Childhood Circumstances Offer Clues to Adult Obesity

Gaining insights from the patient’s childhood environment may prove meaningful in developing more effective weight management strategies in adults.

With Patricia East, PhD, and Carolyn Apovian, MD

Pinpointing factors in early childhood and adolescence that lead to a higher likelihood of obesity in adulthood may finally lead to successful interventions, and a chance to stem this epidemic,1 based findings reported in Childhood Obesity.

A team of researchers has identified specific home and family characteristics, along with certain weight gain patterns in children that offer a clearer understanding of the development of obesity later in life.1

Factors in childhood home setting influence likelihood of obesity as an adult.Key characteristics influencing childhood weight can inform more effective obesity strategies in adults.

Home Setting, Family Dynamics Offers Clarity Regarding Weight Gain

Beyond obvious factors such as weight and weight gain alone, influences such as early confinement in playpens, fathers' absence, maternal depression, and even an untidy home all pointed to a higher body mass index (BMI) at age 21 years,1 said senior study author, Patricia East, PhD, a developmental psychologist and research professor of pediatrics at the University of California in San Diego.

Among the most salient findings, Dr. East told EndocrineWeb, "The home and family characteristics identified so early on had such a significant effect [on later BMI]. For instance, if kids didn't have access to a playground, if parents, particularly fathers, weren’t there to help them stay active,'' that translated to a higher BMI as adults.” And that lack of access encompassed factors such as frequent confinement in a playpen, she says.

Having a higher BMI at age 21 was linked to father absence, family stress, maternal depression, an unclean home, confinement and low provision for active stimulation. Accelerated BMI increase was related to lower learning stimulation in the home at 1 year and less parental warmth and acceptance at children at age 10.1

The researchers were able to quantify that ''bigger children got bigger faster." In other words, ''those children who were overweight at 5 years old got gained more weight over time." The participants who were obese at age 21 years, ''had been gaining 5 BMI units every 5 years. A normal weight increase is only 2 BMI units every 5 years for a normal, slow and steady weight gain," said Dr. East.

Following Children for 21 Years Uncovers Key Obesity-Inducing Influencers

The children were recruited from the Santiago Longitudinal Study, which included 1790 infants in a cohort study of nutrition and growth. The infants were identified from community clinics serving low-to-middle income families, beginning in 1991 through 1996.

Those eligible for the study had to be healthy, singletons, born at term and weighing at least three kg. The infants were from parents of mixed European, Spanish and American Indian descent.

Researchers had information not only on BMI over time but also had data on family stress, the make-up of family units, maternal depression, frequent child confinement (in playpens), cleanliness of the home, access to stimulating activities, parental warmth and acceptance as well as tendencies to be punitive.

Higher BMI among the cohort at age 21 years was significantly linked to a greater linear change in BMI (ris= 0.61, P < 0.001) and a greater linear change was strongly correlated to higher growth acceleration (irsq = 00.84, P < 0.001). However, BMI at 21 was not related to greater growth acceleration.1

The BMI and rate of increasing body weight starting as early as five years “are important for predicting weight status in young adulthood," the authors reported. "You can't gain weight fast [at age 5] and be slim at 21," Dr. East said. Another key factor in weight at adulthood was confinement for more than a half hour a day, which proved hazardous to weight status, Dr. East said.

The researchers also uncovered a favorable factor to inform treatment. "At any point in the timeline, you can start implementing preventive avenues to try to reduce their speed of growth," she said. And while the study was done in Chile, Dr. East believed the findings were just as applicable to individuals in the United States; the childhood obesity issues are similar across continents.

Root of Obesity Stems from Common Actions in Home Environment

The study findings make good sense, said Caroline Apovian, MD, FACN, professor of medicine and pediatrics at Boston University School of Medicine and director of the Center for Nutrition and Weight Management at Boston Medical Center in Massachusetts upon reviewing the study for EndocrineWeb.

Most of the findings are logical at first glance, she said. "If you keep a baby in a playpen or Pack n’Play, she isn’t moving or running around," Dr. Apovian said. While convenient for busy parents, there is clearly a significant downside to the use of playpens. They might not be the best idea given the potential for lasting adverse implications for weight status in children, she said.

The other factors demonstrating a strong association with adult obesity—maternal depression, family stress, and absent fathers—also provide good insights, Dr. Apovian told EndocrineWeb. Even the link with an untidy house resonated. The researchers did not delve into why that was associated, but Dr. Apovian speculated that mothers with very tidy houses might have more ''cognitive restraint."

"There is strong evidence now on cognitive restraint,"2,3 she said. "When someone shows the ability to demonstrate personal restraint, she is less likely to gain weight." As such, those same mothers who demonstrate cognitive restraint will likely have developed greater self-awareness in placing value on the importance of cleaning house—and the physical actions involved—That modeling might be passed on.

Share Implications of Childhood Environment to Patients and Parents

Both Dr. East and Dr. Apovian agreed that the findings that could be applicable in clinical practice, both in talking to their adult patients and in speaking with their patients who are parents.

"For adults," Dr. Apovian said, "it would be instructive for the physician to relay this kind of information to adult patients." It could help overweight and obese adults to understand what might have led to this struggle with their weight, and that their circumstance is not about a lack of will power but rather has a basis in factors arising in their childhood.

By understanding that circumstances that shaped them during their childhood may have set-up a scenario in which obesity was the consequence, she said, adult patients might come to ''that aha moment in providing a reason why they are having trouble [with their weight] now," she said.

For parents of young children, the findings might suggest they do things differently, such as minimize the use of a playpen to occasional times of acute need rather than a daily plan. Taking time to go to a park or playground where they are able to run around or finding other spaces where children can move rather than sit is critical, according to Dr. Apovian.

For clinicians, Dr. East added, the findings may help to target some helpful questions to their patients who are parents. They might ask how much access the child has to facilities that allow them to be physically active. It would be beneficial to inquire bout the home environment to ascertain the support systems, and to caution parents that for children who are already overweight at a particular age, it is as much about the increase in amount of weight as the rate at which BMI occurs that alert them to consider making changes to reverse the risk of obesity.

"It’s a common refrain to hear, 'They'll lose the baby fat''' of overweight pediatric patients, Dr. East said; her findings suggest otherwise. "It’s far better to intervene early to stop that rapid weight gain. It's not going to stop on its own."

Dr. East has no financial conflicts with this research. Dr. Apovian is on the Takeda Speakers Bureau (maker’s of Contrave) has received research funding from several companies, and she has an ownership interest in Science Smart LLC.


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