Childhood Obesity: A Glimmer of Hope or a Wish?

Journals are bursting with studies of childhood obesity this week. One appeared in Pediatrics. JAMA published two of them. Furthermore, all of these studies were randomized and controlled. On top of all that, JAMA published an editorial, describing “a glimmer of hope” for preventing childhood obesity.

A Glimmer or a Wish?

Unfortunately, we’re not seeing a lot of reason for encouragement in these studies.

Jodie Dodd and colleagues conducted the study published in Pediatrics. They tested the effects of diet and exercise coaching for pregnant women with excess weight or obesity. They were looking for an effect on excess adiposity at 18 months in the children born to these women. But they found none.

In JAMA, Shari Barkin et al reported on the effects of a behavioral program for underserved preschool children. Once again, they found no effect on BMI after 36 months of follow-up.

The third and final study in this group tested a program to promote responsive parenting in early infancy. In the test group, nurses coached mothers to respond to an infant’s needs when sleepy, fussy, playing, or feeding. The goal is to avoid feeding patterns that promote excess weight or obesity.

The results of this last study were mixed. When Ian Paul and colleagues designed the study, they specified BMI percentile at three years as the primary outcome. But before they analyzed their data, they changed the specification. BMI z-score was the right outcome to focus upon, they explained. Luckily, they found a significant effect on BMI z-scores. But the intervention had no effect on BMI percentiles. In addition, none of the secondary outcomes were significant.

Somehow, this doesn’t seem like a robust outcome.

Looking for Hope

Commenting on the two studies in JAMA, Jody Zylke and Howard Bauchner clearly want to be hopeful:

If a larger multicenter trial with long-term outcome data confirms the findings of the study, then a national campaign will be necessary to promote the responsive parenting intervention.

Just as the United States created national campaigns to reduce smoking and treat HIV/AIDS, the same financial and intellectual resources should be committed to the prevention of childhood obesity.

But here’s the thing. Paul et al concede that the clinical significance of the changes they observed is debatable. So even if these results could be confirmed, this program doesn’t offer a huge benefit.

All of these programs have one thing in common. They are counting on behavior changes to alter the physiology of obesity. Maybe we’re barking up the wrong tree. If so, wishful thinking about a “glimmer of hope” won’t get us very far.

We should aim higher.

Click here for the study by Dodd et al, here for the study by Barkin et al, and here for the study by Paul et al. For the editorial by Zylke and Bauchner, click here.

Last Glimmer of Light, photograph © versageek / flickr

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August 9, 2018