The Sooner the Better

Mailman School Symposium Makes the Case for Preventing Obesity at the Earliest Opportunity

April 28, 2015

The road to obesity begins long before young Johnny bites into his first Big Mac. Public health experts at A Smart Start, a recent symposium on childhood obesity hosted by Columbia University’s Mailman School, presented the latest science on factors from pregnancy and breastfeeding to preschool that can steer a child toward a healthy weight into adulthood.

Age 5 may already be too late. Andrew Rundle, associate professor of Epidemiology and co-director of the School’s Obesity Prevention Initiative, discussed research showing that children who were overweight or obese at that age were more likely to be overweight or obese by age 50. By middle age, an obese child could gain 50 extra pounds or more compared to a normal weight peer—excess baggage extremely difficult to shed without surgical intervention.

Incredibly, obesity may begin even before birth, based on how much the child’s mother gains during pregnancy. Rundle’s research shows that children born to women who gained more than the Institute of Medicine (IOM) recommended amount—no fewer than half of women in the United States—were three times more likely to be obese than children whose mothers gained a healthy amount of weight. 

Why so many oversized pregnancies? Cynthia Gyamfi-Bannerman, associate professor of Obstetrics and Gynecology at Columbia University Medical Center, said reasons range from morning sickness, which is treated by eating bland carbohydrates bread to calm the stomach, to social pressure that tells women they look too small. “The environment is telling her that she needs to eat more and gain more and appear to be more pregnant,” Gyamfi-Bannerman said.

Breast Is Best

Once the child is born, the consensus in the literature is that breastfeeding is one of the best things a mother can do for her child’s health, although this has been questioned by recent studies. But few mothers are able to exclusively breastfeed for anywhere close to the required length of time due, at least in part due to the remarkably short and unpaid maternity leave policy in the United States as well as a lack of training among daycare center staff about how to properly handle breast milk that has been pumped. “As a society, we are not set up to support women in their efforts to breastfeed their babies for the suggested length of time,” said Cynthia Colen, a sociologist at Ohio State University.

Gretchen Van Wye, adjunct professor at the Mailman School and assistant commissioner at the New York City Department of Health and Mental Hygiene, underlined Colon’s point, saying we need to prioritize creating an environment “where the social norm is that anyone can breastfeed anywhere” with structures in place to do so privately.

Helping mothers to be less reliant on the bottle could pay real dividends. According to Sally Findley, professor of Population and Family Health, breastfeeding forges a bond between mother and child around feeding habits. “Breastfeeding appears to promote early learning of self-regulation,” said Findley. The mother too learns to pick up on cues from the child that gives her a leg up when it’s time to move on to solid foods. “She knows when the child has had enough.”

On the other extreme, some mothers who bottle-feed their children mix-in sweeteners like cocoa and cereal—a practice common in moms who thought their overweight child was normal weight or underweight.  And mothers who “topped up” were nearly five times more likely to give their child juice or a sweetened beverage before age six months, a study by Findley found.

Serving Up Food Lessons

When a child is old enough for school, new opportunities present themselves to stop obesity in its tracks.

Kiyah Duffey, a professor of nutrition at the University of North Carolina and a parenting blogger, created a preschool nutrition plan that banned sippy cups and had youngsters participate in taste tests to take away their fear of food.

Nutrition needs to come at the right price too. According to Christine Johnson Curtis, assistant commissioner at the City Department of Health, “We can’t just give people nutrition education, but not change the accessibility and affordability of fruits and vegetables.” A New York City program called Farm to Preschool takes a page from the model of Community Supported Agriculture: parents, child care center staff,  and other community members can purchase a $12-14 weekly box of fresh fruits and vegetables sold right at child care centers alongside nutrition workshops and cooking demonstrations.   

One challenge: many children, particularly in low-income communities, are not using formal childcare providers. How do we get reach those informal childcare settings and providers (like neighbors or family members) who might be taking care of these children? asked Tina Kauh, a program officer at the Robert Wood Johnson Foundation. Other open questions include finding ways to encourage physical activity in 2 to 5 year-olds, and tackling obesity and hunger at the same time.

Childhood obesity is a “complex problem and requires many different solutions, and many of them that we don’t know about yet,” said Claire Wang, associate professor of Health Policy and Management and co-director of the Obesity Prevention Initiative. “We’re not just building an evidence base, we’re building a movement.”

Watch video of the symposium: