The Obesity Epidemic – Are We Targeting the Wrong Age Group?

Today’s post is borrowed from “Dr. Sharma’s Obesity Notes.”

Obese Kids are Not Causing the Obesity Epidemic

The math is simple – of the one in five adults in most Western countries, who are now considered ‘obese’, very few of them were obese as kids or even as young adults.

In fact, most obese adults are 40 or older. And, despite the alarming increase in childhood obesity (now affecting about one in twelve kids), obesity rates in younger adults remain at about 10% or less. Indeed, the greatest increase in obesity is seen in 45-54 year old men.

These numbers alone should tell us that most obese adults (and thus, the vast majority of obese people alive today), developed obesity as adults – not as kids!

This is not to say that excess weight in childhood is not a major predictor of excess weight in adulthood – many of my patients recall being teased and bullied about their weight 30 years ago, when they were growing up in rural Alberta, helping with chores around the farm, riding their bikes to school everyday, and playing shinny hockey on a frozen pond all winter.

But the majority of my patients did not have a weight problem till well into adulthood.

Why do I bring this up?

Simply because, I believe that better understanding, or even fully preventing, childhood obesity is unlikely to have a noticeable impact on adult obesity rates anytime soon.

The problems that lead to obesity for the vast majority of obese adults occurred during their adult years.

Their obesity was not caused by lack of phys-ed classes, poor school lunch programs, hallway vending machines, or parents too busy to cook dinners from scratch.

Their obesity was probably also not caused by too much video gaming, too much TV watching, or not playing outside till the lights came on.

Remember, the demographic group with currently the highest obesity rates (almost one in three) were kids in the 50s and 60s – an era, when a 6 oz serving of pop was considered a rare treat.

Why is any of this important?

1) Focusing all of our efforts solely on better understanding the drivers of childhood obesity and trying to prevent it likely means continuing to ignore the drivers of adult obesity, which account for the vast majority of obesity in the population.

2) Even if we successfully eliminate childhood obesity, by say, changing our kids’ lifestyles back to the lifestyles of kids in the 1960s, we may still see obesity affecting as many people in 50 years as it does today.

3) Adults with obesity today will live another 30-40 years (or longer) – many more adults not obese today, will become obese tomorrow – this is why preventing and treating ADULT obesity must be the most important priority for any health care system.

4) While childhood obesity is certainly a risk factor for adult obesity – the main driver of childhood obesity is ADULT obesity – having just one obese parent markedly increases the risk for childhood obesity – having two obese parents is virtually a guarantee. Thus, any solution to childhood obesity must focus on the ‘root cause’ of kids’ excess weight, i.e. having obese parents – these parents need treatment.

5) As far as I can tell, the strongest ‘halo’ affect of treating adult obesity is on their kids (the most extreme examples of this come from the kids of parents who have undergone bariatric surgery). Simply stated: successfully treat the parents and you ‘automatically’ prevent obesity in the kids.

I am not implying that childhood obesity is not a concern and that improving the lifestyles of all our kids (irrespective of their shapes and sizes) should not be an important goal.

All I am saying is that we need to stop ignoring the adults if we hope to make any dent in the obesity epidemic in our lifetime.

Imagine if the obesity epidemic was due to a virus that mostly affects adults – would we just be vaccinating the kids?

Dr. Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program.


What Do You Think of “Maggie Goes On a Diet”?

Maggie Goes On a Diet hasn’t even come out yet and it’s already sparked world-wide controversy. There’s even a “Say No to Maggie Goes On a Diet by Paul M. Kramer” page on Facebook, for instance. Experts, educators and parents are weighing in (no pun intended) on the issue of whether this is an appropriate book for 8 to 12 year-olds. (Amazon cites it as being for 4-8 year-olds, which makes it even more controversial.) Critics worry that it will lead to eating disorders at worst and hurt feelings at best.

This video shows parts of the book and includes an interview with the author (who, ironically, is very overweight himself, a fact no one mentions in the interview).

