Obesity Gets an Early Start
By Bernadine Healy M.D.
Posted Sunday, August 27, 2006
The Centers for Disease Control and Prevention tells us that obesity is one of our nation's biggest public-health dangers. In fact, an epidemic of obesity has swept the globe and threatens to erode the lengthening life spans we enjoy in our modern day. As the New England Journal of Medicine reported last week, those who carry excess pounds into their 50s and 60s pay for it with a shorter life. But shrinking the middle-age bulge will not be achieved or sustained unless we address the roots of obesity, ones that reach back early into life.
That babies are either Mahatma Gandhis or Winston Churchills was just a cute quip when babies' weight was thought to be irrelevant to adult health. But that thinking has radically changed. Some 20 percent of children are now overweight or obese, and those who gain that weight during late childhood or adolescence are at most risk for adult obesity. Yes, you can blame genes for making some kids more likely than others to pile on the pounds, but genes don't change in a few decades. The rising tide of childhood obesity reflects early environment, including imprints left from a mother's womb.
When Mom develops diabetes before or during pregnancy, it's apt to lead to an overgrown baby as her high sugar and insulin levels stimulate the fetus to grow too fast. And these oversugared, oversize babies are at risk for metabolic and weight disorders later on. But we don't want scrawny babies either. Counterintuitive as it might seem, low birth weight is also a risk factor for obesity. The culprit is the accelerated growth in the early months of life, when underweight babies with ravenous appetites compensate for their restricted growth in utero. This so-called catch-up weight gain is necessary, but it is also linked to later obesity and diabetes.
The message for the mother-to-be: Practice good nutrition, get prenatal care, and limit pregnancy weight gain. And toss out those cigarettes, which are placental toxins that make babies too small. In short, on the Gandhi-Churchill scale, healthy is something in between.
Later on, parents should monitor their child's body mass index, a formula that integrates weight and height to help measure and track fat. A BMI of 25 to 29 defines overweight; 30 or more, obesity. But be careful interpreting the results. Obesity is about adipose tissue, not bone or muscle, and for those athletic children with lots of muscle and little fat, BMIs can be meaninglessly high. That's why your doctor also takes into account body shape. Fat that accumulates around the waist as opposed to the arms and legs is of greater health risk. Even for young people, pear and hourglass shapes are better than apples.
Muscle power. The answer for our children is painfully simple: They must eat better and move their muscles more, something that was easier to do in the olden days. Today's world is about brainpower rather than muscle power. Computers and TVs are more compelling than sweating on a bike or taking long walks in the park. Food is in abundance and tastier than ever but often soaked with too much sugar and fat. But parents, take heart. It's easier to modify behavior in children than in adults, especially when you still have control of the grocery cart and the family car.
We all know the drill: Buy healthful foods; offer sensible portions; don't make kids lick their plates clean or push second helpings. Offer the occasional indulgences of yummy desserts, but don't make them staples or forbidden fruit. Keep children active and moving-family jaunts, school sports, and household chores all count. And obese adolescents, who are apt to suffer emotionally from isolation or cruel treatment by unkind classmates, need special support. Already touchy about their changing bodies, they need sensitive, positive messages that acknowledge that there's no one perfect body type but that also encourage a long-term tailored plan for diet and exercise. Parents are right to worry that addressing their child's weight might promote a search for a quick fix or even an eating disorder, but silence is more risky if one considers the long-term threats of obesity, such as diabetes, heart disease, stroke, and cancer.
The biggest risk factor for obesity in the young is still parental overweight. So, set an example for your children with your own healthful diet and exercise behavior. Until bariatricians, the weight-loss medical specialists, can deliver some magic pill to melt fat away without any side effects, we have no other choice if we want to be well for each other.
Childhood Obesity
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