Dr David Bratt
If you want to do something about fat children and overweight adults, you have to improve antenatal care and breastfeeding rates.
Weight control programmes don’t work, you spinning top in mud if you keep trying to lose weight after you have gained it. Only the most dedicated people can do that and face it, you can’t see a piece of fried chicken or a tub of Manzanilla Madness without caving in. In my experience, the only people who have managed to lose weight and keep it off after five years are some willing teenagers who decide, on their own, no mummy advice or doctor consultation, that they want to lose weight and they do it over two or three years.
Experience has shown that there are four ages when the risk of a child putting on too much weight is highest: the first 1,000 days of life; the first year of primary school; the SEA year, and puberty.
The first 1,000 days of life is not the first three years of life. It is the period from conception to the end of the second year and it is key to understanding most overweight. The reason for the excessive weight gain in the first year of primary school is not known but may be related to stress. The changeover from a relatively benign preschool environment to some of our primitive, noisy, sweltering hot chicken coops that pass for classrooms has to be experienced to be believed.
SEA year means children stop playing outside and beat books inside. With that, comes continuous snacking on sugary food items and increased use of social media. The weight gain can be explosive. During puberty, kids can lose control of the natural growth spurt that occurs. Unhealthy eating habits learned years before and barely controlled, can take over, with excessive weight gain.
We have to go back to pregnancy (and perhaps pre and post-conception) and the first two years of life in order to control childhood obesity.
Poor antenatal care can result in babies who are born too small (under five and a half pounds) or too heavy (over seven and a half pounds). Babies like this tend to grow up overweight. It has to do with alterations with the way their bodies have learnt to handle sugar whilst inside the womb.
It seems fairly obvious that children of overweight mothers will weigh more at birth and have higher odds of being overweight throughout childhood and adolescence. Being large at birth combined with diabetes in the mother is associated with a trebling of obesity in childhood.
The opposite is also true. Low birth weight babies, born to mothers with difficult pregnancies (infection, poor nutrition, stress etc), tend to grow up to be overweight.
We also know that breastfeeding exclusively for five to six months followed by the introduction of traditional, local foods low in processed sugars (pumpkin; banana; sweet potato; eddoes; paw paw etc), decreases overweight and obesity by 30 per cent.
Breastfeeding prevents excess weight because it is baby-led. The baby decides how many calories it needs when it has eaten enough for its needs and is satisfied. This promotes satiety responsiveness later on. Mother’s milk contains appetite control hormones (leptin and insulin) that help regulate the baby’s appetite. Breast milk also stimulates the growth of optimal gut bacteria that assists in reducing the number of calories the baby’s gut absorbs.
Weight control programmes must start before birth (controlling the mother’s weight, nutrition, infections, sugar and stress levels) and continue in the first two years life by actively encouraging mothers to breastfeed and give their babies regular home food.
The child is acknowledged to be the father of the man. Is it too difficult to change the mindset of treating adult obesity by preventing it in children? It will take a combined public-private sector initiative. It must be done, for people’s sake, and because we need to decrease the economic costs of treating adult non-communicable diseases.