The “Common Sense Cure” for Childhood Obesity

Will common sense cure childhood obesity? A new study in Pediatrics is humbling. The seemingly preventable problem of childhood obesity is defying our best efforts. Barry Taylor and colleagues conducted a randomized controlled trial of obesity prevention in the first two years of life. They carefully designed a program to target sleep, food, and physical activity. They found no effect.

Digging deeper revealed clues for follow-up research on the sleep intervention. But this trial yielded no real evidence of effectiveness.

Four Decades of Growing Childhood Obesity Prevalence

More than four decades ago, the Lancet called for more vigilance to prevent obesity throughout childhood. Three decades later in the same journal, Cara Ebbeling, Dorota Pawlak, and David Ludwig described a “common sense cure” for the public health crisis of childhood obesity. They told us that “straightforward, if politically difficult, solutions exist.”

Their common sense cure involved a familiar set of prescriptions. “Set aside time for healthy meals and physical activity. Establish stricter standards for school lunch. Eliminate unhealthy foods. Protect open spaces. Regulate political contributions from the food industry.” You get the idea.

Some of those solutions have been implemented. The Let’s Move! campaign did much to improve school nutrition and promote physical activity. Though people have crowed about slower growth in obesity rates, meaningful declines are not evident yet.

Maybe we’re having an impact. Or maybe the epidemic is bumping up against natural limits. The population doesn’t have many susceptible children who are still unaffected.

Still Expecting a “Common Sense Cure” to Work

Hope persists for a “common sense cure” to solve the problem. In a recent systematic review of early childhood prevention, Tiffany Blake-Lamb and colleagues concluded:

Obesity interventions may have the greatest preventive effect if begun early in life. Yet, few effective interventions in the first 1,000 days exist.

They hold out hope for the promise of better conceptual frameworks. But maybe “common sense” and “conceptual frameworks” are getting in the way, not helping. Perhaps old assumptions should give way to four decades of evidence that those assumptions aren’t holding true.

The oldest assumption of all is that an adult with obesity is a lost cause. That assuption ultimately dismisses children with obesity, too. It was the starting point for Lancet four decades ago. The journal’s editors called for an exclusive focus on prevention. They said “most obesity could, with care, be prevented.”

We continue to hope that obesity prevention can work. But we need more than hope. Now that 71% of the population has excess weight and obesity, prevention alone will not solve the problem. Most children now grow up in families where excess weight and obesity are the norm.

Prevention cannot work in isolation. It must go hand in hand with evidence-based care for people who already have obesity.

Click here for the study by Taylor et al and here for the review by Blake-Lamb et al. The Lancet commentaries are here and here.

Close Up, photograph © Andre Chinn / flickr

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March 5, 2017