changes during growth and the potential for attributing physiological functions to pathology, which might lead to unnecessary interventions. Waist-to-height ratio should be incorporated as the first inexpensive measure in diagnosing pediatric obesity with BMI used as a confirmatory tool due to its imprecision.

Introducing the “body composition reset”

One of the most compelling ideas to emerge from the study is what researchers call a “body composition reset.” This term describes the natural shift toward lean tissue development during early childhood. Rather than indicating a buildup of fat, the increase in BMI may actually reflect a healthy phase of growth, one that supports strength, bone development, and overall physical maturation. This finding challenges the assumption that an earlier adiposity rebound automatically signals a higher risk of obesity later in life.

Why waist-to-height ratio matters

Unlike BMI, the waist-to-height ratio focuses on fat distribution, particularly abdominal fat, which is more closely linked to health risks such as heart disease, Type 2 diabetes, high blood pressure, liver disease, and bone fractures. Because it is less influenced by muscle growth, this measurement provides a clearer picture of whether a child is carrying excess body fat.

A shift in pediatric obesity screening

The study adds to a growing body of evidence suggesting that BMI should not be used in isolation when evaluating children’s health. Incorporating waist-to-height ratio could help clinicians better distinguish between normal growth and true obesity risk, avoid unnecessary labeling or interventions, and provide more accurate, individualized care, among other things.

Recognition for innovative research

Agbaje’s contributions to pediatric cardiometabolic health have not gone unnoticed. He is the inaugural recipient of the American Society for Nutrition Foundation/Novo Nordisk Foundation Flemming Quaade Award, which honors early-career physicians making significant strides in obesity prevention and management. The award will be presented again at NUTRITION 2026, scheduled for July 25–28, 2026, in National Harbor, Maryland.

So, in a nutshell, a single number like BMI cannot tell the whole story. The new approach may reduce the chances of misclassifying healthy developmental changes as medical concerns. For parents, it should serve as a reassuring message that not every change in BMI signals a problem. Sometimes, it simply reflects a child growing exactly as they should.

Your responses and feedback are welcome!

Source: “Study Challenges Decades-Old Puzzle About Childhood Body Fat,” American Society for Nutrition, 4/23/26
Source: “Adiposity Rebound or Fat-Free Mass Anabolism in Children…,” The Journal of Nutrition, 3/9/26
Image by beyzahzah/Pexels

It’s Sodi-licious

A recent post observed that, rather than decreasing, the amounts of fat, sodium, and sugar in manufactured breakfast cereals have only continued to increase. Over the past decade, journalists in the health field have unrelentingly noted that such products — especially those aimed at children — inevitably include more and more sugar, sodium, and fat. It is almost as if attentive reporting on the topic has perversely led the situation to become even worse.

Plenty of information appears printed on food packaging, and an abundance of articles about the contents of those packages are published through various media. Regarding the boxes, cans, bottles, and other food packages, along with the journalism about what is inside them, why don’t all these information sources just go ahead and say, “Salt”? Is someone just showing off with fancy words, or what? Sodium and salt, aren’t they the same?

As it turns out…

After consulting Sharon Small, a dietitian who specializes in counseling patients about their cardiovascular health, journalist Wendy Bazilian reported:

Sodium is a mineral and a key component of salt. Salt is actually called sodium chloride because it is made up of 40% sodium and 60% chloride… [W]hile your body needs sodium to function properly, too much (typically consumed as salt) can increase the risk of certain health issues.

There can be sodium without salt, but not salt without sodium. A food or drink may contain sodium but no salt. Sodium is an element and a metal. Salt is made of two things, sodium and chlorine, and is not as bad for the body as sodium alone. Sodium does vital things for the body, but unaccompanied and in too large a quantity, it can damage the kidneys and can lead to high blood pressure and stroke risk.

The two main sources, and an additive

Sea salt comes from the ocean and is less processed than table salt. Table salt comes not from tables, but from mines, and is more processed. For many years, sellers of salt have included iodine with their product. Because salt is consumed almost universally, it was seen as the ideal vehicle through which to slip in enough iodine to prevent a massive public health crisis.

If a human thyroid gland is to function effectively, it needs iodine. Without it, the thyroid is unable to properly do its job regarding “metabolic rate, heart and digestive functions, muscle control, brain development, and bone health.” If a fetus does not get enough iodine, the results can include physical deformities and cognitive impairment.

Even with salt vendors doing their best, it is estimated that around two billion members of the earth’s human population experience health issues due to iodine insufficiency.

