Posts Tagged ‘Childhood obesity’

Parents, remember these numbers: 5210

July 29, 2012

Five-two-one-zero (5210) is a reminder of what our children need each day in order to be healthy. Here is the breakdown:

5    = Five or more servings of fruits and vegetables

2    = No more than two hours of recreational screen time (no screen time under 2 yrs old)

1    = At least one hour of physical activity

0    = Zero servings of sugary drinks (drink water and fat-free or 1% milk instead)

[To remember the numbers I think “five to ten”]

For more information see

Here is a short video to use as a teaching tool for children:

Here is a more detailed video for help in designing a 5210 program in a community:

Do you know a fat person?

July 20, 2010

Call them obese, huge or fat — the stigma won’t go away. And I’m not sure it should.  Obesity is bad for a person’s health, bad for the planet, bad for fellow airline passengers, and even bad for babies born to obese mothers (which, in turn, is bad for the economy; see NYTimes article).  When something causes this many personal and social problems we usually assume it is not a good thing to have or be.

“But,” some say, “we mustn’t blame the victim.  Obesity isn’t a weakness or a fault; it’s genetic. When we stigmatize people, they suffer even more, and may even avoid seeking help.” There is a kernel of truth to this concern, but it distracts us from the main point: obesity can and should be eliminated over time, through more research, and through attacking many known contributing factors (factors such as the  marketing and subsidizing of unhealthy foods).

The most active researchers who advocate against “weight bias” and “weight stigma” (Kelly Brownell and Rebecca Puhl at Yale, for example) also tell us that the obesity epidemic is growing and the health consequences are horrible.  They do not claim the problem is due to a change in genetics.  People can do a lot to prevent and even treat obesity, without altering genes (see many of my posts in this blog).

An anti-obesity program in Singapore that targeted overweight children was discontinued because of concern about stigma, even though the program was effective (reducing the percentage of overweight children from 14% to 9.5% in fourteen years — 1992 – 2006; click here for more information). I don’t know what should have been done in this case; there are no easy answers.

Outright discrimination against people based on appearance is generally wrong, and fat people should be treated sensitively and humanely, no matter what caused their affliction.  (Many equate stigma with discrimination, but I see a difference between the two concepts.)

Whether or not it reduces stigma, television has recently upped its focus on obesity by producing such shows as “Drop Dead Diva,” “Huge,” “Mike and Molly,” and, of course, “The Biggest Loser.”  A new series starts next month, “Too Fat for Fifteen: Fighting Back,” and at least one other obesity-related series is in the works. See this article for a discussion of how obesity is being addressed on TV.

[The photo at the top of this post is from ABC Family’s series “Huge”]

Ending overeating

July 7, 2009

Kessler overeating

A very important new book (The End of Overeating: Taking Control of the Insatiable American Appetite by David Kessler) accurately describes major factors contributing to the obesity epidemic: cleverly formulated manufactured food designed to seduce us into overeating, addictive ingredients (salt, sugar and fat) which act like nicotine in cigarettes to keep us coming back for more, a profit driven system of marketing and government subsidies which works against our best interests, and the loss of boundaries limiting when and how much we eat. It is indeed frightening to think that a 2-year-old’s appetite “knows” to shut down when enough calories have been consumed, but by the time that child is four (in our culture) there is often a loss of that self-control mechanism.

Kessler’s solutions include re-training our minds to devalue unhealthy processed foods loaded with the Big Three (salt, sugar, fat); reforming our policies and practices which encourage this vicious cycle; and doing much more to educate people as to what they are consuming (such as requiring nutritional information in restaurants).

I agree with all this, but take issue with some of the concepts Kessler promotes. My main complaint is he oversimplifies the issue of food containing salt, sugar and fat by using an addiction model. Too much of these ingredients is indeed unhealthy, but a simple addiction model will not work.

Another problem is his use of the term “real food” (see NPR interview) which is a vague concept, at best. Many seemingly real foods contain salt, sugar and fat (either naturally, or because of the way they are produced), and not all “manufactured” foods are bad (e.g., some fish farmed in a sustainable way are better for us than some “wild-caught” fish). I can buy a chicken that has been doctored with added salt and fat, or I can buy one (usually smaller and more expensive) which has been grown almost organically. To the average consumer, both seem “real.” Also, I can buy “sea salt” and “unrefined real sugar” and think I am getting something healthier than standard table salt and corn syrup, but the bottom line (sodium and calories) may be exactly the same.

Finally, he promotes a black vs. white dichotomy between a disease-like state we cannot directly control (“conditioned hypereating”) and old fashioned willpower, telling us “it is not our fault” that we overeat. Fault, per se, may not be the issue; rather, we should learn ways to increase our resistance to external cues and marketing, educate ourselves about nutrition and portion size, and practice coping skills to enhance self-regulation. I have written about this at length elsewhere.

It takes a village to impact obesity epidemic

February 27, 2009


The results of the latest (and so far best) research on diets are in:  most people won’t stick to them. The New England Journal of Medicine (2/26/09) published the study which has now been widely reported in the news.  Over 800 men and women were followed on various diets for 2 years; the average weight loss was modest (about 9 pounds) and those who attended counseling sessions (an indirect measure of motivation) lost the most.  No one adhered to the diet closely, despite frequent monitoring and much support.  The conclusion is that eating less (calories) is what matters, not the specific content of the diet (in terms of low fat, high protein, low carbohydrate, etc).

