What will it take to reverse childhood obesity? More than a single solution

For decades, pediatricians have tried to lower childhood obesity in the United States. What practical steps would help preschoolers reduce weight, prevent illness and improve the likelihood that they enjoy longer, healthier lives? Shari Barkin wanted to find out.

Barkin, a professor at Vanderbilt University, gathered a large sample size of 610 predominantly Latino children, each between ages 3 and 5, who were paired with a parent. More than half came from low-income households in Nashville recreation centers.

Barkin rolled out weekly skills-building sessions focused on families. She then followed up with coaching phone calls, along with lessons to ensure these new skills were sustainable and the children and families were ready to use them in time for kindergarten. Retention remained at a high 90 percent during the 36-month program.

Yet by the study’s measure for success, it was a dud. Published recently in the journal JAMA Pediatrics, her study showed no significant change in the body-mass index, which hovered at 17.8 on average.

“You can’t focus on one child at a time when you look at complex problems like obesity, but you have to look at communities over time,” Barkin told the PBS NewsHour.

This study, funded by the National Institutes of Health, highlights how complicated childhood obesity continues to be, as the United States scrambles to address one of the greatest risk factors for chronic illness, including diabetes, cancer and heart disease, later in life.

How has childhood obesity changed in the United States?

In four decades, overweight and obesity rates among children and adults has tripled nationwide. Between 1999 and 2016, the number of U.S. children who were overweight or obese continued to increase, despite earlier federal data from 2011 and 2012 suggested a decline among preschool boys, researchers from Duke University said in a February study released in the journal Pediatrics. In 2016, a third of U.S. children between ages 2 and 19 were overweight — up from 29 percent in 1999 — and one out of five children were obese, the study said.

This latest study with preschoolers from Tennessee underscores the complexities of childhood obesity, said Asheley Cockrell Skinner, a health services researcher at the Duke University School of Medicine and the lead author of the February study. She did not play any role with the Barkin study.

Despite years, money and effort spent on preventing childhood obesity, such as the “Let’s Move” campaign under former first lady Michelle Obama and modified nutrition standards for school lunch programs, Skinner said U.S. policymakers, public health officials, educators, parents and the public “aren’t seeing any broad improvement in obesity.”

“In order to truly bend the curve on obesity, we are going to need broad environmental changes,” Skinner said. “If we make great efforts in one area of a child’s life, such as school lunch, it doesn’t override all the other areas of their life.”

Why is childhood obesity a public health problem today?

Obesity touches nearly every bodily organ and function, said Christopher Bolling, a pediatrician who also chairs the American Academy of Pediatrics section on obesity.

When federal data in 2012 suggested that preschoolers were showing signs of lowered childhood obesity rates, Bolling said he and fellow pediatricians were left scratching their heads. To each other, they shared that that wasn’t what they were seeing in practice.

This issue is too important to brush off, he said, especially as “each succeeding generation has more of a problem.”

In his clinic in Crestview Hills, Kentucky, less than 10 miles from where he grew up, Bolling said he sees 5-year-olds who are bigger than 5-year-olds he treated a decade earlier. But he also said many of the children he treats have no access to fresh healthy fruits and vegetables or parks. Many children in Kentucky, nearby West Virginia and across rural parts of the United States, live closer to a fast-food restaurant than a grocery store. The path of least resistance is the one frequently taken, he said.

“There’s been a lot of structural things that got us into this predicament,” Bolling said.

In Skinner’s study of National Health and Nutrition Examination Survey from the Centers for Disease Control and Prevention, she found that while nearly every demographic group of preschoolers reported increased obesity rates, African-American and Hispanic children reported significantly higher rates, signaling concern over continued disparities in chronic disease and health outcomes within these groups.

While public health officials and pediatricians struggle with how to chip away at persistent childhood obesity, research offers a firm understanding of how the nation got to this point, said Jack Yanovski, the chief investigator for growth and obesity at the National Center for Child Growth and Human Development.

Thanks to mechanization and innovation, people can live more sedentary lifestyles rather than hustle from one labor-heavy task to the next. At the same time, food has become cheaper, and high-calorie fast-food is more widely available. But Yanovski said the resulting obesity is a problem from which the United States hasn’t yet innovated its way out.

What is at stake if childhood obesity continues to rise?

Globally, obesity rates are on the rise, but nowhere compares to the United States, where roughly 40 percent of adults are obese. By 2030, half of the U.S. adults are projected to be obese. That means more people will be sick, lowering quality of life and raising health care costs. But if researchers, policymakers and the public work together to confront childhood obesity with multi-dimensional sets of solutions now, Yanovski said there is reason to hope for a better future.

“Obesity is a complex problem that isn’t going to have one solution,” he said. “We’re all going to have to work together to improve the health of our nation.”

He said researchers need to think more creatively when launching pilot programs and pay greater attention to the results. He also suggested probing more deeply into motivation research and how it can be applied to obesity prevention efforts.

In the Barkin study, Skinner cautioned against viewing it as a failure because the study did not produce significant changes in BMI. Instead, she said children at risk of developing obesity who learn different behavior patterns — engaging in more active play or eating healthier — could produce results long after the research ends.

“It’s possible that making changes in behaviors — which were seen in this study — lead to long-term health improvements.”

And in an Aug. 7 editorial that appeared in the journal JAMA, pediatricians Jody Zylke and Howard Bauchner wrote that the United States has joined other nations in lowering smoking rates, in transforming HIV/AIDS into a chronic disease rather than a death sentence and in halving cardiovascular disease rates in 20 years. But when confronted with obesity, the authors leveled criticism, saying U.S. doctors “can more easily prescribe a drug than influence eating and exercise habits.”

“Just as the United States created national campaigns to reduce smoking and treat HIV/AIDS, the same financial and intellectual resources should be committed to the prevention of childhood obesity,” they wrote. “Overall population health in the United States is unlikely to improve and the cost of health care is likely to continue to increase unless the prevalence of obesity and severe obesity in children, adolescents, and adults is reduced.”