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A recent study suggests that efforts to prevent childhood obesity should perhaps begin before birth.


Childhood obesity: A growing problem

by Chelsea R. Robbins
March 17, 2010


Obesity has emerged as the No. 1 health problem facing children in the United States, according to a report from the National Institute of Health.

Childhood obesity has more than tripled in the last 30 years. The percentage of obese children ages 6 to 11 increased from 6.5 percent in 1980 to 19.6 percent in 2008, according to the Centers for Disease Control and Prevention.

These alarming rates have pushed national organizations such as the Elk Grove Village-based American Academy of Pediatrics to team up with first lady Michelle Obama and the White House last month in launching “Let’s Move,” an initiative to reduce the nation’s population of overweight and obese children by encouraging healthier eating and increased physical activity.

Chicago pediatrician Dr. Adolfo Ariza, said the first lady’s initiative will likely increase awareness of childhood obesity and make some positive impact, but the problem is much bigger than many people may think.

“Obesity is the expression of several things that are happening that are part of a complex problem in society,” said Ariza, a research assistant professor of pediatrics at Northwestern University’s Feinberg School of Medicine. “We need a healthier lifestyle.”

Dr. Elsie M. Taveras and colleagues at Harvard Medical School published a study in the March 1 online issue of journal Pediatrics, which suggested that efforts to prevent childhood obesity should perhaps begin even before birth.

Dr. Katherine Kaufer Christoffel, an obesity expert at Children’s Memorial Hospital, said a multitude of factors that can contribute to a child’s future excessive weight gain prior to conception.

A certain set of risk factors are present in the mother even before she gives birth, such as her weight, eating habits and whether or not she has diabetes.

Nearly two-thirds of U.S. women today begin their pregnancies overweight and almost half of them are obese, Kathleen Rasmussen, a Cornell University professor of nutritional sciences, and colleagues reported last year in the book "Weight Gain During Pregnancy: Reexamining the Guidelines," published by National Academies Press.

An expectant mother’s initial weight may increase the chance of her baby being born too small or too large, which increases the baby’s chance of becoming obese in the future, Christoffel said.

Further, the duration of a woman’s pregnancy, how well-nourished the baby is during pregnancy, maternal weight gain and whether the expectant mother develops gestational diabetes are all contributing factors that add to a baby’s risk of becoming overweight.

Children of mothers who gain more weight than recommended during their pregnancy have a 48 percent increased risk of becoming overweight at age 7, compared with children of mothers who follow the recommended maternal weight gain, according to a 2008 study in the American Journal of Clinical Nutrition. Brian H. Wrotniak from the Children’s Hospital of Philadelphia and the Center for Clinical Epidemiology and Biostatistics, and colleagues authored the study.

Christoffel, who is the medical and research director of the Consortium to Lower Obesity in Chicago Children, a childhood obesity prevention program at the Children’s Memorial Research Center, said the earlier intervention or prevention for childhood obesity begins, the better.

She noted that contributing postnatal factors include whether a child breastfeeds or not and the rate of weight gain in the first month and in the first couple of years.

“Non-breastfed babies are at an increased risk of about 25 percent [in developing childhood obesity].” Christoffel said. “[The rate] is not trivial but it’s not double or triple. [Breastfeeding] is still something we should be promoting.”

How quickly a baby gets off of the bottle and begins eating solid foods is another factor that increases a child’s risk of becoming overweight or obese. The sooner a child starts eating solid foods, the higher the risk is. 

“In terms of an outcome of a child’s weight at age 5, for example, we really have to think in terms of all [the possible factors],” Christoffel said. “If we intervene effectively with one we’ll do some good and if we intervene effectively with many, we’ll do more good.”

Both Ariza and Christoffel believe one of the most significant sets of factors in preventing and treating childhood obesity starts in the home. If parents are making the decision to have healthy foods in their home, cooking meals rather than eating prepared foods and sitting down for family dinners on a regular basis, children are at a reduced risk of becoming overweight or obese.

Obesity affects about 28 percent of Chicago children, compared with the nation’s average of 19.6 percent, according to the Consortium to Lower Obesity in Chicago Children. However, the association recently reported that Chicago’s average dropped 2 percent from 2003 to 2008.

Although the city’s rates may be slowly progressing, Illinois is one of the leading states for overweight and obese children.

The Trust for America’s Health and the Robert Wood Johnson Foundation reported in July that one in three Illinois children is overweight or obese and that Illinois ranks 10th in the nation for the amount of children ages 10 to 17 who are overweight.

Christoffel said the argument that is often made by health foundations and agencies is that the emphasis to prevent childhood obesity should be at the community and societal levels.

“They say the biggest bang for the buck is going to be in changing the environment to promote healthy eating and healthy activity, “ Christoffel said. “I think in the long term that’s probably true, but at the present time we’re not there.”

It may take as long as 30 or 40 years until enough people learn to change their lifestyles and work together to alter social norms to become healthier, she added.

“We really have our work cut out for us,” Christoffel said. “I think we’re on the right path but we have a long, long way to go.”