Fresh Perspective

The Urgent Need for Fresh Thinking on Childhood Obesity

Two major research programs spanning two decades for reducing childhood obesity have yielded null results. Altogether, none of five separate studies from these two programs have shown an effect. No effect on obesity. No effect on related health outcomes, either. These studies are important because they target populations where obesity is most severe – low-income urban youth. “We need a new approach,” says Bill Dietz in a commentary published with the studies in Pediatrics. He’s absolutely right. And furthermore, we need fresh thinking about the problem itself.

Thinking Beyond the Individual

Both Dietz and the researchers clearly understand that thinking focused only on individual behaviors and choices is inadequate. Dietz writes:

It should be no surprise that the behavioral interventions to prevent obesity had limited traction in families with food insecurity, lack of physical or financial access to healthful foods, unstable or low-quality housing, and exposure to violence.

Likewise, the authors of the latest study are clear on the need for a new approach. Education alone is not enough to change behaviors, they say. In addition, they write about the need for research into poverty and other determinants of health-promoting behaviors. Overall, their focus is on behaviors and the community factors that shape those behaviors.

They are absolutely right to focus beyond the individual.

Thinking Beyond Behavior Alone

However, these researchers note, but do not address, an important gap:

The effect of biological influences was not taken into account in this study, such as microbiome, metabolic, and genetic influences on body weight.

In fact, we know that obesity is a problem of physiology as much as it is a problem of behavior. Many of the youth in these studies already had high BMIs. Especially in teens, purely behavioral interventions for serious obesity have limited efficacy.

Thus, expecting behavior to reverse obesity might be an unreasonable expectation. Behavior change is a good idea, certainly. Also important is addressing community factors that drive behavior. But changing behaviors that lead to other chronic diseases – like cancer or diabetes – seldom reverses those diseases. Obesity appears to be no different. When the physiology that regulates fat tissue is broken, it needs to be fixed.

Therefore, we need better interventions for youth with obesity. But because the research to date has focused exclusively on behavior, we don’t have them. Better interventions will only come from fresh thinking and research that goes beyond an exclusive focus on behavior.

Click here for the study and here for the commentary.

Fresh Perspective, photograph © Matthew Fang / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


June 27, 2019

3 Responses to “The Urgent Need for Fresh Thinking on Childhood Obesity”

  1. June 27, 2019 at 10:15 am, Stephen Phillips said:

    “In fact, we know that obesity is a problem of physiology as much as it is a problem of behavior. Many of the youth in these studies already had high BMIs”

    Regarding you statement above:

    Please keep in my mind that pediatric growth charts are guidelines not destinies….
    Kids have linear growth potential…adults do not.
    That means kids can grow into their weight…we cannot (youth is spoiled on the young).
    Many kids will develop excess adipose tissue before they experience a growth spurt. Diagnosing obesity and stigmatizing a child simply because of an “adipose spurt” and BMI is a rush to judgement. Family and lifestyle histories must be evaluated prior to interventions.
    Indiscriminate weight loss interventions for kids can interfere with normal development and in fact foster lifelong obesity.
    Growth Charts are comprised of statistics…statistics are central tendencies…kids are not statistics

    • June 27, 2019 at 10:26 am, Ted said:

      Absolutely right, Stephen. Unnecessary treatment is never wise. However, a teen with severe obesity is very likely to become an adult with severe obesity and its complications. A young child with severe obesity is clearly at risk.

      Furthermore, stigmatizing care for any patient is irresponsible. Full stop. First do no harm.

  2. June 27, 2019 at 6:48 pm, John said:

    Is it not clear that physiology drives behaviour. We do need to change our thinking. Shaming and blaming does not work! We simply do not know what will work.