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Post-publication Peer Reviews to:
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![[Read P3R]](/icons/misc/sectionDOWN.gif){kind=icon}
The childhood obesity epidemic: call for desperate measures
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Jose L.M. Mesa, Research Fellow Department of Medical Physiology, School of Medicine, University of Granada, E-18071 Granada, Spain
Send letter to journal:
mesajl{at}supercable.es Jose L.M. Mesa
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In 1974, one medical journal called for efforts to prevent obesity in childhood.(1) Far from dropping, childhood obesity, with its associated risks for coronary heart disease, type 2 diabetes, cancer, some musculoskeletal disorders, and psychosocial complications, has risen greatly worldwide since then.(2,3) The last evidence confirming the childhood obesity epidemic and its psychological complications is the study of Mustillo et al,(4) demonstrating a rate of childhood obesity 3 to 4 times more common than expected from national rates using Centers for Disease Control and Prevention 2000 criteria. In view of its rapid development in genetically stable populations, the childhood obesity epidemic can be primarily attributed to adverse environmental factors. Therefore, there is an urgent need to push back against the environmental forces which produce childhood obesity. What should mothers do? It has been suggested that prenatal overnutrition might affect lifelong risk of obesity.(5) Besides, intrauterine exposure to inhaled smoke products rather than lifestyle factors associated with maternal smoking is an independent risk factor for subsequent childhood obesity.(6) Therefore, prospective mothers should adopt healthy nutritional habits and do not smoke (neither actively nor passively) since before conception. Children who were bottle fed seem to be more at risk of obesity later in childhood than those who were breast fed, after adjustment for socioeconomic status, birthweight and sex.(7) Thus, babies should be breast fed. Replacing television viewing for physical activity Reducing television, videotape, and video game use may be a promising approach to prevent childhood obesity.(8) Television viewing may promote weight gain not only by displacing physical activity, but also by increasing energy intake. Children seem to passively consume excessive amounts of energy-dense foods while watching television. Additionally, television viewing including 30-second food commercials influence preschool children’s food preferences.(9) Unfortunately, most food commercials aimed at children are for fast food, soft drinks, sweets, and sugar-sweetened breakfast cereal. Thus, parents should limit their preschooler's exposure to television, and replace it for physical activity, which has greatly diminished in technologically advanced, car- driving, telecommuting nations. What physical activity? In a recent meta-analysis,(10) when the data were partitioned by exercise intensity, duration, mode, and intervention program, was found that a low exercise intensity (60-65% maximal oxygen uptake; e.g., swimming walking, running or cycling moderately), a long exercise duration (>30 min), the combination of aerobic plus high-repetition (8–12 repetitions) resistance exercise, and an intervention of exercise plus behaviour modification resulted in the greatest decreases in percent body fat in children. Attained the previous measures, the childhood obesity epidemic would be on the rack. In order to checkmate it, other comprehensive actions by many sectors of society are needed: Educators’ and health officials’ actions 1) Children spend great time at schools, so educators and teachers should instil healthy habits in them. A good starting point could be to remove junk food commercials on school television, soft-drinks machines, and educational materials sponsorships of soft-drink and snack-food industries. Of course, governments should recompense schools for these actions. 2) Educators and health officials should advise parents to limit their children’s television and video game utilization, and replace it for physical activity. Furthermore, they should train parents in healthy habits of nutrition and exercise. 3) Health officials should support several national or international no-TV or no-car/bus weeks per year. Additionally, they should support walking, jogging, swimming or cycling weeks. Urban development actions Urban planners and architects should build communities in which walking and bicycling are safe and convenient. For this, suitable sidewalks or bike paths would be needed. Besides, cities, towns, and buildings could be designed to help people lead healthier lives (e.g., making stairs and stairwells more accessible and attractive to use). Local governments should build attractive facilities to entice young people to walk and jog more, play tennis and basketball, and lift weights. Government actions 1) Governments should counterbalance the food industry’s marketing effort. Junk food should not be sold in schools, and fast food commercials should clearly state their unhealthy properties. Chain restaurants and manufactures should list caloric contents on menus and products, as well as put recognisable good-food symbols on products that meet specific criteria. 2) Governments should launch mass-media campaigns to promote better diets and more physical exercise for children, healthy habits for prospective mothers, and basic knowledge on childhood obesity for parents. 3) It would be desirable to increase the number of hours per week of physical education in schools and fund them to involve children in routine physical activity. In order to develop effective comprehensive public policy response to the childhood obesity epidemic, we must expand its psychological, physical and economic sequelae as well as its treatment to society and politicians; otherwise, we and our children will live in an overweight population, experiencing such sequelae. Acknowledgments This work was funded by a grant from Spanish Ministry of Health (FIS 00/0015-003) and Spanish Ministry of Education, Culture and Sport (grant number AP2002-2920) References 1 Anonymous. Infant and adult obesity [Editorial]. Lancet 1974;1:17- 8 2 Booth ML, Chey T, Wake M, Norton K, Hesketh K, Dollman J, et al. Change in the prevalence of overweight and obesity among young Australians, 1969- 1997. Am J Clin Nutr 2003;77:29-36 3 Wang Y, Monteiro C, Popkin BM. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. Am J Clin Nutr 2002;75:971-7 4 Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ. Obesity and psychiatric disorder: developmental trajectories. Pediatrics 2003;111(4 Pt 1):851-9 5 Whitaker RC, Dietz WH. Role of the prenatal environment in the development of obesity. J Pediatr 1998;132:768-76 6 von Kries R, Toschke AM, Koletzko B, Slikker W. Maternal smoking during pregnancy and childhood obesity. Am J Epidemiol 2002;156:954-61 7 Armstrong J, Reilly JJ. Breastfeeding and lowering the risk of childhood obesity. Lancet 2002;359:2003-4 8 Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA 1999;282:1561-7 9 Borzekowski DL, Robinson TN. The 30-second effect: an experiment revealing the impact of television commercials on food preferences of preschoolers. J Am Diet Assoc 2001;101:42-6 10 Le Mura LM, Maziekas MT. Factors that alter body fat, body mass, and fat-free mass in pediatric obesity. Med Sci Sports Exerc 2002;34:487-96 |
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