Pediatric weight expert provides obesity trinity answers

In a first person paper published in the August 27, 2010 issue of Childhood Obesity, Dr. Melinda Sothern, Director of Health Promotion and Professor of Public Health at LSU Health Sciences Center New Orleans, provides three ways to de-program the 1950s obesity trinity underlying the current obesity epidemic in the United States and protect future generations from its health consequences.

"The combination of prenatal tobacco use, infant formula, and frequent pregnancies -- i.e., the obesity trinity -- synergistically created the first generation of nutritionally programmed youth, the baby-boomers," writes Dr. Sothern. "Suburban living, value-priced fast food, cable TV, and computers sealed their fate. Now in their 50s and 60s, this generation has the highest prevalence of obesity in history, triple that of their parents. Of more concern are their obese children, many programmed due to maternal obesity and gestational diabetes."

Dr. Sothern is most concerned about the vulnerability of the grandchildren of baby-boomers.

"These are the preschoolers with significant obesity, the 6󈝸-year-olds with metabolic syndrome and the obese adolescents with hypertension, type 2 diabetes or non-alcoholic fatty liver disease, so resistant to treatment that the only solution may be bariatric surgery," notes Dr. Sothern. "More alarming are the severely obese, insulin-resistant teenage girls who will ultimately provide the optimal fetal environment for the next generation of metabolically programmed newborns."

Dr. Sothern believes that efforts should focus on three opportunities for change-at the beginning of pregnancy, prior to puberty when metabolism may likely be set for life, and in the years leading up to motherhood. She advises that:

• intense nutrition and physical activity behavioral counseling begin at the first obstetrical visit and continue until the child enters preschool
  
• preschoolers be provided opportunities at home, in school, and throughout the community to engage in free play most of their waking hours, offered appropriately portioned, nutrient dense foods in designated areas away from media distractions
  
• high quality weight-management programs with intense behavioral counseling be available to families with already obese youth.