Preventing childhood obesity: It’s never too early to start

What’s the best way to prevent children from becoming obese?

While theories abound, one thing we’ve learned so far: It’s never too early to start.  A New England Journal of Medicine study last week showed that children who are overweight in kindergarten are much more likely to become obese teenagers. Other recent research suggests risks begin in the womb, and include a mother’s weight gain, blood sugar levels and smoking habits.  Risks may even stretch back generations; the great-grandchildren of a group of rats exposed to DDT had higher levels of fat and weight gain than progeny of those not exposed.

TEDMED 2013 speaker Peter Attia, an MD who conducts what his organization, NuSI, considers the most comprehensive research on the causes of diet-related diseases to date in adults, says that factors likely to trigger children to become overweight in the first place may indeed be present at birth, and are tough to surmount.

Does a typical school lunch contribute to food-related diseases?
Does a typical school lunch contribute to food-related diseases?

“Genetic factors aren’t as likely to explain changes over relatively short periods of time. The epigenetic factors – genetic factors turned on by environmental triggers – may have a lot to do with a mother’s eating behaviors while a child is in utero.  [Studies so far] certainly suggest that the quality of a mother’s diet plays a role in a child’s susceptibility to obesity and insulin resistance,” Attia says.

And these influences are only likely to grow along with a child, he says.

“There’s a whole host of systems and structures that got that child to be where they are; they’re probably related to socioeconomic status, education, and what the child consumed for the first five years of his or her life. All of those factors aren’t going to go away,” Attia says.

Communities are scrambling to catch up, and many are looking at the school environment as a logical start point. In TEDMED’s Google+ Hangout last week, Great Challenges team members and special guests discussed measures schools are taking to educate kids about good nutrition and ensure that they receive it on school premises. They include efforts to help schools procure locally grown fresh food for cafeteria lunches; on-site gardens where children harvest and study the science of food; and nutrition education and cooking classes. (Watch a video of the insights shared here.)

Will these interventions happen quickly and go far enough? Attia has hypothesized that foods high in sugar — juice, soda, candy bars, sugary cereals, and sauces — are prime culprits of diet-related illnesses like type 2 diabetes and fatty liver disease.  And right now they’re commonly available in cafeterias and on school property.

The fast rise of these ills in children – as many as seven million cases of fatty liver disease in the U.S. – should be a wake-up call that vast changes are needed, starting with improved medical research on their causes, Attia says.

“Do we honestly want to continue reiterating the same dogma for the next 30 years that says ‘Just eat less and exercise more, and if you have the right moral fortitude you’ll be fine?’

“It’s been a scientific and policy failure in adults. All you have to do is look back when the mantra started, and look at how many people were obese, and how many had type 2 diabetes, and follow through on the amount of spending that’s gone to propagating that message, and compare that to the numbers today,” he says.

What’s happening to kids also reinforces what Attia expressed in his TEDMED talk:  That we mistakenly attribute obesity and its related diseases to a failure of personal responsibility.

“ ‘People who are obese and diabetic are morally corrupt.’ We don’t come out and say that, but that’s the implication. ‘These are bad people. These are lazy people who lack discipline.’

“But do we really believe that children are morally bankrupt, lazy, slothful entities who just choose to be gluttonous?  We have a hard time believing that for a five-year-old,” he says.

Stacy Lu

What do we really know about nutrition and obesity? Peter Attia answers your questions on Facebook

Join TEDMED Speaker Peter Attia, MD, for a Facebook Chat on Nutrition & Obesity on Thursday, 6/20 at 2pm ET

Can we trust anything we think we know about nutrition?  What do we really know so far about how our food intake and our weight gain? Why are we working harder than ever to eat well and be healthy, with no reductions in obesity and with diabetes rates skyrocketing? Could it be that official dietary guidelines are based on science that’s not rigorous enough to draw real conclusions?

Peter Attia at TEDMED 2013 Photo: Jerod Harris
Peter Attia at TEDMED 2013 Photo: Jerod Harris

TEDMED 2013 speaker Peter Attia, a physician and former McKinsey & Company consultant,  started a new organization, Nutrition Science Initiative (NuSI) to thoroughly investigate these questions and more, along with journalist Gary Taubes, author of “Good Calories, Bad Calories” and “Why We Get Fat.”

