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Coles et al remind us of the serious medical and psychological effects of childhood obesity. There are several major causative factors that are rarely acknowledged. The most important is the simple fact that parents should be in control of the purchase, the preparation and the feeding of food to their children even though this is made more difficult by our modern, time pressured lifestyle.
Problems start at birth when the main focus on a babies health is on weight gain rather than general activity and well being. The link between loving and feeding is a close one and as toddlers become more demanding it is difficult to resist their requests for sweets and snacks. We live in a culture where saying "No" and setting limits is often mistaken for being authoritarian and unpleasant. Another problem area is supermarket shopping where access to unlimited quantities of food and special offers encourages parents to buy more than is necessary.
Family mealtime where everyones sits round the table to eat is increasingly rare even though it is the ideal opportunity to observe how much and how fast a child eats. It is highly likely that speedy eating and limited supervision of meals is a factor in childhood obesity.
Although lack of adequate exercise is clearly another factor together with various hormonal and genetic factors, the ultimate cause is always too many calories. And for children their calorie intake should be under the control of parents and care givers - however difficult this might be. We all share a responsibility to support and encourage parents to prevent obesity in their children and to deal with the issues that tend to undermine their efforts.
Competing interests:
No competing interests
01 October 2016
John B Pearce
Emeritus Professor Child and Adolescent Psychiatry
Your clinical review article in BMJ was timely and brings out the need to understand the multi-dimensional problem associated with childhood obesity compared to adult obesity.
The body metabolism in a child is tuned to developmental process which is in a more synthetic phase than, say, a catabolic one.
It would be appropriate to find out the basal insulin levels in normal and obese children. We could also compare the insulin levels between, for example:
1. child with adult
2. an ageing person
in normal and obese subjects.
Rather the anabolic to catabolic hormones between these two groups.
Childhood obesity is a global problem but with possible ethnic variability flattened by a change in lifestyle aping western food habits.
Fast food, physical inactivity coupled with, say, internet games or television shows make the problem more complicated.
The easiest solution is to fall a prey to finding an anti-obesity drug influenced by corporate pharmaceutical companies and ignoring finding a long time solution to bring about behavioral change related to physical and psycho-social elements.
We need to teach children that they need to eat a diet that is culturally compatible to their genetic phenotype, with adults as examples following the advice with respect to their life style and diet.
Such an approach will help children have normal functional homeostasis contrary to say the dysfunctional metabolic homeostasis in obese children.
Competing interests:
No competing interests
30 September 2016
Dhastagir Sheriff
Professor
Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research
Re: Emerging treatments for severe obesity in children and adolescents
Coles et al remind us of the serious medical and psychological effects of childhood obesity. There are several major causative factors that are rarely acknowledged. The most important is the simple fact that parents should be in control of the purchase, the preparation and the feeding of food to their children even though this is made more difficult by our modern, time pressured lifestyle.
Problems start at birth when the main focus on a babies health is on weight gain rather than general activity and well being. The link between loving and feeding is a close one and as toddlers become more demanding it is difficult to resist their requests for sweets and snacks. We live in a culture where saying "No" and setting limits is often mistaken for being authoritarian and unpleasant. Another problem area is supermarket shopping where access to unlimited quantities of food and special offers encourages parents to buy more than is necessary.
Family mealtime where everyones sits round the table to eat is increasingly rare even though it is the ideal opportunity to observe how much and how fast a child eats. It is highly likely that speedy eating and limited supervision of meals is a factor in childhood obesity.
Although lack of adequate exercise is clearly another factor together with various hormonal and genetic factors, the ultimate cause is always too many calories. And for children their calorie intake should be under the control of parents and care givers - however difficult this might be. We all share a responsibility to support and encourage parents to prevent obesity in their children and to deal with the issues that tend to undermine their efforts.
Competing interests: No competing interests