These findings are not surprising, but what is most interesting is the accompanying editorial which describes a study in France where entire villages were used to counteract the obesity epidemic.  Here is the summary from the NEJM editorial:

A community-based effort to prevent overweight in schoolchildren began in two small towns in France in 2000. Everyone from the mayor to shop owners, schoolteachers, doctors, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and various branches of town government joined in an effort to encourage children to eat better and move around more. The towns built sporting facilities and playgrounds, mapped out walking itineraries, and hired sports instructors. Families were offered cooking workshops, and families at risk were offered individual counseling.

Though this was not a formal randomized trial, the results were remarkable. By 2005 the prevalence of overweight in children had fallen to 8.8%, whereas it had risen to 17.8% in the neighboring comparison towns, in line with the national trend.11 This total-community approach is now being extended to 200 towns in Europe, under the name EPODE (Ensemble, prévenons l’obésité des enfants [Together, let’s prevent obesity in children]).12

Like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action. Evidence for the efficacy of the EPODE12 approach is only tentative,11 and what works for small towns in France may not work for Mexico City or rural Louisiana. However, the apparent success of such community interventions suggests that we may need a new approach to preventing and to treating obesity and that it must be a total-environment approach that involves and activates entire neighborhoods and communities. It is an approach that deserves serious investigation, because the only effective alternative that we have at present for halting the obesity epidemic is large-scale gastric surgery.

The NEJM research article is here:

The editorial is here:

More on “Who needs exercise?”

June 8, 2008

After writing my last post on exercise, I came across this article, which has some very important implications for young people. Again, it shows how complex the question “who needs exercise?” is and how important it is to specify “for whom?” and “exactly what do you mean by exercise?”

Preventing Childhood Obesity: Vigorous Physical Activity—YES, Restricting Calories—NO*

by Bernard Gutin, PhD

My colleagues and I at the Medical College of Georgia investigated the relationship among diet, physical activity and body composition in 661 African American and white adolescents ages 14 to 18.1 We hypothesized that fatter youths would have higher levels of energy intake and lower levels of both moderate and vigorous physical activity.

To our surprise, we found that higher levels of percent body fat were associated with lower levels of energy intake and lower levels of vigorous (but not moderate) physical activity. Youths who did the most vigorous physical activity and consumed the most calories were the leanest. Those who did no vigorous physical activity had a percent body fat of 28.6 and consumed 1744 calories a day, while those who did at least 1 hour of vigorous physical activity each day had a percent body fat of 19.4 and consumed 2203 calories a day. See Relationship of Vigorous Physical Activity, Caloric Intake and Percent Body Fat.

Although moderate physical activity, such as brisk walking, burns calories, we found that lower percent body fat was linked to greater amounts of vigorous, but not to moderate, physical activity. Vigorous activity includes sports, games and dance activities such as running, swimming, soccer and aerobic dancing. These activities impart a significant “mechanical load,” which means they work your body’s muscles and bones. This type of activity stimulates stem cells to differentiate into bone and muscle rather than fat.2 A healthy body composition in youths requires both a large amount of vigorous physical activity and ingestion of sufficient calories and nutrients to support this tissue-building process.

This idea is further supported by experimental studies that looked at the effect of mostly vigorous physical activity, without restriction of calories, on body composition. Research on youths with varying levels of fatness and fitness found moderate physical activity to be ineffective in preventing obesity, so we conducted studies using 300 to 400 minutes a week of mostly vigorous physical activity and found positive effects on body composition, including reduction of visceral adipose tissue (the fat around abdominal organs). Within the intervention groups, those youths who participated regularly and maintained the highest heart rates during the physical activity sessions showed the greatest decreases in percent body fat and the greatest increases in bone density.3,4

Youths who are obese and unfit can benefit from exercise of relatively low intensity and duration. For example, in obese youths, studies using 155 to 180 minutes per week of physical activity at moderate to high intensity produced favorable reductions of percent body fat and visceral adipose tissue and increases in bone density and aerobic fitness.5 As children improve in fitness, they should be encouraged to progress to higher amounts and intensities of physical activity.

An expert consensus panel has suggested that youths engage in at least 420 minutes a week (about 60 minutes a day) of moderate to vigorous physical activity.6 The research reviewed here suggests that greater emphasis should be given to vigorous rather than moderate physical activity.

Taken together, these findings suggest that a paradigm shift is needed to improve the effectiveness of pediatric obesity prevention interventions. It is well known that eating a nutritious diet supports the development of muscles and bone and other aspects of proper growth and development, as well as good health. However, limiting energy intake runs counter to the biologic demands of growth, which require adequate calories and nutrients. When youths engage in adequate amounts of vigorous physical activity, calories and nutrients are preferentially directed to the production of lean tissue (muscle and bone) rather than fat. So, insuring a high quality diet and plenty of exercise, rather than calorie restriction, is the model to pursue to prevent obesity and improve body composition.


* A longer version of this editorial will soon appear as a Perspective article in the journal Obesity.

Bernard (Bob) Gutin, PhD, is Adjunct Professor of Nutrition at University of North Carolina in Chapel Hill and Professor Emeritus at Teachers College of Columbia University and the Medical College of Georgia.