 

This Thursday, June 20th at 2pm ET, Peter will answer questions about NuSI’s work to date, and what he sees as the best way to understand and combat obesity. Join us to discuss his contrarian and potentially revolutionary approach. Check out the Facebook event page for details and to RSVP.

Peter Attia’s NuSI plans three studies with new approach to nutrition and obesity

What’s really driving our scourge of obesity and its related metabolic diseases, including diabetes, Alzheimer’s disease, cancer, and heart disease? The medical community generally holds that we eat an overly large number of calories, causing an “energy imbalance” that leads to fat accumulation — and most of its advice to the general population speaks to that: “Eat less and exercise more!”

Yet, after 50 years of studying the problem and about a decade trying hard to fix it — mainly via health messaging — we continue to gain weight exponentially. Obesity has increased 250% since the 1960s, and diabetes more than five-fold. Why can’t we solve this?

Peter Attia at TEDMED 2013. Photo: Jerod Harris
Peter Attia at TEDMED 2013. Photo: Jerod Harris

For starters, what if all of our efforts to fight weight gain have been based on inconclusive science? What if our “treatment” is then incorrect, rather than conventional wisdom that says people just can’t follow it?

TEDMED 2013 speaker Peter Attia and his non-profit organization,Nutrition Science Initiative (NuSI) hope to help science, and eventually public policy, reach the truth. Attia and co-founder Gary Taubes, a science and health journalist and author of “Why We Get Fat,” founded NuSI a year ago. They hold that research on nutrition has not been nearly rigorous enough to date to make existing claims about the relationship between nutrition and health due a host of factors, including a lack of proper controls, difficulties in meticulously monitoring subjects, and insufficient resources to conduct the necessary experiments to show cause and effect.

Supporting their claim, a meta-search published in the New England Journal of Medicine last January concurs, saying that most popular dietary recommendations concerning obesity, from the value of eating breakfast and more fruits and vegetables, to the evils of snacking, are unproven.

Peter Attia works out in a metabolic chamber, an instrument that will be used in at least one of his upcoming studies about nutrition and obesity. Photo: Terry Manier
Peter Attia works out in a metabolic chamber, an instrument that will be used in at least one of the upcoming NuSI studies about nutrition and obesity. Photo: Terry Manier

To begin its quest, NuSI is funding and facilitating what it hopes will be the most rigorous research to date on the relationship between nutrition, obesity and metabolic disease to date, starting with three large experimental collaborations at six leading academic institutions over the next three years.

NuSI will release details on the projects in the next few months. We do know that, as the Wall Street Journal reports, the Laura and John Arnold Foundation (LJAF) of Houston, Texas has recently agreed to fund approximately $40 million of research over the next three years. We’ll give updates here.

For more info: www.nusi.org; @NuSIorg

TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular Interactions

By Medgadget Editors

The second day of TEDMED 2013 began with the curator, Jay Walker, providing a recap of the first day, which set the stage for the first session of the day: “How Can Big Data Become Real Wisdom?” This session was the most technologically focused of the day.

Larry Smarr at TEDMED 2013 TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular InteractionsThis session started with computer scientist Larry Smarr, an advocate of personalized medicine, who noted that applying changes to the data we already collect can give us a new vision. For example, by applying data visualization techniques we can make the data “organ centric” in ways that clinicians traditionally do not expect.

As he pointed out, “stool is information rich media” that the typical clinician will usually not think of using to help diagnose or treat a condition. Smarr had amazing computer resources at his disposal, and when he combined this information with a detailed description of data and symptoms, he obtained very specific answers. As he worked on his own medical condition, an inflammatory bowel disease, it occurred to him that medicine can and should be this individualized for all.

Deborah Estrin 2 TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular InteractionsDeborah Estrin discussed the use of the large amounts of data we generate to create a “Digital Social Pulse” that can be used by individuals to get feedback about their health, as well as by health care providers to assist in the care of patients. This realization came to her painfully, realizing after her father’s death that his patterns of phone calling and emailing changed drastically before anyone knew there was a deep fundamental problem.

