Evidence Suggests Early Years Key in Fighting Obesity

Obesity has been very much in the news this week after the American Medical Association voted to label the condition a disease, a move that could eventually pave the way for expanded insurance coverage of treatments and further raise public awareness of a condition that affects about one in three Americans.

As the New York Times suggests in its coverage, the headline-grabbing move is likely more about shining a bright light on the issue rather than any science-driven revisionism (the A.M.A.’s own Council on Science and Public Health advised against the reclassification):

To some extent, the question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed upon definition of what constitutes a disease. And the A.M.A.’s decision has no legal authority.

Semantic or not, the A.M.A.’s change could have a host of real-world consequences, ranging from more discussions between doctors and patients to more insurance coverage and new treatments.

But as obesity’s rising prevalence suggests, there are no easy remedies. Obesity has many overlapping causes – genetics, stress, poverty, the built environment, sedentary lifestyles, increased consumption of processed foods, food marketing, food deserts, the list goes on. And that’s partly why it’s so difficult to combat. Winning public health strategies remain elusive, as reporter Maureen O’Hagan of The Seattle Times noted in her excellent series on Washington state’s ongoing efforts to curb the state’s obesity epidemic:

So what's the solution? Eat less, move more, right? The problem is, there's so much we don't know. We were told to drink low-fat milk; now studies show it's associated with weight gain in kids. Is there a cause and effect? The science isn't there yet. … Salad bars in schools? More mixed results. How about putting calorie counts on menu boards? So far, studies haven't shown it changes eating habits. Still, grants are paying to put them up in local schools.

But while there may be no single cause responsible for the obesity epidemic, there is mounting evidence that early-childhood and even gestation can “program” children in ways that make it far more likely they’ll become overweight or obese down the line.

Some of this research may sound head-slappingly obvious: In a new study published in the International Journal of Obesity this week, Duke researchers found that moms who model and encourage exercising and eating well for their children are more likely to have kids who emulate healthy eating and activity.

Dr. Truls Østbye, one of the researchers, said in a statement that while obesity may have many factors, “we feel that the home environment is critical, particularly among children. However, we didn’t have a lot of evidence as to how important this was.” The new study backs up that feeling with fresh evidence.

According to another recent study from Canadian researchers, the critical importance of the home environment includes that earliest of all home environments: the womb. An AP report summarizes the fascinating study:

In a first-of-a-kind study, Canadian researchers tested children born to obese women, plus their brothers and sisters who were conceived after the mother had obesity surgery. Youngsters born after mom lost lots of weight were slimmer than their siblings. They also had fewer risk factors for diabetes or heart disease later in life.

Researchers attributed the difference between the siblings to differences in the womb environment before and after the weight-loss, which in turn can effect which genes are expressed or “turned on” in the child and thus the likelihood that they’ll be overweight.

Or as the AP story has it in what’s surely a front-runner for unsavory-quote-of-the-week:

Fetuses are "marinated, and they're differently marinated" depending on mom's weight and health, said Dr. John Kral of New York's SUNY Downstate Medical Center, who co-authored the Canadian study.

Fascinating as this clever study might be, the idea of intergenerational transmission of health problems and the broader notion of “fetal programming” isn’t exactly new. But the new research does appear to give added impetus to studies looking at what pregnant mothers might do to improve their mental and physical health, and by extension, that of their baby.

At the University of California, San Francisco, the MAMAS study, which focus on pregnancy, and the related SEED study, which focuses on the infants after birth, are looking to see if certain treatment programs during pregnancy can improve the health of both mother and child.

The studies are targeting low-income, minority women who are overweight or obese. The treatment takes them through an eight-week course designed to teach stress-reduction methods and healthy eating. To do that, the study is testing a “mindfulness” approach that emphasizes the power of attention, awareness, connecting with one’s body, and so forth.

“In addition to all the risks to the mom, the excessive weight programs the baby for life,” says lead researcher Elissa Epel, Ph.D., in a video overview of the work. “We are working hard to see how reversible this is.”

The pair of studies isn’t finished yet, but the researchers say they’re thrilled with the preliminary data. How thrilled? “The data, so far, adds new meaning to my life,” Epel says.

“Basically, they show that women who do well and respond to the intervention by having optimal weight gain [in pregnancy] and a decrease in stress are having babies with better physical and mental health outcomes,” says researcher Nicole Bush, in the video.

That’s promising news because it suggests that there are behavioral strategies overweight pregnant moms can adopt during pregnancy in order to give their child a better chance physically and mentally.

But even if these results hold up, are these kinds of interventions scalable? It’s too soon to say. But the notion of improving the health of children by investing more in hands-on training programs for parents – building essential life skills and lowering stress – is an idea that’s been getting more and more attention from child development experts lately.

Image by Ben Yapp via Flickr