My worry is about how this book gets in the hands of a grade-school girl. If the book is given to her personally the message she’s going to get is, “They think I’m fat.” Even if it’s true that a child needs to lose weight, there are more sensitive ways of approaching the issue. A fat person knows he or she is fat, especially in this society with all the images of skinny people on TV and in movies and commercials. Not only that, but he or she has been sent the message that fat people are marginal in our society. Maggie herself achieves “fame and popularity” as a soccer player, but not until she becomes thin. Admittedly, part of the book’s message is that Maggie is not only fat, but she’s also not physically fit and supposedly the author’s intent was to show kids a model of how to become more healthy. But the truth is, you don’t have to be skinny to be physically fit, yet you wouldn’t know that from this book.

There are other things I take issue with, like the part where the author writes that Maggie got fat from eating bread and cheese. No one food makes someone fat and in fact bread and cheese are sensible parts of any diet. I also wonder why the author doesn’t criticize the kids who tease and bully Maggie for being fat. He acts as if this is a given—fat people are going to be treated badly—and seems to view it as a motivator for a fat person to lose weight. When in reality we should be teaching our children that it’s not right to be mean to people who are different, even if that difference is that that they’re fat.

I also question the title. Wouldn’t it have been better, and more sensitive, to have called it, “Maggie Makes Her Dreams Come True” or even “Maggie Gets Fit”? The author says that the word “diet” has many meanings and not all of them are negative. This just shows his insensitivity. Telling someone that they need to go on a diet does carry a negative connotation. It’s code for, “You’re fat.”

If a little girl finds this book in the library or book store and expresses interest in it, it might be a sign that she is ready to do something about her weight problem. But if she doesn’t have a weight problem, that should be a red flag that you need to have a conversation about body image and eating disorders.

But perhaps the biggest problem I have with the book is that it targets girls. If the author had come out with editions for boys and girls, I would have felt better about it. Girls are already bombarded with the message that they must be thin. Boys, not so much. What made the author think that his best audience would be female? Perhaps because he knows that they’re more likely to be concerned about their weight? The facts are that boys are more likely to be obese than girls. [Source.]

What do you think about this book or others like them? Do you think they’re helpful or hurtful? Are you comfortable with the target of grade school girls?




Reconsidering Michelle Obama

Perhaps I’ve been too hard on Michelle Obama.

I criticized her in an earlier post for making childhood obesity her cause instead of something more “earth-shattering.” But today I ran across some of her recent comments about the issue that show that she realizes there’s more to the problem than our children’s inactivity. (Her campaign is called “Let’s Move.”) This is from an opinion essay on by Roland Martin:

“The crisis that we’re facing around childhood obesity hits everything,” Obama said. “It’s about education, what our kids are learning about nutrition in the schools, the quality of the food in the schools. It’s about our neighborhood development. How are neighborhoods designed?

“Are our kids — do they have access to safe places to play? Are we structuring communities in a way that facilitates healthy living? Are there accessible and affordable healthy foods in our communities? And it’s about economic opportunity as well, because if folks can’t afford to put food on the table, then they’re eating what they can.

“So this is one of those issues that requires us to talk about a little bit of everything. And it makes us look at ourselves a little more closely and it makes us look at the broader society.” [Italics mine.]

On the “Let’s Move” campaign’s website, there are sections aimed at elected officials and community leaders about how to make healthy food affordable and accessible in areas that are predominantly low-income and underserved by food markets. Granted, the website doesn’t promote this aspect of the problem as much as it does the importance of healthy eating and physical activity, but at least it’s mentioned. For example:

Food insecurity and hunger among children is widespread.  A recent USDA report showed that in 2008, an estimated 49 million people, including 17 million children, lived in households that experienced hunger multiple times throughout the year.

I said in my post that I’d rather see a campaign that gets food to hungry children than one that takes it away from overfed ones. But there’s no reason why you can’t do both.

Visit Share Our Strength for more about childhood hunger.

Go to this USDA Food Environment Atlas to learn more about food accessibility where you live.