Roots of Childhood Obesity Found (or Not)

Respect the Game

One amazing feature of the childhood obesity epidemic is that so many things correlate with it. When that happens, it’s always very tempting to assume a cause-and-effect relationship. Sometimes the relationship exists, other times not. Of course, poor nutrition (in the form of overfeeding and unhealthful choices) is the most glaringly obvious culprit.

As a combat surgeon in Afghanistan, Dr. Kevin Patterson noticed a difference between American, Canadian, and European surgical patients, and the Afghanis. The internal organs of Westerners tend to be encased in fat. This is directly attributable to the “developed nations” diet, which can start making trouble in infancy and only gets worse with age. Reporter Terry Gross relates the doctor’s words about the effects of urbanization:

Type 2 diabetes historically didn’t exist, only 70 or 80 years ago. And what’s driven it, of course, is this rise in obesity, especially the accumulation of abdominal fat. That fat induces changes in our receptors that cells have for insulin. Basically, it makes them numb to the effect of insulin.

The body tries valiantly to compensate by producing even more insulin, and that works for a while, but eventually the pancreas just can’t keep up. It stops secreting enough insulin to meet the organism’s needs, and then it’s diabetes time.

Recently, a rather surprising connection was noted by Il Ho Shin and colleagues, of Kyung Hee University in South Korea. Chronic otitis media, or inflammation of the middle ear, is usually treatable, except in about 10% of the children who suffer from it. This research team discovered that such children, in whom the condition becomes chronic, have a “significantly higher body mass index” (link is ours). There is also a change that interferes with their ability to taste, particularly to taste sweet and salty foods. Nothing is definite yet, but this apparent raising of the taste threshold is thought to indicate a promising direction for further research.

So, based on this new information, it seems that an underdeveloped sense of taste leads to obesity. Unless it doesn’t. Maybe the problem is, instead, an overdeveloped sense of taste, as described in a Psychology Today article about “supertasters.”

A supertaster, according to Dr. Susan Albers, is someone with more than the average number of taste buds, and about ¼ of the population seems to fall under that definition. This means that “supertasters,” captivated by the “explosion of flavor” they experience, might go ahead and eat without inhibition, in pursuit of that pleasure. But there is more to it.

Because bitter flavors are also intensified, the supertaster probably tends to avoid foods with any hint of bitterness in their flavors, including cancer-preventing vegetables. Or, to mask the bitterness, they salt their food more, and that can lead to a whole different set of problems including a risk of heart attack. And there is a difference between male and female supertasters. Dr. Albers explains it like this:

The upside for female supertasters is that they often avoid sweet, high fat foods, which makes them less vulnerable to cardiac problems and obesity. It makes sense. Supertasters don’t need much sweetness or fat in their meals because a little goes a long way for them. Male supertasters, on the other hand, are more likely to be drawn to high fat foods, which increases their risk of obesity.

A difference between male and female subjects also showed up in the findings reported in a childhood obesity study by Dr. E. Ann Yeh, not long ago, which apply more to boys than girls:

A new study conducted by pediatric MS specialists at the University at Buffalo has found that children with multiple sclerosis and other pediatric demyelinating disorders are at increased risk of childhood obesity, compared to children without these disorders.

Along with all the other problems associated with multiple sclerosis and similar conditions, it looks as if special care must be taken with the nutritional needs of children afflicted by them. Another angle is the insufficient nighttime sleep theory, for which Bill Hendrick gives an explanation at WebMD. The idea is put forward that, as with the capacity to learn languages, there is a critical age window when the child’s brain and metabolism can be particularly affected. And then there is the warm house theory of obesity, for which the reader is referred directly to a piece by Nancy Walsh.

And, of course, non-physical difficulties can also be responsible for childhood obesity, showing up as early as age four-and-a-half. If a two-year-old does not have a secure emotional attachment with parents, the odds increase that the child will be obese before age five. Christopher Fisher explains the dynamic:

Psychologists describe securely attached children as those who rely on their parents as a ‘safe haven,’ which allows them to explore their environments freely, adapt easily to new people, and be comforted in stressful situations. Toddlers who are insecurely attached tend to have experienced negative or unpredictable parenting, and may respond to stress with extreme anger, fear or anxiety, or avoid or refuse interactions with others.

Sarah Anderson, who teaches epidemiology at Ohio State University, and was lead author of this study, believes that secure attachment to parents is a very strong indicator of emotional health for a child, and therefore a pretty good sign that a child will be able to cope with stress in ways that are not self-destructive. Anderson worked with co-author Robert Whitaker, who teaches pediatrics and public health at Temple University.

They made use of a huge body of data called the “Early Childhood Longitudinal Study,” assembled by the National Center for Education Statistics. It includes records for 6,650 children, and the ability to compare those children at 24 months (second birthday) and at four-and-a-half years. There is enough information to keep researchers coming back over and over again, to draw from the deep reservoir of facts. Fisher goes on to explain particulars of how this study was done, and it really is quite fascinating. To say a little more about the conclusions:

Obesity may be one manifestation of dysregulation in the functioning of the stress response system, Anderson said, adding that that likelihood, coupled with these latest findings, suggests that there is more to preventing childhood obesity than focusing on food intake and exercise.

In fact, many thoughtful people have reached the conclusion that there is more to obesity than taking in calories via food and using up calories via exercise. It’s just that they don’t always agree on what the other factors are, or whether there is perhaps only one missing factor. As Dr. Pretlow says, the “healthy eating and exercise” approach for ending the childhood obesity epidemic just isn’t working. In his view, which is shared by many, the missing factor is food addiction.

Your responses and feedback are welcome!

Source: “How Western Diets Are Making The World Sick,”, 03/24/11
Source: “Changes in sense of taste linked to obesity, chronic ear inflammation,” Modern Medicine, 03/22/11
Source: “Are you a Supertaster? Mindless Eating & Your Taste Buds,” Psychology Today, 06/25/10
Source: “Children with MS are at Increased Risk of Becoming Obese in Childhood,” UB News Center, 05/11/11
Source: “Sleep Linked to Childhood Obesity,” WebMD, 09/07/10
Source: “Warmer Houses May Increase Obesity,” MedPage Today, 01/26/11
Source: “Children With Insecure Parental Attachments May Be At Increased Risk For Obesity,” The Behavioral Medicine Report, 04/23/11
Image by colros (Sandra Cohen-Rose and Colin Rose), used under its Creative Commons license.

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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:


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.

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