She noted that we analyze data but do not bring it back to the person who generated that data and there is a lot that we can learn from our digital data, just like bread crumbs that lead to their source. She sees real potential for enhancing healthcare with personalized data insights so that “we don’t have to just rely on our subjective memory.”

Elizabeth Marincola, publisher of Science News, discussed the concept that public dissemination of knowledge can be profitable even in an open access environment, which is essential because in her view open access publishing goes to the heart of science. Then, Max Little, applied mathematician, spoke on the “The Unreasonable Effectiveness of Math” and how we can build this into our approaches to data.

Amy Abernethy TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular InteractionsThe final speaker for the session was Amy Abernathy, oncologist and palliative medicine physician. She shared the story of a patient, who had a “special treasure” to share…her data. Abernathy noted that our ability to personalize medicine is within our grasp, but the irony is that at the bedside we have trouble applying all this information to an individual, we need big data, but we also need the ability to use it. From her patient, she learned some key “pearls” about data: First, the patient needs to own their data, then patients should be able to control how their data is shared and used (to include the ability to rescind access if needed). Finally the data needs to be portable, and to be able to be used across a variety of settings and uses. She closed with the observation that “data is a non-depletable resource” and we need to find ways to use it in many different ways.

The second session of the day was focused on “Translating the Untranslatable” and featured speakers like the Mayor of Oklahoma City, KC Mick Cornett, about transforming his community from one of the “fattest cities” in the country to one that’s relatively healthy. David Agus, author of “The End of Illness,” who spoke about his vision of cancer as a disease. Sue Austin shared an amazing video of her scuba diving in her wheelchair that was turned into a miniature submarine. For many, a highlight of the session was a talk by Sally Okun, the first nurse to speak at TEDMED. She promoted the power of patient stories and how we need to capture them from the patient’s point of view, as well as the physician’s. Finally, the session closed with Richard Simmons who got the entire TEDMED audience moving with song, dance, and his message of “counting your blessings every day.”

The next session focused on “Shifting the Patterns of Power” and featured speakers like entrepreneur Jonathan Bush, urban farming advocate Ashley Atkinson, medical researcher H. Shaw Warren, mathematician Max Little, and closed with an amazing talk by Peter Attia, a physician who shared an amazing story of his growth as a person and as a physician.

The final session of the day addressed “What Happens When You Mix Up The Models” and began with the announcement of a new TEDMED initiative, Lab TV, by Jay Walker and Francis Collins, Director of the National Institutes of Health. This project will enable researchers to share in real time their work, and perhaps even assist in the research.

Lab TV will try to get curious and scientifically minded people to interview researchers, go into labs, and provide a first person point of view of the latest scientific advancements, with the final goal of getting the public educated about what’s under development and to give a chance to researchers to profile their work to a wider audience.

Next in the session, Mike Pazin of the National Human Genome Research Institute spoke about his project to take the raw human genome data and build a disease encyclopedia to make the data useful. He made the observation that this type of research is possible only because new devices have allowed individual genomes to be analyzed cheaper than ever before. Then Gary Slutkin, epidemiologist, discussed his work in using epidemiology to look at violence as a public health problem.

David Odde and Black Label Movement TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular InteractionsDavid Odde of the University of Minnesota in particular had a very interesting approach to the use of art, and dance in particular, to study how cells move and interact. As he was studying cellular activity, he talked to a dancer and demonstrated how the activity or body storming of the dancers can be used as a method of rapid prototyping of various types of cellular activity, including the migration of tumor cells, microtubule activity, and other cellular behaviors.

After this initial effort, the concept of “body storming” became more developed, with the addition of boundaries, groups, and permitted moves by dancers to more closely model actual cellular activity under various conditions. This effort directly led to better computer models and observations of cellular activity.

After performances by the The Manzari Brothers and David Odde & Black Label Movement, Zubin Damania, of ZDoggMD fame, addressed his plans to create new models of primary health care.

Reporting by Medgadget guest blogger Mike Moore and editor Gene Ostrovsky. This post originally appeared on Medgadget.com. Photos by Jerod Harris.