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Preventing Childhood Obesity: Health in the Balance
ago, even though their genetic susceptibility and that of their child has not changed over this period. Parental obesity more than doubles the risk of adult obesity among both obese and nonobese children under 10 years of age (Whitaker et al., 1997). For example, an obese preschool child with normal weight parents has approximately a 25 percent chance of being obese as an adult. However, this same preschool child with an obese parent has more than a 60 percent chance of being an obese adult (Whitaker et al., 1997). An additional implication of the adult and childhood obesity co-epidemics relates to intergenerational transmission. There are a number of potential mechanisms by which maternal obesity in pregnancy may promote offspring obesity (Whitaker and Dietz, 1998; Levin, 2000; Oken and Gillman, 2003), and further research is needed to examine these mechanisms.
Children can inherit obesity susceptibility genes from an obese parent or parents, or can be exposed, after birth, to diet and activity patterns that promote obesity. Moreover, recent research suggests that an altered intrauterine environment may be a third mechanism (see Chapter 8). For example, obese mothers are more likely to experience diabetes in pregnancy, and some evidence suggests that the offspring of mothers who have diabetes in pregnancy may have an increased risk of developing obesity later in life (Silverman et al., 1998).
In a study of low-income families enrolled in the WIC program, children born to mothers who were obese at the time of conception were twice as likely to be obese at 4 years of age (Whitaker, 2004b). Although much remains to be learned about the mechanisms of intergenerational obesity, these data suggest that it may be important to consider the promotion of healthy body weights among pregnant mothers as part of childhood obesity prevention efforts, and obesity research efforts should examine prevention interventions for pregnant mothers who are obese as well as for their children.
CONSIDERING THE COSTS FOR CHILDREN AND FOR SOCIETY
The primary concern about childhood obesity is its potential impact on well-being, not only in childhood but into adulthood, with the term “well-being” reflecting the committee’s view that social and emotional health is as important as physical health. As discussed in Chapter 1, families may differ in the value they place on the different health outcomes of obesity, and the merits they attribute to certain benefits or drawbacks of changing behaviors to address it (Whitaker, 2004a). Research suggests that some parents do not perceive weight to be a health issue for their children (Baughcum et al., 2000; Jain et al., 2001; Borra et al., 2003), independent of their child’s physical and social functioning. Thus, individuals may differ in the value