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Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United States

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2486 (Published 04 July 2018) Cite this as: BMJ 2018;362:k2486

Re: Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United States

Obesity is a result of an interdependent interaction between genetic and environmental factors, with a complex system that influences metabolism and appetite. It´s important to discuss the role of epigenetic aspects in the presented study [1]. Obesity is not an eating disorder like binge eating disorder, defined by abnormal eating habits that negatively affect a person's mental or physical health. Binge eating disorders affect about 1.6% of women and 0.8% of men/year [2]. This disorder is highly associated with other psychiatric disorders like depression or substance abuse. In this study only alcohol consumption and smoking status were investigated; the assessment of more covariates and potential effect modifiers could exclude the possibility of uncontrolled confounding by these factors, for example, cannabis and depression in women.

The authors stated that the participants had relatively homogeneous socioeconomic status and educational attainment. I think, that there are different, divergent explanations for the association between BMI and income/social class.

A lifestyle (healthy or unhealthy) will perhaps be transmitted across generations. There are family traditions, lifestyle differences between the USA, Europe and Asia, and social stigmatization of persons with obesity. In contrast, there is an idealization of skinny fashion models and neglecting eating disorders. Former President Richard M. Nixon said in view of a portrait of John F. Kennedy: “People look at you and they see who they want to be. They look at me and they see what they are” [4].

1) Dhana K et al. Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United States.BMJ 2018;362:k2486
2) Smink FR et al.. "Epidemiology, course, and outcome of eating disorders". Current Opinion in Psychiatry. 2013;26 (6): 543–8.
3) Wilks DC et al.Objectively measured physical activity and fat mass in children: a bias-adjusted meta-analysis of prospective studies". PLOS One. 2011); 6 (2): e17205.
4) “Nixon” 1995, biographical film

Competing interests: No competing interests

09 July 2018
Detlef Degner
Associate Professor of Psychiatry, assistant medical director
Department of Psychiatry, Medical School of Georg-August University, Goettingen
Von-Siebold-Str 5, D-37075 Göttingen, Germany