Childhood Obesity
January 2013
A family and community affair
Rates of childhood obesity are now increasing with each generation. Children today not only will, on average, be heavier than their parents but also, for the first time in recorded medical history, will potentially face a reduction in average life span, meaning they will live shorter lives than their parents’ generation. This is alarming given modern medicine has, for decades, increased average life span. Obesity increases the risk of death far greater than does smoking. Statistics indicate that one-third of children in Australia are classified as overweight or obese. The obese child typically becomes the obese adult and the need to address issues of weight gain very early in life is now considered one of the most important interventions we can make in an attempt to reduce adult obesity and mortality.
At the core of Integrative Medicine is an approach to health that is preventative and health creating. Integrative Medicine provides us with an opportunity also to look beyond the individual or self to focus more comprehensively on the family, children and the future. Studies indicate that obesity runs in families.
The news that obesity is on the rise is not unfamiliar. Every day we are told that obesity rates are unacceptable and most people can list the reasons why – too much screen time, too much junk food, not enough activity and so on. But knowing about obesity and doing something about it (which involves real and lasting behavioural change) is clearly a more difficult transition than we, as a population and as healthcare providers, can manage on our own. Through Integrative Medicine, we can develop programs that provide a wealth of opportunities to bridge the gap between knowing what to do and actually doing it.
While diet and exercise are the two main weight management strategies offered, the integrative approach also looks at issues related to environment, stress, culture and family structure. Weight and mental health are listed as the two most common health issues for children. A study from 2012 indicates one in seven adults experience severe stress, with stress levels in young people higher than those in older people. Paediatric depression, anxiety and stress are emerging as significant health issues, and youth mental health is now a priority in healthcare.
Over thirty years ago, I conducted research into the eating habits of primary school children – over one-third were obese or overweight, two thirds did not consume adequate fruit and vegetables and over a third suffered from constipation. With research findings today showing similar trends we need to approach children’s health, and in particular children’s obesity, from a fresh and integrative perspective. It is important to start before a child is even born.
High birth weight in infants, the mother and father’s BMI (Body Mass Index), rapid weight gain in infant years and having an overweight mother who smoked in pregnancy have all been shown to increase the risk of obesity in the childhood years. Mothers who were overweight before becoming pregnant had children that were up to four times more likely to be overweight by age seven. Children of smoking mothers (during pregnancy) were 47 percent more likely to be overweight compared to children of non-smoking mothers. In contrast, infants who were breastfed for longer than one year were less likely to become obese children. It appears that the early introduction of solid foods may be linked to excessive weight in preschool years. Even those who were breastfed only briefly had less weight gain. The decisions a mother makes about nutrition and food intake during her pregnancy will influence the child’s propensity towards obesity through genetic changes of the foetus. The changes to carbohydrate metabolism, more specifically glucose, influence the various developmental tasks and phases involved in the growing foetus, and become specific and deeply coded physical and genetic programs that the child carries for life.
Research shows that exerting excessive control over what and how much a child eats may contribute to that child becoming overweight. Quality relationships, such as developing strong emotional bonds with children in their early years, can have a significant impact on obesity rates in adolescent years. Parenting styles that respond to a child’s emotional states with comfort, consistency and warmth may provide a sense of security and attachment that helps a child manage stress levels throughout their entire lives. The effect of stress on the human body is now understood to be directly related to weight gain as the increased cortisol related to stress and anxiety has an effect on insulin levels and a series of complex biochemical reactions in the brain and body. Children, just like adults, can benefit greatly from learning stress management and relaxation techniques, and sound sleep behaviours.
Inadequate sleep for children is directly linked to obesity. In children each one-hour reduction in sleep was associated with a 40 percent increase in the risk for obesity. Although average sleep varies by age, research indicates approximately ten and a half hours sleep a night is required by primary school-aged children. At school, something as simple as children having recess directly before lunch (rather than lunch first) resulted in a higher consumption of vegetables and fruits, better behaviour in the afternoon and a reduction in visits to the school nurse of over 40 percent. Strategies at a collective level, even those as simple as a rethink on school lunchtimes, are now considered essential. The World Health Organisation considers obesity a global epidemic similar to cancer or diabetes and one that needs a collective approach, not only a focus on the individual. Family and community, plus an integrative approach, are key.
Although genetic and environmental factors play a role, the family influence carries the most significant ‘weight’ in how children develop and sustain eating behaviours, attitudes to food, over-feeding and knowledge about foods in general. Research shows children who cook are hungrier for healthy foods. How babies are weaned can impact on their preference for healthier foods. A new study by psychologists at The University of Nottingham has shown that babies who are weaned using solid finger food are more likely to develop healthier food preferences and are less likely to become overweight as children than those who are spoon-fed pureed food.
While nutrition and exercise are essential components of a healthy lifestyle, research is now showing us a range of factors that influence how we think and behave around food, and how our bodies process or manage energy in and energy out. For example, we are developing a better understanding about the role environmental toxins play in obesity (and in health generally). Phthalates, a human-made, endocrine-disrupting chemical which is found in cheap chemically processed foods, mimic hormones in the body which are linked to childhood obesity. Another emerging aspect to do with weight management is the role of the numerous gut bacteria. The disruption of gut bacteria by poor diet and antibiotics is shown to be a factor in weight gain.
The National Institute of Integrative Medicine, supported by the Ponting Foundation, is developing a pilot program for school-aged children that focuses on children’s wellness through a totally integrative approach. This community-based, multifaceted, holistic and integrative approach will focus on children and their families within a supported environment. Children will learn new ways to live well that will not only create healthy models for their future, but also create lasting change for families today.
Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM). He oversees the facilitation of the practice of Integrative Medicine at the NIIM Clinic in Hawthorn, as well as the promotion of education and research.
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