Wishful Thinking Comes Back to Bite in Childhood Obesity
It’s a comforting story: “Communities are seeing positive results from comprehensive efforts to reduce childhood obesity.” People investing government and foundation money in this effort want to believe that it’s working. But it’s not. A new report in Pediatrics yesterday made that undeniable. Wishful thinking is coming back to bite in childhood obesity. Said lead author Asheley Skinner:
There’s a misconception that obesity as a problem is on a decline. That’s very much not the case. This study is important because it reminds us that obesity in children is not going away
Obesity in the youngest group is a concern. Because when obesity starts younger, most of these children continue to have obesity throughout childhood and into adulthood. The earlier you start seeing this, the harder it is to address it for these kids.
Entrenched Interests
In a companion editorial David Ludwig points out that we lack an effective strategy for addressing the drivers of obesity. He says:
The battle against childhood obesity faces many obstacles, most notably entrenched special interests and a business-as-usual mindset.
On that point, he is exactly right. Those entrenched special interests are quite diverse. They start with a food industry that seeks to sell us ever more appealing food. But they also include government and nonprofit stakeholders who are deeply invested in the business-as-usual prevention strategies. Let’s Move! Eat more healthy food!
Caring for the Kids Affected
Meanwhile, Skinner et al point out that the prevalence of severe childhood obesity is soaring. Roughly five million children have it. Yet for those five million children, we have fewer than 50 centers equipped to deliver effective obesity care. This neglect is shameful.
Time to Find Better Solutions
Sarah Armstrong was a co-author and she points to the need for finding better solutions:
We have known about this epidemic of childhood obesity — and have been pouring research dollars and public health dollars into this problem — for at least 20 years. And despite that, we don’t seem to be making a big dent in the situation.
We need to double down our efforts and find out what’s going to work, or the health of our future generation is really in jeopardy.
Baylor’s Tom Baranowski emphasizes the need to invest in obesity science:
The research needs to be more sophisticated, and we need to incorporate more biological perspectives into what we’re doing for obesity.
We must do better. Children who are living with obesity – especially severe obesity – deserve full access to a better standard of care. We must get serious about looking beyond the same old nutrition and physical activity strategies that have failed. And perhaps most important, investing in the science of obesity will be equip us with the knowledge to defeat it.
Blind stabs into the darkness of ignorance isn’t working.
Click here for the study by Skinner et al and here for Ludwig’s commentary.
Childhood Fantasy Voyage, painting by Thomas Cole / WikiArt
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February 27, 2018
February 27, 2018 at 8:17 am, Allen Browne said:
My thoughts about the latest data:
We need to learn from the latest data.
We have not made progress.
The leveling off of the incidence of obesity is a manifestation of susceptibility of the population to whatever moves the set point to an unhealthy level.
Many tools may be good for health but not for obesity prevention or obesity treatment when used by themselves.
Don’t throw the baby(the tools of healthy living and behavioral change and MI) out with the bathwater.
We do not know the causes of obesity.
We need to look at the disease of obesity through a new lens.
A physiological lens
The system (fat mass homeostasis) is unhealthy in people with obesity
Energy regulation is not voluntary
The “set point” is real
It is a clarion call
Enough is enough. We know how to deliver health messages many ways and at many different times in a child’s life – starting prenatally. But, what doesn’t work, doesn’t work. And it makes sense from a physiological point of view. We need to learn how to modify the physiology to help the child get healthier from the sequelae of obesity – mental health and clinical health.
Bias and stigma based on false premises need to be eradicated by establishing correct premises:
The system (fat mass homeostasis) is unhealthy
Energy regulation is not voluntary
The “set point” is real
The key is how to move the set point and establish a homeostatic system that supports a healthy fat mass and a healthy child.
What to do now.
Solving a puzzle is a process.
Attempts that don’t succeed are necessary. Ironically, failure and null findings are keys to success.
Attempts that don’t succeed are nobody’s fault. Ignoring attempts that don’t succeed is everyone’s fault. Use them to learn.
Look at the situation from 30,000 ft:
Obesity is bad for everyone
Obesity is a multi-faceted, heterogenous disease
abnormal physiology
environmental and psycho-social determinants
bias and stigma
in the patients
in the parents
in the healthcare providers
in the public
We have lot’s to do. It’s a big job. We need everyone. The children need us. Let’s go!
March 08, 2018 at 4:55 pm, John DiTraglia said:
Maybe the “entrenched special interests and a business-as-usual mindset” is Dr. Ludwig’s.