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Why Preventing Childhood Obesity Should Not Be About Preventing Childhood Obesity


Conventional wisdom of public health ‘gurus’ dictates that the solution to the obesity epidemic is to start early – particularly to target ‘prevention’ measures at kids – the younger the better.

A thoughtful and provocative commentary by Robert C. Whitaker, from the Departments of Public Health and Pediatrics, Temple University, Philadelphia, published in the latest issue of Archives of Pediatric and Adolescent Medicine, suggests that it may be time to focus on societal norms and the values underlying those norms rather than focusing on the ‘symptom’ (childhood obesity).

Thus, Whitaker reminds us that:

“The childhood obesity epidemic is just one symptom of our way of living. Reversing the epidemic may require that we apply a new approach to improving child health in the 21st century. One approach is to make societal changes to enhance human well-being rather than to prevent a particular symptom, such as childhood obesity. In the process, we may address obesity and other socially determined health conditions while preventing new ones from emerging.”

The discussion about ‘diet and exercise’ recommendations or targeting advertising to children is ‘misguided’ because it distracts from the broader societal discussion of how much value we place on creating a healthy and nurturing environment for our children.

As I have pointed out before – the questions (and answers) should focus on the ‘whys’ and not the ‘whats’ that determine our childrens’ health and well-being – in fact, obesity is only one of many problems attributable to the same ‘whys’.

Or, in Whitaker’s words:

“Many of the other “new morbidities,” such as depression, substance use, attention-deficit disorder, and bullying, are likely to share causes rooted in our way of living. To address those root causes, we must ask not only how our way of living has changed but why.”

Ignoring the ‘why’, Whitaker warns, may actually make things worse – not better:

“It is plausible that we could reverse the obesity epidemic by changing children’s environments in ways that make children less well than they are now, especially if we do not recognize that obesity may reflect how children are coping with multiple stresses induced by our current way of living.

For example, protecting children from food marketing or removing televisions from their bedrooms may leave children lean, but not well, if we fail to address the questions of whether we should market anything to young children or have more than 1 working television in a household.”

It is these decisions (that adults have made) that shape the environment for our kids.

“The decisions that led to changes in our way of living reflected the values of adults—what was important to us. Although these changes may have been disproportionately influenced by the values of those with the most political and economic power, the changes also reflected the values that parents brought to parenting, consumers brought to the marketplace, and voters brought to the polls.”

In fact, Whitacker suggests, the underlying ‘root causes’ of both the adult and childhood obesity (and other) epidemics likely share the same shift in values (consumerism, time pressure, etc.). Recognising these common roots should shift societal norms and values to benefit all – young and old, and not just their body weights.

“For example, addressing the problems of food insecurity and neighborhood safety can improve the well-being of both adults and children, involves questions of societal values, and can affect problems beyond the symptom of obesity. The need for a shared framework is also suggested by the fact that reversing the childhood obesity epidemic requires reversing the adult obesity epidemic, which should not necessarily require different approaches.”

Thus, both children and adults

“… need to find purpose and meaning in life, which requires lifelong growth and development… autonomy, competence, mastery, self-acceptance, positive relations with others, and transcending self through commitment or connection to something or someone else.”

“An emphasis on relationships might also clarify the tradeoffs in connecting to others through face-to-face vs electronic communication. The importance of helping children identify their natural gifts and find meaning and purpose in their lives might highlight the trade-offs in education between children’s cognitive development and their social, emotional, and spiritual development. Such trade-offs, while not about obesity per se, could also affect energy balance.”

I, for one, certainly concur with Whitaker that it will take a major and open public dialogue about the norms and values that underlie the way we run our societies to address these health issues of our times.

As I have said before, blaming, shaming and punishing will not solve the problem – this is simply shooting the messenger.

Nor will calls for laws and bans or other measures that target the symptoms (e.g. fast food) without addressing the real problem (e.g. lack of time) really solve the obesity issue (should we perhaps be learning something from the hopelessly lost ‘war on drugs’ here?)

No one said this would be easy.

AMS
San Francisco, CA

p.s. Hat Tip to Geoff Ball for alerting me to this article

Whitaker RC (2011). The childhood obesity epidemic: lessons for preventing socially determined health conditions. Archives of pediatrics & adolescent medicine, 165 (11), 973-5 PMID: 22065178

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8 Comments

  1. Well written and well said! Chapeau!

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  2. Great article – a true public/population health approach for everyone – not just “high risk” (though that’s just about everyone these days!).

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  3. Hear, hear Dr. Sharma,
    I agree 100% with all the quotations you have extracted from the thoughtful and provocative commentary by Robert C. Whitaker.
    Thanks for bringing this powerful message to our attention.

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  4. Well said, Dr. Sharma. Teaching about nutrition and exercise are only treating symptoms, rather than the underlying cause. Our after school curriculum for kids aims at building the foundation of a healthy life by teaching not only nutrition, but school skills, money management and character building.
    We strive to look at the bigger picture with kids, hoping the end result is happy, healthy kids.

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  5. Well put, Dr. Sharma! We couldn’t agree more that fighting childhood obesity isn’t just about teaching kids about nutrition and fitness. It is about teaching kids values for areas of life.

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  6. Similar to this argument about childhood obesity, we recently published a study suggesting that emphasizing well-being benefits might bring improved exercise participation compared to promoting it for its clinical and medical-based benefits. Talking about the outcomes health professionals hope to achieve is not the solution to help individuals adopt health behaviors they can sustain.

    We published a paper called Rebranding Exercise: closing the gap between values and behavior that addresses this issue as well.

    The published study can be accessed here: http://www.ijbnpa.org/content/pdf/1479-5868-8-94.pdf

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  7. Great to see! Where do we start? and who goes first? Is this the role of public education? Parent and Family? Anyone…..? It is so much more about building good values, especially with ones self!

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