Perspective of Infancy Obesity Prevention

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Perspective of Infancy Obesity Prevention

• Yuezhen Lin MD, PL-2
• Dept. of Pediatrics
• Texas Tech Univ. HSC at El Paso

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Abstract

• The incidence of obesity has been increasing.
• No effective treatment available yet.
• Early prevention would be our goal.
• Current studies/perspective on infancy obesity
  prevention were reviewed.

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Obesity is an Increasing Concern Globally

• During the past 20 years, the amount of research
  activity, knowledge, and interest in obesity
  among the medical community as well as the level
  of public attention to the issue of weight, diet,
  and exercise have been dramatically increasing.

• 1200 diet books listed on Amazon.com
• 88 published since 1997

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Obesity in the U.S. is Getting Worse

• Obesity among adults has risen significantly in
  the United States
  
• The obesity rate has doubled among 6- to
  11-year-olds
  
• The obesity rate has triple among 12- to
  17-year-olds
  

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Kids are Getting Fatter
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The Etiology of Obesity

• Genetic Factors
• Environmental Factors
• Behavioral Factors

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Leptin Obesity
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Calories Stored Calories Eaten Calories Used
Eating More and Exercising Less
OVERWEIGHT
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THEN
NOW
Eating Out

• Home-cooked meals were common
• Few fast food restaurants
• No supersizing

• We spend HALF of all food dollars eating out side
  the home
  
• We eat TWICE AS MUCH in restaurants as at home
• We eat more emptycarbohydrates

French Fries

• 2.4 ounces
• 210 calories

• 5.6 ounces
• 530 calories (320 extra calories)
• McDonalds Extra Value Meal Large Fries and Large
  Coke
  
• 835 calories.

Snacks

• 20-oz. soda
• 3½" cookie
• 11 cups of popcorn
• 1,155 calories (745 extra)

• 6.5-oz. soda
• 1½" cookie
• 5 cups of popcorn
• 410 calories

Even Salads Are Bigger!

• 3½ cups
• 790 calories

• 1½ cups
• 390 calories

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THEN and NOW Exercise
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Childhood Obesity Increases Health Risks

• High Cholesterol and High Blood Pressure
• Insulin Resist.- Type 2 Diabetes (45 new diagT2
  vs T1)
  
• Bone and Joint Disorders
• Asthma
• Sleep Apnea Gall Bladder Disease (tripled in
  last 20 yrs)
  
• Low exercise tolerance
• Increased viral infections
• Premature physical maturation and Polycystic
  Ovaries
  
• Psychological and social problems

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Obesity Causes as Much Suffering as Cancer
Reported Problems with Quality of Life
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Prevent Treat

• Developing effective strategies to prevent and
  treat pediatric obesity is one of the most
  compelling medical challenges of the 21st
  century
• No effective treatments yet
• Mainly focus on prevention
• How and when to intervene for obesity in
  childhood?
  

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Risk Factors

• Parental obesity
• Maternal gestational diabetes
• High birth weight
• Low birth weight
• Formula feeding rather breastfeeding
• Early introduction of solid foods
• Overfeeding
• Television viewing ( 8hrs/week) at age 3 years
• Catch-up growth
• Weight gain in first year
• Short sleep duration at age 3 years

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Potential Risk Factors

• Breast feeding in woman who smoked during
  pregnancy
  
• Programming the regulation of appetite

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When to Intervene
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Critical Periods for the Development of Obesity

• Identifying critical periods is the first step
• Prevention should focus on these periods
• Critical periods include
• Known
• Prenatal Period
• Adiposity Rebound (ages 3-6 years)
• Adolescence
• ???
• Neonatal
• Early Infancy

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Current Studies

• Size at birth, early postnatal catch-up growth
  and excess childhood weight gain
  
• Associated with an increased risk of adult
  cardiovascular disease, type 2 diabetes and
  obesity.
  
• Rapid growth during the first 4 months of life
• Associated with being overweight at age 7 year
• Even rapid weight gain in the first week of life
  
  
• Associated with being overweight at 30s

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Infant Growth/size Matters

• Both infant size and infant growth are related to
  an increased risk of obesity in later life
  
• However, the precise patterns of growth leading
  to obesity are unclear

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Hypothesis

• Infancy might correspond to a critical period for
  the development of biological mechanisms that
  regulate obesity.
  
• Animal model studies show that permanent changes
  in brain structure and enzyme function that are
  associated with adult obesity in animals with
  rapid neonatal weight gain

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Early Prevention is Our Goal

• Rising rates of obesity and overweight in
  children, even at pre-school ages, have shifted
  efforts towards the identification of very early
  factors that predict risk of subsequent obesity,
  which may allow early targeted interventions.
• Early identification of childhood obesity risk
  will be aided by identification of maternal and
  fetal genes that regulate fetal nutrition and
  growth, and postnatal genes that regulate
  appetite, energy expenditure and the partitioning
  of energy intake into fat or lean tissue growth.
  

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Prevention in Infancy

• Infancy has not been targeted yet
• No effective and safe intervention strategies in
  infancy has been demonstrated for the prevention
  of later obesity
  

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The Final Point

• Infancy might be the potential target for obesity
  prevention. Further evidence is needed, and any
  interventions need to rigorously be tested the
  benefits and risks.
• Before we revise our current recommendations, it
  will be prudent to balance the short- and
  long-term interests of the child by endeavoring
  to
• (1) optimize maternal nutrition and health, to
  avoid low birth weight
  
• (2) breast-feed ideally
• (3) consider birth weight, gestation and future
  "nutritional environment" when making decisions
  about infant feeding
  
• (4) use appropriate growth charts
• (5) avoid excessive postnatal weight gain
• (6) think about the whole life span
• (7) extrapolate from animal studies cautiously

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References

• Ong KK. Size at birth, postnatal growth and risk
  of obesity. Horm Res. 200665 Suppl 365-9. Epub
  2006 Apr
  
• Johnson DB, Gerstein DE, Evans AE and
  Woodward-Lopez G. Preventing obesity a life
  cycle perspective. J Am Diet Assoc. 2006
  Jan106(1)97-102
• Ong KK and Loos RJ. Rapid infancy weight gain and
  subsequent obesity systematic reviews and
  hopeful suggestions. Acta Paediatr. 2006
  Aug95(8)904-8
• Weaver LT. Rapid growth in infancy balancing the
  interests of the child. J Pediatr Gastroenterol
  Nutr. 2006 Oct43(4)428-32
  

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References

• Baird J, Fisher D, Lucas P, Kleiinen J, Roberts
  H, Law C. Being big or growing fast systematic
  review of size and growth in infancy and later
  obesity. BMJ. 2005 Oct 22331(7522)929
• Dennison BA, Edmunds LS, Stratton HH, Pruzek RM.
  Rapid infant weight gain predicts childhood
  overweight. Obesity (Silver Spring). 2006
  Mar14(3)491-9
• Nicolas Stettler, Virginia A. Stallings, Andrea
  B. Troxel, Jing Zhao, Rita Schinnar, Steven E.
  Nelson, Ekhard E. Ziegler, Brian L. Strom. Weight
  Gain in the First Week of Life and Overweight in
  Adulthood - A Cohort Study of European American
  Subjects Fed Infant Formula. Circulation.
  20051111897-1903.
• http//www.cdc.gov