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Preventing Childhood Obesity: A Conversation With Wash U's Debra Haire-Joshu

(Via Flickr/InspiredHomeFitness)

Obesity has increased dramatically in the United States over the past several decades.

In Missouri, almost two-thirds of adults ― and more than a quarter of children and teens ― are either overweight or obese.

Washington University researcher Debra Haire-Joshu works to prevent obesity, particularly in young children. She spoke with St. Louis Public Radio's Véronique LaCapra.

Why does it matter if we’re overweight?

Haire-Joshu: Well, if you’re overweight and/or obese, you’re going to have much greater risk for developing chronic diseases and developing them earlier. Chronic diseases around hypertension, cardiovascular disease, and in particular Type 2 diabetes, which is becoming epidemic in this country. That’s the next big epidemic on its way, if it’s not here already.

You know, 20-30 years ago, we never saw Type 2 diabetes in children, and now it’s a regular occurrence. And that is almost specifically related to the risk factor of weight.

And for children, how much of a role do their parents’ genetics and/or behavior play in their risk of becoming overweight or obese?

Haire-Joshu: Well, we know that it’s a multi-component problem. And so the genetics play a role, environment plays a role, and behavior plays a role. Genetics, we can’t really do anything about the genetic piece, and that’s going to vary a little bit per person. But we can do things about behavior, and we can take action about the environment.

So I understand what you mean by behavior: am I eating fruits and vegetables; am I exercising. But what do you mean by environment?

Haire-Joshu: So when we talk about environment, we talk about all of the things that affect access and availability to being able to be healthy, to making a healthy choice a fairly simple choice.

And as a country, we’ve been very, very successful in really taking that away. And by that what I mean is, you don’t really seem very many sidewalks anymore, but by golly [we've] got great cars. So we’re sedentary. We don’t get up and move anymore, like we used to. We don’t meet national guidelines for getting up and moving.

In terms of food, our portion sizes have increased over time. We’ve been very successful in growing foods, and we’re marketers. We have to sell foods. And so business has processed foods, they’ve increased portion sizes and done it so that it’s fairly cheap. And so you put a lot of food in front of somebody, and we know from studies the more food’s there, the more you eat. You eat even when you’re not hungry.

So the question becomes how do we adjust that environment or balance that environment so that we make it easier for us to make the right choices to be active and to eat right.

And how do we do that?

Haire-Joshu: Well, I work primarily with young children because I do prevention. And I think, if you’re going to prevent, you want to not be changing bad habits, you want to start the good habits. And mom and dad control the food environment. So a lot of the work that we do is, we work with various organizations to really do stealth interventions, I call them. We take the science that we know works, and integrate it within the practice patterns of these different organizations.

So for example, we work a lot with Parents As Teachers, national organization, wonderful home-visiting organization, that works in the homes of young parents around child development. And we work with them to integrate helpful information around how you feed a child, when you feed a child, appropriate portion sizes for a child. Parental modeling of good behavior, so that changes mom and dad’s behavior, too. Talk about activity. And start integrating that at a time when most parents will do things for their kids that they won’t do for themselves.

We also strongly believe that you really start prenatally.

What does the science show about that, the influence of a mother’s diet on a child’s — or a fetus, really — their future likelihood of becoming overweight or obese?

Haire-Joshu: We’re doing a study now, here at Washington University. And we’re going to see what the impact of appropriate weight gain is on mom, on birth outcomes, and on baby.

There’s some science that suggests that the babies are certainly larger at birth, they have poorer outcomes. And there’s some science to suggest that neurodevelopmentally, they’re delayed over time, related to mother’s increased weight and obesity. So we’ll be able to test that out and see whether or not that’s true.

Follow Veronique LaCapra on Twitter: @KWMUScience