Be The Best Role-Model You Can Be
By Donald Kushner, M.D.
The last few years have seen tremendous efforts to focus attention on the need to control Childhood Obesity America. The Federal Government has outlined its approach to address this issue as well as including efforts by the public, nonprofit, and private sectors. Today we see schools reevaluating meal programs, national campaigns to encourage exercise and food manufacturing companies reducing calories and fat in their products among the many initiatives instituted. But before we, as a society, grandparents and parents, get too comfortable in our easy chairs waiting for this government lead initiative to be successful, we need to understand what the literature demonstrates and our roles in dealing with childhood obesity.
A factor contributing, perhaps most importantly, is the role of the family. A two generational study found the average BMI of both parents best correlated with the likelihood of childhood obesity America with children of obese parents four times more likely to become obese. Less than 5% of obese children came from normal weight parents.
The cause of this is likely due to multiple factors including societal effects, family issues and genetics. For the latter it is important to recognize there is lower correlation with childhood and parental obesity than for stature suggesting obesity is affected by other issues.
Additionally, data suggests daughters of obese mothers are 10 times more likely to be obese and sons of obese fathers are six times more likely. However, opposite sex parental obesity does not influence child BMI. This pattern of gender behavior is more likely due to behavioral rather than genetic influence. This observation strongly suggests the approach to prevent childhood obesity is best directed to the parents, not the environment.
Further evidence solidifies the importance of parental behavior. The Early Bird Diabetes Study found 90% of excess weight in girls and 70% in boys had already been found by age of five. Weight at birth did not correlate with weight at five years but weight of five years did correlate with weight at nine years. Because this age is before children begin school, efforts supporting parents is most likely beneficial when geared towards parents.
A study published in the International Journal of Pediatric Obesity reviewed the literature evaluating parents as the mediator of change and compared three models. One in which children only attended sessions, one with parents and children and one with parents alone. The last model demonstrated the most effective treatment.
Although parents play an important role, evidence also suggests grandparents play a role. A study published in 2008 demonstrated children of overweight parents was 2.5 times more likely to be obese and 4 times more if parents were obese. Interestingly, children of normal weight parents were also 2.5 times more likely to be obese if grandparents were obese.
The importance of early intervention and role modeling by parents gives parents an important role and responsibility. It is also important to recognize the potential of child attention to benefit adult lifestyle changes and impact upon weight. A social- cognitive theory by Bandura suggests a reciprocal reinforcing relationship among family members for acquiring and maintaining new behaviors. Others find the family unit an ideal environment to introduce and maintain behaviors in a mutually beneficial manner.
Fortunately adults have been attempting to lose weight. 50 per cent of overweight adults are actively trying to lose weight. In 2005 the weight loss market was estimated to be nearly $50 billion dollars. A study we conducted through physicians’ offices revealed that nearly 60 percent of people have made at least 4 attempts to lose 15 pounds in the past year.
This last demonstrates both the good and bad about weight loss. People appear to continue to seek improvements in their health and weight but do not seem to find success. The focus on Childhood Obesity America and the above data presents both a challenge and an opportunity. Although there is no clear solution to the problem of obesity it appears that several principles will be helpful to everyone involved to improve health.
First, appropriate goals are important. Many people have overly aggressive goals for weight loss. But as a parent and clinician, I believe a goal of being healthier is more important. This can occur with only a 10 percent weight loss.
Secondly, an approach should be balanced. This includes appropriate nutrition and adequate physical activity and associate behavior.
Thirdly, the approach must be capable of being maintained for the long-term. A quick fix is exactly that. The concern is not what one weighs in 6 months, but rather what one weighs in 6 years. Any approach to weight loss must be changeable to meet the demands of changes in life.
Fourthly, evidence demonstrates support is important. As discussed above this support primarily runs from parent to child but the converse is also true. When considering an approach to weight loss it is important to recognize whether the general direction is appropriate for parents and for children. For example, meal replacements and dietary supplements may give temporary benefit, but are not beneficial to children.
And lastly, any attempt at changing lifestyle needs to be comprehensive. No attempt will be effective without addressing nutrition, fitness and behavior. It is the last which is most likely to be deficient. These changes do not come easily and need to address thoughts, emotions and behaviors.
Lifestyle changes are critical to reducing childhood obesity and improving health of families. Each member of the family has different needs which need to be addressed. Societal changes to reduce childhood obesity are important, but involvement of the family is critical. Making these changes is never easy but these goals are achievable. Perhaps the best aspect of addressing Childhood Obesity America is that as parents and grandparents, we can help our children-and they can help us.
Dr. Donald Kushner is specialist in Internal Medicine and Medical Director for http://wise-about-weight.com/