Preventive Medicine Column
Dr. David L. Katz
As one of the judges for US News & World Report’s “best diet” report for the past several years, my most consistent and adamant concern has been: what about family? Dieting is an infamously go-it-alone endeavor. People eat with their families; but they “diet” without them.
This is a questionable practice for the dieter. We all know, and probably believe the adage that “in unity, there is strength.” Yet, with the particular brand of blind gullibility weight-loss wishes seem to induce, we routinely abandon that strength in an effort to lose 30 lbs in six weeks. The result tends to be success in the short-term, and then long-term weight regain with interest.
We should expect just this. In a modern environment that conspires mightily against healthful eating, routine exercise, and weight control, achieving any of these is challenging at best. Doing so while practicing Diet X for self, and Diet Y for family is nearly impossible. It’s also inconvenient, unpleasant, and isolating.
So, even just for the selfish sake of the dieter trying to lose weight, it makes sense to adopt an approach that derives the strength of unity at the level of household. When we share activities and commitments, they become part of our routine, they take their place in family values, become elements of culture- the currents of which carry us along.
But as a parent, I don’t think the benefit for self is the strongest argument for the salience of family. The strongest argument is not about what others can do for us, but what we are obligated to do for them. Parents are obligated to defend the well being of our children, and going on any kind of diet that leaves them behind is- forgive the bluntness- an abdication of that sacred responsibility. All the more so in an age of epidemic childhood obesity, and ever mounting evidence of its all-too-often dire consequences.
The case for family-centric approaches to health and weight control was highlighted yet again by a study just published in the New England Journal of Medicine, and attracting such prominent media attention as front-page placement in the New York Times.
As with all research, the details matter, but in this case, the fundamentals are simple, refreshingly transparent, and largely immune to any devilry. The researchers simply tracked a nationally representative cohort of roughly 8,000 kindergartners for roughly nine years, and monitored the change over time in body-mass index. What they found was that obesity and overweight developed predominantly by age 5, or not at all. Children subject to obesity or overweight by kindergarten were much more likely to be overweight or obese as tweens and teens. The development of overweight and obesity dropped off steeply over time, meaning that those kids who dodged this bullet for the first five or six years of life generally did so throughout childhood.
This has profound implications. First, there has long been evidence that obesity at or around puberty is a potent predictor of adult, and consequently lifelong obesity. Connecting the dots here gives us this: avoiding obesity in early childhood markedly increases the likelihood of avoiding it at puberty which in turn increases the likelihood of avoiding it forever after. The converse of this causal pathway is, of course, the corresponding bad news: get it wrong early, and a lifelong struggle with weight is apt to ensue.
The other implication that jumps out at me has to do with personal responsibility, one of the more polarizing topics in the weight control domain. However views may differ about responsibility for better use of feet and forks, we can all agree that we should not be pinning it on 3-year-olds. This study suggests that an overweight 3-year-old is much more likely to be an overweight 13-year-old, who in turn is much more likely to wind up an obese or overweight 33-year-old. An admonishing finger wagged at that 33-year-old ignores the fact that they inherited a disadvantage from a time before their responsibility for much of anything had yet begun.
And yet, as a society we sanction a multi-billion dollar weight loss industry for adults. We line up, sign up, go on and fall off- all the while leaving our kids out of it. We just need to look around to see how well this is working out for adults. But more importantly, every time we neglect a family-based approach to health and weight control, we increase the likelihood that our children will grow up to need those weight loss services even more desperately than we do.
The best way to lose weight is by finding health, in a manner we share with our children. The future of childhood obesity is not about karma, it’s about the culture kids encounter on their way to kindergarten- and we, the parents, are responsible for that.
Dr. David L. Katz