“Train up a child in the way he should go: and when he is old, he will not depart from it.” Proverbs 22:6

“Parents should make it their first business to understand the laws of life and health, that nothing shall be done by them in the preparation of food, or through any other habits, which will develop wrong tendencies in their children.” –Counsels on Diet and Foods, p. 237

“Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is not only affecting the richest countries, but many low- and middle-income countries are being impacted, particularly in the cities. The prevalence has increased at an alarming rate. Globally, in 2016 the number of overweight children under the age of five is estimated to be over 41 million. Almost half of all overweight children under five lived in Asia and one quarter lived in Africa. Overweight and obesity, as well as their related diseases, are largely preventable; therefore, prevention of childhood obesity needs to be a high priority.” http://www.who.int/dietphysicalactivity/childhood/en/

Worldwide, one in three children are overweight or obese. Though childhood obesity is on the rise worldwide, the patterns differ between developing and developed countries. In developing countries, obesity may coexist with undernutrition, with children in the relatively affluent urban areas more likely to be obese than their rural counterparts. Like adult obesity, childhood obesity has many influencing factors, but essentially obesity is caused by taking in more food (energy) than is being using up, over a long period of time.

Addressing obesity in children needs to start early. Research suggests that, if untreated, 85% of obese children will become obese adults. This statistic alone is reason enough to address weight issues in the early years. Obese children face the same health risks as adults, and are more likely to develop diseases at a younger age. Childhood obesity is associated with a higher chance of premature death and disability in adulthood. The earlier that a person becomes obese, the longer they will live with the health problems that arise from obesity. The risks associated with the diseases brought on by obesity depend on the age of onset and the duration of obesity. The most significant health consequences of childhood overweight and obesity often do not become apparent until adulthood; but, by then the damage has been done. However, already in adolescence there is evidence that excess weight is causing problems that would normally not be seen until persons are middle-aged or older. These include problems such as heart disease and diabetes. Obese children and adolescents suffer from both short-term and long-term health consequences. The sooner children who are obese reach a healthy weight the better for them in the long run. Along with the risks for life-shortening chronic diseases, being overweight in a society that stigmatizes this condition contributes to poor mental health associated with shame, self-blame, low self-esteem and depression. Obesity in childhood can contribute to behavioural and emotional difficulties that can also lead to poor socialization and reduced educational achievements.

The choice to raise healthy children should start even before a child is born. Avoiding overindulgence and eating healthily is even more important when pregnant. The average woman in the United States who becomes pregnant is already overweight or obese. Almost 60% of these women will gain more weight than necessary when pregnant, which will likely be retained post-pregnancy. Also, it is widely accepted now that food choices that a pregnant woman makes translates to problems in their offspring.  An in-utero diet high in fat or sugar often leads to the child growing up obese. In studies with rats who were fed high-fat, high-sugar, diets, their offspring grew up with changes in the brain that drove them to want to consume high-sugar and high-fat foods, even when offered alternate healthy choices. The suggestion is that these same changes can occur in the brains of children whose mothers ate a high-sugar, high-fat diet when pregnant. Thus, pregnant women should not feel that pregnancy is a time to indulgence in an unhealthy diet, which may be driven by hormonal changes. Evidence is emerging that the health of fathers at the time of conception can influence the risk of obesity in their children.

A new study at the University of Southhampton has confirmed that the mother’s diet during pregnancy has lifelong effects on her baby. Whether the mother is skinny or fat during pregnancy seems to have little effect on whether her baby is prone to obesity later on. Rather, it is what she eats during those critical months and the nutrition of the food she selects that makes all the difference. A nutrition-poor pregnancy diet can alter the way the DNA of the fetus functions, leading the child to store more fat in later life. Surprisingly, these changes were found to be independent of the child’s birthweight.

The changes in DNA function do not end there. They also strongly influence how the child responds to diet and lifestyle factors years later. The study examined babies at birth for these change, and found that they are strongly predictive of the child’s obesity status at six or even nine years of age. This study proves that just focusing on interventions in adult life will not reverse the epidemic of chronic diseases. To ensure a healthy population, effort must be expended on the pre-pregnancy and pregnancy diet of the parents-to-be! Preventing childhood obesity should be targeted on improving a mother’s nutrition and her baby’s development in the womb. These early life factors influence risk of disease many years later. Trying to fix problems after the baby is born has limited effect.

