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Implications of childhood obesity for adult health: findings from thousand families cohort study

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7324.1280 (Published 01 December 2001) Cite this as: BMJ 2001;323:1280

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Missing the point of our paper…

We entirely agree with Gibson, Must and colleagues that childhood BMI
does indeed track strongly to adult BMI, a point we made clearly in our
paper. However, our important and entirely novel observation was that
childhood BMI is a poor predictor of adult percentage body fat,
suggesting that it is mainly build that tracks throughout life and not
adiposity. While we cannot be sure that BMI in childhood did appropriately
classify all of the children in our study, it is the substantial
differences between the results when BMI and percentage body fat were used
which are important to understand.

Frank obesity during childhood was uncommon in our study and for that
reason we cannot address the question of the fate of very obese children –
and did not purport to do so. Other studies would suggest that they may
indeed do badly. What our study could address was the question of whether
plump (rather than obese) children should excite concern, and whether
relative thinness as a child offers protection – either against obesity in
adult life or adult risk of cardiovascular disease. What we found was
consistent evidence that neither was true.

As we argued, our results were consistent with the rest of the
literature. This tends to be somewhat selectively quoted, apparently to
support the paradigm that obesity has its origins in childhood, with the
implication that by adulthood it is too late to do anything about it. For
example it has been clearly demonstrated in many studies, as well as our
own, that most obese adults were not fat children, but this is not
generally known and is rarely mentioned when childhood obesity is
discussed. Similarly we found two previous studies similar to our own
examining adult health consequences of childhood overweight. The one that
suggested a bad outcome is widely cited (1), while the other much larger
study, which was consistent with ours, was only recently rediscovered by
one diligent reviewer and is seldom otherwise cited (2).

It is just because this is such an important subject that it is vital
that we base our public health strategy on sound, objective evidence. We
cannot know for sure what the future holds for today’s children: but it is
surely better to base our prognostications on the limited evidence we have
than on presumption. We agree with Vitetta and colleagues that it is
likely that today’s children are becoming obese sooner. However, what our
study suggested was that this does not carry any greater health risk. It
could be argued that today’s children, after secure, adequate nutrition
throughout childhood, may suffer fewer adverse consequences of adult
obesity.

We have found no evidence that being a thin child is of long term
health benefit. We thus argue that efforts to turn the tide of adult
obesity will be misdirected it they are directed primarily at turning
plump children into thin ones. The target should be those who are truly
at risk: inactive, overeating adults.

References

1.Vanhala M, Vanhal P, Kumpusalo E, Halonen P, Takala J. Relation
between obesity from childhood to adulthood and the metabolic syndrome:
population based study. BMJ 1998;317:319.

2.Abraham S, Collins G, Nordsieck M. Relationship of childhood weight
status to morbidity in adults. HSMHA Health Report 1971;86:273-284.

Competing interests: No competing interests

24 February 2002
Charlotte M Wright
Senior Lecturer
Louise Parker
University of Glasgow G3 8SJ