The food industry

In the USA, the average adult absorbs about 3,400 milligrams per day of sodium, but 2,300 mg (about a teaspoonful) is widely acknowledged to be quite enough. The stodgy old American Heart Association, however, would actually prefer no more than 1,500 mg per day, or less than half the amount actually consumed by the average grownup.

Most of the incoming sodium uses packaged foods and restaurant meals for its delivery system, concentrating on 10 main popular products. Few of those choices contain any form of vegetation, unless you count the sauce on pizza.

Even a responsible eater who never even picks up a salt shaker most likely absorbs way too much sodium. This causes the professionals who spend their lives studying these matters to mention such topics as hypertension, heart disease, and stroke. Oh, and kidney stones. Often, the effects do not manifest until the window of opportunity for redemption has passed.

A question that a reasonable person might ask is, “If sodium is problematic, why don’t the manufacturers just leave it out, and let people salt their food according to taste?” Apparently, because some other, less civic-minded manufacturer will go ahead and include salt, and consequently sell more product.

Your responses and feedback are welcome!

Source: “ Salt vs. Sodium: What’s the Difference? Health Experts Explain,” EatingWell.com, 12/31/25
Source: “Why Does Salt Have Iodine Added To It?,” SeaSalt.com, undated
Image by Couleur/Pixabay

It’s the Newsiest — Breakfast, Cereal, and Kids

A particular news story appeared almost exactly a year ago, in response to a major journal’s publication of “Nutritional Content of Ready-to-Eat Breakfast Cereals Marketed to Children.” That all-too-typical piece announced that breakfast cereals are “filled with increasing amounts of sugar, fat and sodium,” a statement equally true at this very moment in time.

Does anyone out there believe that the situation has improved since then? If so, we have a very attractive bridge to sell you. Sorry, but no, the shameful trend has not reversed. Oh, and guess what? “The study also found that cereals’ protein and fiber content — nutrients essential for a healthy diet — have been in decline.” That sobering fact is just as true today as it was 12 months ago, and we feel confident in betting that it will be even more true a year in the future.

The original article concerned the analysis of 1,200 new or reformulated cereal products that had appeared on the market over the previous decade and a half. Most of them were products that had already existed, with a few minor tweaks thrown into the mix. Not improvements, just inconsequential changes. Study co-author Shuoli Zhao mentioned the existence of “evolving consumer awareness about the links between excess consumption of sugar, salt and saturated fat and chronic conditions like diabetes, hypertension and cancer.”

And yet…

But somehow, marketing strategy has not reflected any awareness of increasing customer intelligence, or of elevated industrial integrity. Professor Zhao is quoted as saying,

What’s most surprising to me is that the healthy claims made on the front of these products and the nutritional facts on the back are actually going in the opposite direction.

The study found that the total fat content per serving of newly launched breakfast cereals increased nearly 34% between 2010 and 2023, and sodium content climbed by 32%. Sugar content in the newly introduced products rose by nearly 11%, according to the analysis. Kellogg Company, General Mills and Post Holdings, the three largest makers of breakfast cereals in the United States, did not respond to requests for comment.

Well, what remains to be said? Do we really want them to speak aloud the painful truth? “Hey, you virtuous protectors of the consumer have insisted that all information be revealed. Full disclosure has been duly made. We are as revealing as a striptease artist. The public knows everything about our measurements, and ya know what? The public doesn’t give a tinker’s dam.”

There was some talk of attempting to remove some artificial dyes from the U.S. food supply, but whether any serious attempt will be made to back up the notion with legislation is unclear. Speaking of law, no statute anywhere insists that breakfast cereal must be moistened with milk. Try wetting it down with fruit juice and see what happens.

The Center for Science in the Public Interest, a nutrition advocacy group not involved in the study, published some words from its executive director, Peter Lurie, who was surprised to learn that “large food companies have not made a more concerted effort to reduce the sugar, salt and fat content of their breakfast cereals.”

Well, why should they? If there is a word that describes an attitude more apathetic than apathy, that word would describe the industry’s mental state regarding this issue.

Your responses and feedback are welcome!

Source: “American Breakfast Cereals Are Becoming Less Healthy, Study Finds,” NYTimes.com, 05/21/25
Source: “Nutritional Content of Ready-to-Eat Breakfast Cereals Marketed to Children,” JAMNetwork.com, 05/21/25
Image by Picdream/Pixabay

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.