Sister White instructs women who are pregnant: “Women who possess principle, and who are well instructed, will not depart from simplicity of diet at this time of all others. They will consider that another life is dependent upon them and will be careful in all their habits and especially in diet. . . . Diseased children are born because of the gratification of appetite by the parents. . . . If so much food is taken into the stomach that the digestive organs are compelled to overwork in order to dispose of it and to free the system from irritating substances, the mother does injustice to herself and lays the foundation of disease in her offspring. If she chooses to eat as she pleases and what she may fancy, irrespective of consequences, she will bear the penalty, but not alone. Her innocent child must suffer because of her indiscretion.” –The Adventist Home, p. 257–258

During infancy, breastfeeding assists in the prevention of childhood obesity. Breast milk provides the baby with food that is easy to digest and very nutritious, and the baby helps to decide how much to eat and when to eat it. Both the breastmilk itself and the way the baby feeds helps to develop healthy eating patterns. Breastfed babies seem to be better able to regulate their food intake and thus are at lower risk for obesity. Babies who are fed formula have a higher protein and total energy intake, leading to increased body weight during the infant stage, which is associated with development of obesity later in childhood. Formula-fed babies also produce higher levels of insulin which leads to early development of the type of cells that store fat. Breastfeeding also avoids the early introduction of foods that can lead to unhealthy weight gain.

In adults, measuring obesity is done by calculating the Body Mass Index (BMI) which looks at the ratio of height to weight. The measurement used to assess for obesity in children is different than in adults. Because children are growing, the ratio of height to weight may not give a true picture as whether a child is overweight or obese. In assessing children, BMI measurements are linked with age-and sex-appropriate percentiles. A BMI that is above the 85th percentile for a child’s age and sex group coincides with the adult definition of overweight; and a BMI above the 95th percentile is consistent with the adult definition of obese.

The biggest difference between childhood obesity and adult obesity is that young people have generally less control over their food intake. The type of food and the amounts are decided upon by their parents. Because of this, children with obese parents are 12 times more likely to be overweight than if their parents were a healthy weight. The parent’s lifestyle choices are imposed on their children, at an age when they do not have the capacity to make their own decisions on diet and exercise. Once they become older, children have more responsibility over their lifestyle choices; however, by then, habits may be so ingrained that children are unable to change the course set when they were too young to choose for themselves.  A study from the late 1990s shows that 52 percent of children who are obese between the ages of three and six are obese at age twenty-five as against only 12 percent of normal and underweight three- to six-year old children. Also, genetics plays a big role in obesity. Recent studies have concluded that about 25 to 40 percent of BMI has been inherited. Certain people may have a higher genetic susceptibility to weight gain.

“Children are generally brought up from the cradle to indulge the appetite and are taught that they live to eat. The mother does much toward the formation of the character of her children in their childhood. She can teach them to control the appetite, or she can teach them to indulge the

appetite and become gluttons. . . . care should be taken to furnish the table with healthful food prepared in a wholesome and inviting manner.” –Ibid., p. 261–262

“Whoever eats too much, or of food which is not healthful, is weakening his power to resist the clamors of other appetites and passions. Many parents, to avoid the task of patiently educating their children to habits of self-denial, indulge them in eating and drinking whenever they please. The desire to satisfy the taste and to gratify inclination does not lessen with the increase in years; and these indulged youth, as they grow up, are governed by impulse, slaves to appetite. When they take their place in society, and begin life for themselves, they are powerless to resist temptation. . . . When we hear the sad lamentation of Christian men and women over the terrible evils of intemperance, the questions at once arise: Who have educated the youth? Who have fostered in them these unruly appetites? Who have neglected the solemn responsibility of forming their character for usefulness in this life, and for the society of heavenly angels in the next?

“When parents and children meet at the final reckoning, what a scene will be presented! Thousands of children who have been slaves to appetite and debasing vice, whose lives are moral wrecks, will stand face to face with the parent who made them what they are. Who but the parents must bear this fearful responsibility? . . . Were not the sins of the parents transmitted to the children in perverted appetites and passions? And was not the work completed by those who neglected to train them according to the pattern which God has given? Just as surely as they exist, all these parents will pass in review before God.” –Christian Temperance and Bible Hygiene, p. 76

Maintaining a stable weight requires a delicate balance between energy intake and energy expenditures. Very young children seem capable of adjusting their food intake to match their energy needs, but as children grow up, they seem to lose this apparently innate ability. Their food intake, rather than being based on energy needs, is influenced by external cues, such as the amount of food presented, opportunities for snacking, and the types of foods available, especially fast foods. Several studies have found a link between overweight and soft drink consumption. Many high-calorie foods and drinks are readily available in the school environment. And, when parents have little time to prepare meals for their families, they purchase fast foods and pre-prepared convenience foods, which tend to be calorie dense. Many children consume foods that are “empty calories”, foods which provide calories with little nutritional value. Looking at convenience foods, portion sizes of these foods have increased exponentially. Thus the increase in childhood overweight may be driven not just by increased consumption of particular foods, such as sodas, but also by the change in the food market toward larger portion sizes. It has been shown that older children will consume higher amounts of food if it is provided for them. They do not tend to regulate their consumption when presented with a particular amount of food. Thus, when portion sizes increase, so does their intake.

