Paying Attention to Kids

Unicycling at Lewis & Clark

Childhood Obesity News has been looking at the good things that can happen when grownups listen and pay attention to kids. In the Pacific Northwest, government agencies have joined with health workers in the tribal community to address the problem of preventing and treating childhood obesity. Over the past 10 years, type 2 diabetes has increased unacceptably, and, apparently, teenagers are the most affected. The leadership decided to make a high priority out of “upstream” interventions, going on the ever-more-obvious evidence that obesity starts before birth.

Kaiser Permanente and Northwest Portland Area Indian Health Board (NPAIHB) have been fighting childhood obesity on several fronts, through education, community programs, and research. Emily Schwartz gives examples:

… [O]ne tribe created and maintained a breast-feeding room at its tribal health clinic; another passed a resolution to stop buying sugar-sweetened beverages for tribally sponsored events.

A study done by NPAIHB and Kaiser resulted in both good news and bad news. Some of the bad news wasn’t really news, and came as no surprise — nearly half of all American Indian children are overweight. Included in this study were kids from three tribes in the states of Washington and Oregon, representing more than 200 families in all. For some of the participants, in-home visits to pregnant women were added to their already established program, in order to compare how the experimental groups prospered under the various types of treatment.

The author tells us:

The visits started in the third trimester of pregnancy and lasted until the babies were 2 years old. The intervention boosted breastfeeding rates, reduced consumption of sugar-sweetened beverages and helped to slow excess weight gain.

The good news is that families can be persuaded to change their behavior to help prevent children from becoming overweight. But the rest of the bad news is, the trend has not yet been reversed or even brought into equilibrium, but only slowed down. Schwartz gives the hard information:

Body Mass Index — which is a measure of weight in relation to height — did increase for all of the children in the study, but the increase was significantly less in the tribes that received the community intervention and in-home visits. BMI scores increased by 30 percent in the tribe that received community intervention alone and by 8 percent in the tribes that received both interventions… One tribe received only community interventions and two tribes received the community intervention along with in-home visits and telephone calls from community health workers.

One thing complicates this type of study. Other research has shown that just the very act of participating in a study can make a difference to a person’s life. For instance, whether they are in an experimental group receiving actual medication or a placebo, or even in a control group that takes nothing, people can get better for subtle psychological reasons that are difficult to recognize or measure.

When subjects react to being part of an experiment, their behavior might stem from something as elementary as a naïve desire to please the scientists by giving the “right” answers. When it comes to a disease process as many-factored as obesity, a  subject can’t help being influenced in some metaphysical way, merely by being studied.

The Skeptic’s Dictionary puts it this way:

It is thought that the touching, the caring, the attention, and other interpersonal communication that is part of the controlled study process (or the therapeutic setting), along with the hopefulness and encouragement provided by the experimenter/healer, affect the mood, expectations, and beliefs of the subject, which in turn triggers physical changes such as release of endorphins, catecholamines, cortisol, or adrenaline. The process reduces stress by providing hope or reducing uncertainty about what treatment to take or what the outcome will be. The reduction in stress prevents or slows down further harmful physical changes from occurring.

The Washington Post has a special section called “KidsPost,” which asked its participants to send in their suggestions to a contest called “Solutions for Childhood Obesity.” They got over 300 entries, and here is a very brief, paraphrased summary:

Age:     Suggestion:
11           Let kids cook, and teach healthful cooking in schools.
10          Make exercise fun by doing circus-style activities such as   juggling.
11           Convince supermarkets to put tempting junk food high up on shelves.
4            Start a garden.
7            Parents and schools, set things up so kids have to eat vegetables and fruits first.
10          Ride a unicycle, which develops muscles, balance, confidence, agility, and provides cardiovascular stimulation, as well as burning 196 calories an hour.

Your responses and feedback are welcome!

Source: “Community Interventions And In-home Visits May Slow Excess Weight Gain In American Indian Children,” Medical News Today, 06/03/10
Source: “placebo effect,” The Skeptic’s Dictionary
Source: “Kids’ solutions to childhood obesity,” The Washington Post, 03/21/11
Image by Jeremy McWilliams, used under its Creative Commons license.

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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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