Multietiological Stew

Recently, the journal Childhood Obesity published a piece titled “Behavioral Research Agenda in a Multietiological Approach to Child Obesity Prevention” that emphasizes once again, in case we ever forget for a minute, how complicated life can be.

Etiology is a branch of medical knowledge concerned with the root causes of illness, which first proved its usefulness by saving the lives of people who would otherwise have been condemned as witches. With the realization that diseases come from germs, not curses, the human race hit a huge turning point.

For centuries, we could only play catch-up, scrambling to alleviate symptoms as effectively as possible, occasionally managing to keep some sick people alive, and maybe even seeing some of them recover. Eventually, it got to where we could look a little deeper and figure out how to prevent suffering.

Of course, it was never easy. Tradition is always a formidable barrier. It took quite a few years for surgeons to accept that hand-washing prevents the spread of disease. It seems that in each new iteration of the discovery journey a mountain of resistance has to be overcome.

Now what?

The human tendency to cling to old ways is especially prevalent when we are stuck in the middle, acknowledging that the old way doesn’t work, yet unable to see a clear path forward. “So, Answer A doesn’t work. Fine. What does work? Now you’re telling me, it might be Answer B, or C, or D…” Even people who are willing to try something different are tempted give up in despair.

But when multifactorialism shows up, it gets even worse. “Oh great, now you say it could be a combination of things? A little bit of A, plus a dollop of B, and a heaping helping of C, and just a dash of D…” Factors work together in uncharted ways, and synergy can throw a monkey wrench into any theory.

Multietiological approach

This paper has three authors, Tom Baranowski, Ph.D.; Kathleen J. Motil, M.D.; and Jennette P. Moreno, Ph.D. It begins with the stark admission,

Serious limitations have been found in the simple energy balance model (energy in — energy out) as the single or primary biological strategy for virtually all child obesity prevention interventions. Experts have criticized it for not reflecting the likely multifactorial nature of obesity.

Right up there in the first paragraph, the authors note that “A substantial number of other possible, even likely, causes of obesity have been identified.” This paper discusses three of those potential causative (or at least complicating) factors — infectobesity, the microbiome, and biorhythms.

At present, infectobesity refers mainly to the activities of adenovirus 36, although other, as yet unsuspected organisms might do similar damage. Regarding adenovirus 36, we need to know how the infection gets a foothold and how it spreads, and why; and whether the possibility exists of a vaccine to prevent it:

If we assume that not everyone who is infected becomes obese, it would be important to know the behaviors and other exposures that minimize or enhance viral infection immunity in general and resistance to adenovirus 36 in particular.

The introductory sentences of the microbiome section hint at the complexity:

Imbalances in the bacterial (and maybe the viral, fungal, and eukaryotic) phyla in the microbiome can lead to obesity. The microbiome begins to develop (from the mother) in the immediate postnatal period and changes substantially early in life, due, in part, to diet and physical activity influences.

That’s a lot of ifs and maybes, packed into one short paragraph. Then, with the addition of circadian and circannual rhythms, things really get crazy:

Once the operative nutritional factors can be identified, the role of school and family influences on chronobiology, meal content, and timing may be determined. Longitudinal analyses of interrelationships among diet, physical activity (PA), sedentary behaviors, sleep, and indicators of circadian rhythmicity are needed, including their impact on the microbiome.

As always — and this will not come as a surprise — the need for additional research, both wide and deep, is emphasized. Childhood obesity is not an easy nut to crack.

Your responses and feedback are welcome!


If you have a child between the ages of 14 and 18 years that is overweight and can read English, you may be eligible for a clinical research study at the Children’s Hospital of Los Angeles (CHLA) that is currently recruiting participants. Please visit for more information.

Source: “Behavioral Research Agenda in a Multietiological Approach to Child Obesity,”, 04/22/19
Photo credit: You As A Machine on Visualhunt/CC BY-SA

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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.
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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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