Projections and Protections

Writing for Forbes about childhood obesity and the holidays, Peter Ubel made some harsh points. When it comes to sustaining weight loss over the long term, who is able to succeed? Not, apparently, people who have suffered extensively and publicly to lose the weight, like those on a very popular TV show. He references a study of contestants on The Biggest Loser, “most of whom gained back most of the weight they lost.”

No, not even people who possess the advantage of every possible type of support that money can buy, like Oprah Winfrey. Ubel wrote,

Modeling indicates that excess weight accumulates slowly, and excess weight gain among young children is due to relatively small changes in energy balance… Changes needed to prevent excess weight gain and prevent obesity are thus quite small in childhood. By adolescence, however, excess weight has accumulated for more than a decade… Once people become obese, myriad biologic factors conspire against their efforts to lose weight.

In other words, only the littlest children have a fighting chance to stave off obesity via improved diet and physical activity, the tools available through the energy balance equation. With each passing year, that possibility fades into the unrecoverable past. By the time adolescence rolls around, obesity is, to put it politely, established. The fat cells have moved in, redecorated the place, officially registered their change of address with the Post Office, and made themselves at home.

The only hope lies in prevention, and while of course the family is vital, it is not all-important, because the efforts of society must contribute too. The writer does not want to hear from the “no government intervention” proponents, or from the “taxation is theft” zealots. If the government must step in and make laws to protect children from obesity, as he and many other people obviously feel that it must, what measures actually work?

In this instance, success is defined under the criterion of bang for the taxpayers’ buck. On which societal actions should we spend money now, to prevent spending a whole lot more in the future? Ubel found the answer in a multi-author meta-study that first identified seven popular interventions that have been tried by governmental bodies: tax sugar-sweetened beverages; end subsidies that enable advertising unhealthful food to children; include calorie counts on restaurant menus; raise nutrition standards for school meals; do the same for school vending machine items; improve early care and education; and increase access to bariatric surgery for adolescents.

The team looked at facts gathered so far, by searching the National Library of Medicine for articles containing the term “child obesity” up through 2014. Out of 31,000 published articles they found only 89 that also used the term “cost-effectiveness.” What, projected into the future, has a chance of working? They asked a computer program to make predictions:

We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015–25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals.

Three of the interventions studied were found to be cost-saving across the range of modeled uncertainty: the sugar-sweetened beverage excise tax, eliminating the tax subsidy for advertising unhealthy food to children, and setting nutrition standards for food and beverages sold in schools outside of school meals… These interventions were projected to save more in reduced health costs over the period studied than the interventions would cost to implement.

Your responses and feedback are welcome!

Source: “How To Keep Santa From Making Our Kids Fat: Three Ways To Reduce Childhood Obesity,”, 12/23/16
Source: “Cost To Implement,”, November 2015
Photo credit: Kazuhito Hokamura on 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.
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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