Childhood Obesity: An Unresolved Public Health Problem By John Menchaca, MD

Childhood Obesity:

An Unresolved Public Health Problem

By John Menchaca, MD

Childhood obesity continues to be a major public health problem for at least the past forty years and continues to worsen.1-2 Multiple approaches have been tested to prevent and treat obese children both at home, school, or both, though all with poor results. It is well recognized that many of the obese children will eventually become obese adults with several complications. These well-documented complications including diabetes, cardiovascular disease, liver disease, increased cancer, and dementia.2,3 Hence, there is a need to explore other therapeutic approaches.

In the past two decades, attention has been focused on the role of the prenatal period on the development of childhood obesity. To the disappointment of many, interventions during the pregnancy have not yielded satisfactory results.2,3

In recent years, attention has turned to the periconceptional period, which is three months before conception to the end of the first trimester of the pregnancy. Animal studies are very encouraging.5 Furthermore, studies on the donor sperm in in vitro fertilization procedures have demonstrated that sperm from obese male donors are abnormal and are associated with obesity in the offspring resulting from the pregnancy.6 The role of maternal obesity has been likewise well documented.7 Preliminary clinical studies of interventions on obese mothers before conception are very encouraging.7 There are numerous studies underway to confirm that interventions that improve the weight and nutritional status of the obese mother will help minimize the risks for the offspring to become obese in their later years.8

The most difficult, if not impossible task, is to identify the mother before she gets pregnant so intervention measures can be initiated. One approach is contacting the mother after she has her first baby, initiating interventions to improve her weight and nutritional status before she gets pregnant with her second baby. Our obstetrical colleagues could stay in touch with the mother in-between the first and second pregnancies to hopefully improve her weight and nutritional status before she gets pregnant. This would hopefully minimize her offspring’s risk for obesity. Another option for the physicians involved with the mother’s first baby and its well-baby care is to become involved with the mother’s postpartum period. Obviously, there would have to be additional reimbursement for the physician’s involvement over the two to three years between the pregnancies. A final, third option, is more vigorous health education in middle and high school for both males and females. This would make it so when they move on to parenthood, both young mothers and fathers will be at optimum status at the time of conception.

In summary, what we have done and are trying now has not succeeded. We must consider other approaches to help stem the tide of childhood obesity and, by default, adult obesity.

John Menchaca, MD is a member of the Bexar County Medical Society.

References

1. Ogden, C.L. et al: Trends in Obesity Prevalence Among Children and Adolescents in the United States 1988-1004 through 2013-2014 JAMA 2016 Jun 7; 315(21) 2292-2299 2. Al- Khudairy et. al: Diet, physical activity, and behavioral intervention for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database

Syst. Rev. 2017 (6) CDO 12691 3. Colquitt, Jill L. et. al. Diet, physical activity, and behavioral intervention for the treatment of overweight or obesity in preschool children up to age of 6 years.

Cochrane Database Syst. Rev. 2016 May 2016 (3) CDO 12125. 4. Meyer, D.M. et al: Evaluation of Maternal Dietary n-3 LC – PUFA Supplementation as a Primary Strategy to Reduce Offspring Obesity; Lessons from the INFAT Trial and Implications for Future Research. Front. Nutri. 2020 7: 156 5. Nichols, L.M. et al: The Early Origins of Obesity and Insulin Resistance, Timing, programing, and Mechanisms. Int. J Obesity 2016 40: 229-238 6. Sultan, S. et al: Male Obesity Associated Gonadal Dysfunction and the Role of

Bariatric Surgery. Front. Endocrinol. (Lausanne) 2020 vol 11 p 408 7. Catalano, P.: Reassessing strategies to improve pregnancy outcomes in overweight and obese women. 2019 vol 7: pp 2-3 8. Erickson, M.L. et. al: Rationale and Study Design for Lifestyle Intervention in Preparation for Pregnancy (LIPP): A Randomized Controlled Trial. Contemporary Clinical Trials 94(2020) 106024