How to Prevent Childhood Obesity

No one can doubt that it is a disadvantage to be overweight whether or not it is a significant risk factor for subsequent disease. There seems to be a strong case for discouraging young children from becoming overweight if this can be achieved. Those who believe that obesity is largely genetically determined may regard this as impossible. We prefer the view that some children will benefit if the overall adiposity of the population can be prevented from rising by sensible policies, even if some individuals very strongly predisposed to obesity will get fat irrespective of environmental factors. Repeating the experience of the United States, where there appears to be an explosion of obesity among both children and adults is something we must try to avoid.

It was thought that infantile obesity programmed individuals to a lifetime of being overweight, events during the first months of life probably have little bearing on later body habitus, provided that the infant is fed either breast milk or correctly prepared infant formula and not commenced on high calorie solids too early. Most very plump infants slim down during early childhood and true infantile obesity persisting into adulthood is very rare. Apart from following the laid down principles for infant feeding, there seems little justification for the Introduction of policies aimed at preventing overweight in babies.

Prevent Childhood

Much more important seems to be the post-toddler period. The age period from two years to six years is the leanest time of life, so the onset of obesity during this time is an important matter which may have a permanent effect. Significant obesity begins to appear in the preschoolchild. Just why some children not previously fat begin to put on weight is not really understood. Meta-bolically based theories do not explain this, as one would expect individuals predetermined to be fat to be so from the start. It seems prudent to assume that the pattern of eating and activity has something to do with it.

This is the period where children may adopt particular patterns of eating and physical activity. Parents who find it convenient to place a child in front of a television or video screen with a bag of crisps and a bottle of pop should be aware that this is an unsound practice with possible long-term harmful consequences. Social policy which leads to the trapping of families into this sort of life-style needs to be re-examined.

Parents should be encouraged to avoid excessive calorie and fat intakes in their children’s diets and to discourage snacking on ’empty calorie’ foods and drinks. If parents are overweight they should be encouraged to re-examine thier own eating and activity patterns. The promotion of a life-style for the whole family which involves a reasonable amount of physical activity is to be encouraged. Regrettably UK National Travel Surveys have demonstrated a decline of about 20% in annual distance walked, and 27% in distance cycled between 1985 and 1993. A recent strategy statement from the Department of Health highlights the need to promote moderate activity in children as a priority; however, encouraging children to walk or cycle to school is unlikely to be successful unless they can do this in a safe environment.

The prevalence of obesity increases sharply after adolescence and goes on increasing into adult life. Paradoxically some fat children may slim down during adolescence, presumably because of cognitive pressures. Many simply decide that they will not be fat any longer. A population of ‘restrained eaters’ emerges, people who consciously or unconsciously restrain their intake of energy to achieve a desirable body habitus but who would, presumably because of the nature of their genetically determined metabolism, become obese otherwise. This subset of the population at least demonstrates that some individuals can alter their body weight by dietary means.