The prevalence of obesity has doubled in 73 countries around the world and steadily increased in others since 1980. In children the prevalence of obesity rose from 4% in 1980 to 8% in 2015. Childhood obesity is associated with an increased risk of multiple metabolic disorders, including diabetes and cardiovascular disease, as well as premature death, in adulthood. Identifying modifiable risk factors for the prevention of childhood obesity has become a public health priority. While the role of genetic underpinnings of obesity is widely recognized, the rapid increase in obesity in recent years is more likely attributable to lifestyle changes and the obesogenic environment. A significant number of factors, including environmental, biological, economical, psychological and social, contribute to the development of obesity and would be likely targets of intervention.

A recent study showed that despite the rise in obesity over the last decades, weight loss attempts have decreased in overweight adolescents from 2009-2014 compared to 1988-1994.  The authors suggested that with more than one-third of adolescents having overweight or obesity, it is cognitively difficult to view overweight as abnormal. Presumably, adolescents with overweight or obesity seem satisfied with their weight and thus, are not motivated to engage in weight loss efforts.

The magnitude of the problem and the consequences of obesity on quality of life and heath status of children and their families underscore the urgent need for the development of programs that can produce safe weight loss and effective weight management. Schools should be a focal point for obesity prevention, since nutrition education can result in long-term behaviour change. A Cochrane Review suggested that a school curriculum incorporating lessons about healthy eating, physical activity, and positive body image was one of the most promising strategies, although other studies are inconclusive. Lifestyle factors contributing to childhood obesity include lack of physical activity, sedentary activities, and consumption of a highly calorie diet.  Sustained calorie restriction and exercise is necessary to achieve and maintain weight loss, but difficult to sustain without ongoing support. Support occurs most readily in a social environment that facilitates healthy eating and physical activity.

It is well recognized that interventions for children and adolescents have better outcomes when all family members are involved. A recent study showed that offspring of women adhering to an overall healthy lifestyle had a substantially lower risk of obesity than children of mothers who did not practice these lifestyle choices. These findings highlight the potential benefits of implementing family-based interventions in schools and communities. When struggling against barriers such as an obesogenic environment that includes increased screen time, decreased physical activity and increases in highly caloric food, maintaining a focus on modifiable lifestyle changes within families would be a critical step in for facilitating positive behaviour changes that will have a long term impact on weight management.

What we would like to hear from you in this discussion:

1. What strategy would you implement to prevent obesity and diabetes in children?

2. What prevents children from learning good eating behaviours?

3. What do you think the role is for nutrition education?

Website recommended for more information

http://www.iom.edu/Reports/2013/Nutrition-Education-in-the-K-12-Curriculum.aspx

For the IOM report see http://www.iom.edu/Reports/2012/Accelerating-Progress-in-Obesity-Prevention.aspx

For the Cochrane Review see Cochrane Database Syst Rev 2011;12: CD001871.

For more on the Children’s Food Trust see http://www.childrensfoodtrust.org.uk

For more on IN FORM see http://www.bmelv.de/SharedDocs/Standardartikel/EN/Food/IN%20FORM.html

For more on the curriculum review see http://nzcurriculum.tki.org.nz/content/download/456/3630/fi le/heeposition-statement.doc

For more on the School Food Plan see www.schoolfoodplan.com.

For the IDF KiDS Educational Guide on Nutrition and Diabetes in Schools see here.

Reference reading:

1. GBD 2015 Obesity Collaborators. 2017. Health Effects of Overweight and Obesity in 195 Countries over 25 Years.New Eng J of Med.; 6;377(1):13-27.
2. Dhana K, Haines J, Liu G, Zhang C, Wang X, Field AE, Chavarro JE, Sun Q. 2018. Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United States. BMJ. 4; 362:k2486. doi: 10.1136/bmj.k2486.
3. Hawkins DR, Kazmierski K, Hansen A, Reid C, Brown A, Opoku ST, Zhang J. 2018. Trends in Weight Loss Efforts Among US Adolescents With Overweight and Obesity. JAMA Pediatr. doi: 10.1001/jamapediatrics.2018.1012.
4. Mayor S. 2013. Nutrition education: the way to reduce childhood obesity? Lancet Diabetes Endocrinol; 1(1):14. doi: 10.1016/S2213-8587(13)70099-8. 

Information about the discussion leader

Dr. Violeta Moizé, R.D., MS, PhD. received her PhD in Food and Nutrition from the Barcelona University in 2017 and a master’s degree in Food Design and Innovation (2011). She received a Bachelor of Science and Technology of Food in 2008 and has been certified as a Registered Dietitian since 1996. Recently, she was awarded a Marie Curie Grant to conduct independent clinical research during a 3-year research fellowship at the New York Obesity and Nutrition Research Center of Columbia University. Since 2000 she has worked as a staff nutritionist in the Obesity and Diabetes Unit of the Hospital Clínic of Barcelona, where her research and clinical duties are focused on Bariatric Surgery, Diabetes and Dyslipidemia. In her role as a healthy lifestyle educator, she emphasizes strategies for behavior change using a comprehensive and motivational approach. In addition, Dr. Moize has served as advisor to commercial companies for development of weight loss programs, is a frequent national and international speaker on obesity, eating behavior and nutrition related topics and has authored numerous book chapters and scientific papers on obesity-related topics.