Obesity remains a significant public health problem. Now that we have the basic physiology in hand, it’s time to talk about the biggest problem in reducing this disease: human behavior.
Obesity-related issues are more problematic than those associated with smoking, considering the tsunami of at least forty chronic preventable diseases, which result in its wake. My last three articles in this series discussed the basic physiology of this issue, illustrating why obesity is such a complex problem, not only to prevent in an industrialized culture, but far more so to resolve as well as discussed here, here, and here.
Where do we begin to resolve the underlying causes of obesity versus endlessly treating the symptoms of it? The obvious answer is childhood. In 2014, the National Institute of Child Health and Human Development published “Obesity Begins Early, Prevention Is Best, But Change Is Always Possible.” This report stated:
“Obesity, it appears, has something in common with smoking: once the pattern is established, it’s difficult to change. A new study shows that children who are overweight or obese as a 5-year-old are more likely to be obese as adolescents. Other studies have shown that obese adolescents tend to become obese adults. Thus, it appears that, if a child is obese at age 5, chances are high that child will become an obese adult.”
German investigators conducted a population-based, longitudinal study in which 51,505 children were evaluated during the first year of life, then annually until age 14-years, and again between ages 15 and 18.
- Normal-weight adolescents generally had a normal body-mass index (BMI) throughout childhood.
- Most obese adolescents had normal BMI as infants, but 22% became overweight, and 33% became obese by age 5.
- 90% of children who were obese at age 3 were overweight or obese as adolescents.
- The most significant increases in body-mass index among overweight and obese adolescents occurred between 2 and 6 years of age.
- With children and adolescents becoming increasingly obese, determining the critical time of weight accrual offers the opportunity to better determine interventions.
If obesity does, in fact, begin at such a young age, who has the opportunity to provide the most regulatory intervention? Proactive parents.
Suppose the health consequences of obesity are more problematic than smoking. Why would most parents discipline their children if they caught them smoking but have no problem allowing poor food choices, chronic overeating, and a sedentary lifestyle, factors at the heart of the obesity epidemic? Regardless of how much money the government throws at the obesity issue in the primary grades, attempting to persuade children to eat healthier and exercise more, children will only do what their parents provide them the opportunity to do, encourage, and allow.
Prior to the sedentary, ever-expanding electronic distractions which now entertain children, most children would spend their free time outdoors doing a wide variety of outdoor games, riding their bikes, sports, games, etc. Such activities would keep them physically active for hours and naturally teach them a wide variety of physical athletic skills such as running, jumping, climbing, pull-ups, etc. Even minimal outdoor activities would account for at least 100 calories expended each day, often much more depending upon the activity and time spent doing it. That simple exchange is the caloric equivalent of 10 pounds of body fat at the end of that year.  Add to this the typical additional calories most children would be consuming along with their sedentary activities, say 100 - 200 moderate calorie-dense foods, e.g., “junk food,” which facilitates overeating to reach satiety, and the problem is further compounded.
By the time most individuals who have grown up obese are mature enough to experience and understand the harmful effects excessive weight and obesity have on their health and physical abilities, it’s often challenging, although not impossible, for anything more than modest changes. Successfully maintained weight loss requires dramatic changes in both eating and activity, not as a “diet program” for a few months, but as a change in lifestyle for the rest of their lives. Uneducated about how their body functions, poorly equipped with physical skills from a lifetime lack of exposure to physical activity, bombarded by enormous quantities of food, many, if not most, obese individuals find it understandably very difficult to address this issue with long-term success.
The odds are certainly against them. Most have little long-term success, which is why, according to a February 25, 2019 report from Business Wire, the weight loss and diet control market in the U.S. alone is estimated to be worth $72 billion. The weight loss industry is very aware of the many myths and misconceptions the average consumer embraces, making them easy to exploit. Most consumers simply lack understanding of the basic science skills needed to sift through all the hype and pseudoscience and recycle themselves through one failed program after another. Wouldn’t it be better if the unhealthy habits of this “lifestyle” had been “nipped in the bud” before they had fully formed in those critical years between 2 and 6? The real first step in curtailing the obesity epidemic should focus on educating parents in their role in shaping the eating habits and health of their children.
 One hundred calories daily or 36,500 annually divided by 3500 calories/pound is roughly 10 pounds.
Source: Acceleration of BMI in Early Childhood and Risk of Sustained Obesity New England Journal of Medicine DOI: 10.1056/NEJMoa1803527