Real Issues or Red Herrings?

Why does this paper, written by Baylor College of Medicine scholars Tom Baranowski, Kathleen J. Motil, and Jennette P. Moreno, exist?

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. A substantial number of other possible, even likely, causes of obesity have been identified.

This is not just an ideological disagreement. Many health professionals believe that multietiological approaches are shunned, when they should be embraced.

The authors hold that concentrating on the energy balance model has not been the best course, because interventions based on manipulating the “energy in” and the “energy out,” are not very successful and have not made a demonstrable dent in the worldwide epidemic. Their claim is that currently, the biological sciences, the behavioral sciences, and the prevention sciences do not cooperate harmoniously, and even work at cross-purposes, in active opposition to each other.

The researchers’ attention was captured by three issues in particular — virus-related infection, imbalance in the microbiome, and messed-up biorhythms.

In the authors’ view, a sturdy research agenda that is truly oriented toward prevention would involve a whole series of steps, which they lay out. But what is more, “to exemplify how behavioral or prevention researchers may begin to address such problems from a biobehavioral perspective,” they identify research issues peculiar to each potential etiology.


The shady reputation accorded to adenovirus 36 refuses to go away. Investigators want more complete data on the incidence of this infection among children, and how many of them develop obesity, to figure out once and for all whether there is a cause-and-effect relationship. They want to know how the virus spreads, and what behaviors and exposures are responsible for either enhancing or minimizing the chance of infection. They want to know if a vaccine can be developed, and if so, how to ensure that people will be vaccinated.


There is a lot going on in the human gut. Like the ocean, the microbiome has always been with us, and also like the ocean, we know next to nothing about it. There is pretty good evidence that the birth process and the feeding of the infant both play important roles in the establishment and population of the child’s bacterial, viral, fungal, and eukaryotic inheritance. All these creatures live inside us like tenants who can either provide the landlord with a comfortable passive income, or take a notion to wreck the place.

When our interior fauna don’t get what they need, and lapse into dysbiosis, they have their cunning little methods of registering complaints. Apparently, one of the ways they protest is by making us fat, especially if we are under two years old and have antibiotics prescribed to us. In addition to many other things, the authors say,

The internal and external validity of microbiome research in humans has been challenged. These are issues that prevention and behavioral scientists have usefully addressed.

Circadian and Circannual Rhythms

The field of chronobiology is why anyone interested in childhood obesity has heard so much about the importance of limiting electronic screen time and promoting sufficient sleep. The timing of meals may also be a significant contributing factor to obesity. Chronological issues are especially elusive because most of the information comes from self-reporting. Regarding such events as meals and sleep, timing is an intimate family issue and not particularly amenable to intervention.

Even if biological rhythms are proven to be of crucial importance in preventing obesity, what can be done about it, short of seizing all children and raising them in strictly regimented environments? The amount of eduction and public persuasion required to significantly change these areas of life would be staggering. Americans do not want to be told how to raise their kids, not even when their children’s lifelong health is at stake.

In short, there is plenty here to think about.

Your responses and feedback are welcome!

Source: “Behavioral Research Agenda in a Multietiological Approach to Child Obesity Prevention,”, 04/22/19
Photo credit: Catalina Rusu on Visualhunt/CC BY

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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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