Studies have been done on television’s (as well as other screen-based devices) role in childhood obesity, finding that each additional hour of screen time per day increased the prevalence of obesity by 2 percent. Screen viewing may affect weight in several ways. It replaces the time that could be spent in physical activity. Research has shown that children spend many hours of their day in front of a screen. This averages from 18 hours a week for children less than 8 years old, up to 63 hours a week for teenagers. These screens include TV, Internet, computer games, phones, etc. Also, food-related advertisements on these devices may increase children’s desire for, and ultimately their consumption of, energy-dense snack foods. Screen time often goes hand in hand with snacking, leading to higher energy intake among children.

Health guidelines recommend that children need to be very active; young people should spend at least 60 minutes per day, or 7 hours a week, being active to a level where they are out of breath. Physical activity should part of the family’s daily routine such as designating time for family walks or playing active games together. In this way, parents can influence their children’s behaviour. At the same time, parents are advised to live and promote a healthy lifestyle themselves, because children’s behaviour is often shaped by observation of others. Often when both parents work, there is less time in the family to engage in or promote physical activity. Many schools have decreased the amount of physical education time for students in favour of more academic subjects. The amount of homework has increased, especially with younger children, which also impacts time available after school for physical activities. 81% of adolescents do not achieve the recommended 60 minutes of physical activity per day.

Trends in the built environment (urban sprawl) have resulted in more car trips and in fewer trips by foot or by bicycle. Less than a quarter of children walk or bike to school today compared to more than two-thirds a generation ago. Today’s lower-density housing developments result in schools being further away from children’s homes, and do not provide safe walking routes. In addition to depriving children of an opportunity for physical activity, the change may have other effects on overall physical activity. It has been shown that children who walk to school are generally more physically active than children who are driven to school.

Although the effects of diet and physical activity on health often interact, particularly in relation to obesity, there are additional health benefits to be gained from physical activity that are unrelated to nutrition and diet. Physical activity is a fundamental means of improving the overall physical and mental health of individuals.

As we have seen, there is no one main cause for the increase in children’s obesity. Rather, many developments have taken place to upset the crucial energy balance by simultaneously increasing children’s energy intake and decreasing their energy expenditure. The challenge in creating policies to address children’s obesity is not necessarily to determine what changed to create the current epidemic, but rather, what is the most effective way to change children’s environment and restore their energy balance going forward.

The school setting can have a great impact on children’s health. Because children and adolescents spend a significant time of their lives in school, it is an ideal setting to obtain knowledge and develop skills, to adopt healthy lifestyle choices and to increase physical activity levels. Suggestions for schools involves providing health education to help students acquire knowledge, attitudes, beliefs and skills which are needed to make informed decisions, practice healthy behaviours and create conditions that are beneficial to health. Meals provided should be healthy; vending machines should only contain healthy options, and access to health services needs to be available. Studies indicate that a 10 percentage point increase in the availability of junk food increases average BMI by 1 percent. For adolescents with an overweight parent the effect is double. Daily physical education classes with a variety of activities should be offered, so that students’ needs, interests and abilities are addressed.

The WHO’s statement on childhood obesity recognizes that prevention is the most feasible option for controlling the childhood obesity epidemic, since current treatments are focused on managing the problem rather than bringing about a cure. The goal in fighting the childhood obesity epidemic is to achieve an energy balance which can be maintained throughout the individual’s life-span. In this way, healthy weight children will become healthy weight adults. Their recommendations include: increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts; limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats; limit the intake of sugars; and be physically active—accumulate at least 60 minutes of regular, moderate- to vigorous-intensity activity each day that is developmentally appropriate. Curbing the childhood obesity epidemic requires commitment by governments and the collaboration of many public and private partners. The role of parents include ensuring healthy foods and beverages are available at home, while, at the same time, restricting access to unhealthy foods, and teaching children to make healthy food choices. Providing, supporting and encouraging opportunities for physical activity will improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health. Governments have a central role, in cooperation with other organizations, to create an environment that empowers and encourages behaviour changes by individuals, families and communities, to make positive, life-enhancing decisions on healthy diets and patterns of physical activity.

In 2013, the World Health Organization (WHO) called for zero increase in the prevalence of overweight among children and in the prevalence of obesity among adults. However, given the current pace of increase and the existing challenges in implementing food policies, achieving this goal appears unlikely in the near future. There is an urgent need to act now to improve the health of this generation and the next. For further information please see the Report of the Commission on Ending Childhood Obesity published by the World Health Organization: http://apps.who.int/iris/bitstream/handle/10665/204176/9789241510066_eng.pdf;jsessionid=4125E1042E3B91E4B9F59EF6B1F07511?sequence=1

“How carefully should mothers study to prepare their tables with the most simple, healthful food, that the digestive organs may not be weakened, the nervous forces unbalanced, and the instruction which they should give their children counteracted, by the food placed before them. This food either weakens or strengthens the organs of the stomach, and has much to do in controlling the physical and moral health of the children, who are God’s blood-bought property. What a sacred trust is committed to parents, to guard the physical and moral constitutions of their children, so that the nervous system may be well balanced, and the soul not be endangered!” –Counsels on Diet and Foods, p. 237