Tipping the scales

By Alex Piazza
apiazza@umich.edu

Eat less. Exercise more.

If only it was that easy.

The regimen prescribed by physicians over the years has helped millions of Americans shed pounds and improve their overall health.

But still obesity remains a serious public health problem that affects 1 in 6 children and adolescents in the U.S.

“It’s a temptation for many people to think all you have to do is eat better and play harder,” said Dr. Karen Peterson, a University of Michigan professor of nutritional sciences who has studied childhood obesity for nearly 20 years. “In some sense, that’s true. But from a public health standpoint, we look at a number of factors beyond just diet and exercise. Everything from relationships that children have with their parents to the neighborhoods they grow up in.”

There is an even greater push now for resources to address childhood obesity, as the latest figures show 12.7 million children and adolescents in the U.S. are obese.

Since 1999, the prevalence of obesity in people ages 2 to 19 has increased from 13.9 percent to 17.2 percent, according to the U.S. Centers for Disease Control and Prevention. And research shows children who are overweight or obese are more likely to be obese as adults, increasing their risk of diabetes, cardiovascular disease and certain cancers.

So why do more children in today’s society struggle to maintain a healthy weight? The university is home to several labs and researchers who focus their efforts on unlocking that mystery and fixing the problem.

The university, for example, launched its Momentum Center to develop new research questions and creative approaches to turn the tide on childhood obesity. There, researchers from such diverse disciplines as medicine, public health, education, nursing, kinesiology, design and pediatrics work together to generate more effective approaches to prevent and manage childhood obesity.

“To understand this problem and then be able to implement innovative solutions, you need expertise from a number of different areas, and that’s exactly what we’re trying to do here at Michigan,” said Peterson who, along with Lindsey Mitchell, leads the Momentum Center.

Big brother, Big sister

Who’s to blame?

As a pediatrician, Dr. Julie Lumeng has seen plenty of finger-pointing when it comes to childhood obesity.

“People automatically assume you’re an inept parent if your child is obese, so there’s a lot of mother blaming in today’s society,” said Lumeng, professor of pediatrics and communicable diseases. “But when it comes to eating, children are much more likely to model their eating behavior after other kids—not adults.”

That realization inspired Lumeng and her colleagues to watch hundreds of videotapes that show families eating dinner together. Researchers coded interactions between siblings at the dinner table, which led them to one simple question: Does the addition of a new brother or sister alter the older sibling’s risk of obesity moving forward?

About 700 children participated in the study, which included assessments to gauge their body mass index over time. Their findings show that becoming a big brother or big sister before first grade may lower a child’s risk of becoming obese.

“The effect seems to be strongest when the sibling is about two years apart,” said Lumeng, who serves as associate director of the Momentum Center and also has ties to the Center for Human Growth and Development.

Children with younger siblings are more prone to engage in active play, thus reducing their risk of obesity, which Lumeng believes could contribute to their findings. Parents also may change the way they feed their child once a new sibling is born, which can significantly alter their long-term eating habits.

“The implication of this study is certainly not to go out and have more babies in an effort to prevent their older siblings from being obese later in life,” she said. “Instead, parents should reflect on how their parenting habits might change after having a second child, and whether they can recreate those changes. As we continue to look more closely at the connection between siblings and weight, we can help create new strategies for helping children grow up healthy.”

Health 101

Vending machines were stocked with candy bars and drinks loaded with sugar.

Fruits and vegetables were hard to come by in the cafeteria. And resources to promote physical education were scarce.  This was the stark reality facing many middle schools nationwide.

“The problem here is the culture that we’ve created,” said Dr. Kim Eagle, director of U-M’s Samuel and Jean Frankel Cardiovascular Center. “We’ve had a toxic environment in terms of our health for quite some time, and that’s been reflected in many of our middle schools. We had to figure out a way to create a healthier culture with nutrition and movement in order to stop this epidemic.”

Cue Project Healthy Schools. Twelve years ago, Eagle teamed up with U-M health leader LaVaughn Palma-Davis to design a curriculum that would address childhood health in middle schools.

Their idea has grown into a health intervention program that now is being implemented in more than 70 middle schools across Michigan. With support from the university and its health system, along with government and industry partners, Project Healthy Schools has reached more than 50,000 Michigan youth since its inception in 2004.

As part of the program, sixth-graders participate in lessons that range from tracking their food intake to learning how to prepare healthy meals. So far, the results are evident.

Health screenings show that four years after 1,100 students from Ann Arbor and Ypsilanti schools participated in Project Healthy Schools, their cholesterol and triglycerides improved, and for most years, their blood pressure also improved. Their physical activity increased and sedentary behaviors diminished, as well.

Eagle’s childhood obesity research also illustrates the important connection between family income and weight management. A recent study conducted by Eagle and his U-M colleagues found that family income matters more than race in predicting which kids are overweight.

“We had this sense that obesity really wasn’t about ethnicity or race at all—it was about opportunity,” said Eagle, who based his research on data collected from more than 110,000 Massachusetts students. “Low-income communities often have fewer resources like parks and supermarkets. Without these resources, people in these communities are more prone to consume fast food, and they’re less likely to engage in physical activity.”