A study led by Brian Moss of Wayne State University’s School of Social Work reveals that one third of infants in the U.S. are obese or at risk of obesity. In addition, of the 8,000 infants studied, those found to be obese at 9 months had a higher risk of being obese at 2 years. Other studies have revealed that Infant obesity increases the risk for later childhood obesity and could lead to other obesity-related health problems like heart disease, asthma, high blood pressure and cancer. According to the U.S. Centers for Disease Control and Prevention, childhood and infant obesity has more than tripled in the past 30 years.
Moss, in collaboration with William H. Yeaton from the Institute for Social Research at the University of Michigan in Ann Arbor, published their analysis, “Young Children’s Weight Trajectories and Associated Risk Factors: Results from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B),” in the January/February 2011 issue of the American Journal of Health Promotion. The ECLS-B draws from a representative sample of American children born in 2001 with diverse socioeconomic and racial/ethnic backgrounds. It is one of the first studies to monitor weight status changes of a nationally representative sample of very young children.
For their study, Moss and Yeaton used results from ECLS-B to follow the trajectory of the infants’ weight status at 9 months and 2 years, then performed statistical analyses to examine whether weight persistence, loss or gain was linked to demographic characteristics such as sex, race/ethnicity, geographic region or socioeconomic status. Children above the 95th percentile on standard growth charts were considered to have infant obesity, children in the 85th to 95th percentile were considered at risk for obesity.
Some of their results show that:
• 31.9 percent of 9-month-olds were at risk or obese;
• 34.3 percent of 2-year-olds were obese or at risk for obesity;
• 17 percent of the infants were obese at 9 months, rising to 20 percent at 2 years;
• 44 percent of the infants who were obese at 9 months remained obese at 2 years;
• Hispanic and low-income children were at greater risk for weight status gain;
• Females and Asian/Pacific Islanders were at lower risk for undesirable weight changes;
• 40 percent of 2-year-olds from the lowest income homes were at risk or obese compared to 27 percent of those from the highest income homes.
“This study shows that a significant proportion of very young children in the United States is at risk or is obese,” said Moss. The team notes a consistent pattern of obesity starting early in life. “As obesity becomes an increasing public health concern, these findings will help guide health practitioners by targeting high risk populations and foster culturally sensitive interventions aimed at prevention and treatment of obesity,” Moss said.
“We are not saying that overweight babies are doomed to be obese adults. However, we have found evidence that being overweight at 9 months puts you on track for being overweight or obese later in childhood.”
Using the results of Project EAT-II: Eating Among Teens, researchers from the College of Saint Benedict and Saint John's University, the University of Minnesota, and the University of Texas, Austin, analyzed the diets, weight status, weight control behaviors, and drug and alcohol use of 2,516 adolescents and young adults between the ages of 15 and 23. These participants had been part of Project EAT-I, an earlier survey of middle school and high school students from 31 Minnesota schools using in-class surveys, food frequency questionnaires, and anthropometric measures taken during the 1998-99 academic year.
Participants were identified as current (4.3%), former (10.8%), and never (84.9%) vegetarians. Subjects were divided into two cohorts, an adolescent (15-18) group and a young adult (19-23) group. They were questioned about binge eating and whether they felt a loss of control of their eating habits. More extreme weight control behaviors including taking diet pills, inducing vomiting, using laxatives, and using diuretics were also measured.
The authors found that among the younger cohort, no statistically significant differences were found with regard to weight status. Among the older cohort, current vegetarians had a lower body mass index and were less likely to be overweight or obese when compared to never vegetarians.
Among the younger cohort, a higher percentage of former vegetarians reported engaging in more extreme unhealthy weight control behaviors when compared to never vegetarians. Among the older cohort, a higher percentage of former vegetarians reported engaging in more extreme unhealthy weight control behaviors when compared to current and never vegetarians.
In the younger cohort, a higher percentage of current and former vegetarians reported engaging in binge eating with loss of control when compared to never vegetarians. In the older cohort, a higher percentage of current vegetarians reported engaging in binge eating with loss of control when compared to former and never vegetarians.
Writing in the article, Ramona Robinson-O'Brien, Assistant Professor, Nutrition Department, College of Saint Benedict and Saint John's University, St. Joseph, MN, states, “Study results indicate that it would be beneficial for clinicians to ask adolescents and young adults about their current and former vegetarian status when assessing risk for disordered eating behaviors. Furthermore, when guiding adolescent and young adult vegetarians in proper nutrition and meal planning, it may also be important to investigate an individual's motives for choosing a vegetarian diet.”
Where did the story come from?
The study was carried out by researchers from Hopital de la Pitie and the IPC (Investigations Preventives et Cliniques) Center in Paris, France. It was funded by French public health bodies, the Caisse Nationale d'Assurance Maladie (CNAM) and the Caisse Primaire d'Assurance Maladie de Paris (CPAM-Paris). The study was published in the peer-reviewed European Journal of Clinical Nutrition.
This research was generally covered well by the media, with most stories making it clear that alcohol had not been found to improve health, but rather that people who drank moderately also had better health and social status. The messages from some headlines were more misleading, however, with Metro claiming that “Drinking wine makes you happier” and The Sun suggesting that booze “aids the body”.
The Daily Mail featured particularly clear coverage, with both its headline and article clearly explaining that the good health of moderate drinkers is more likely to be down to healthier diet, exercise and work–life balance rather than any supposed benefits of alcohol.
What kind of research was this?
This cross-sectional study analysed the relationship between alcohol intake, other cardiovascular risk factors and health status in a large French population. The aim was to evaluate potential confounding factors that may be behind the supposed cardiovascular benefits of alcohol.The researchers looked at data on the clinical and biological characteristics of nearly 150,000 people, which were gathered as part of a large ongoing cohort study.
Several observational studies have shown an association between moderate alcohol intake and a lower risk of cardiovascular disease. The lower risk is often attributed to alcohol having beneficial effects on blood levels of lipids, such as cholesterol, or on other factors, such as the effect of the antioxidants in alcoholic drinks. The researchers point out that addressing the underlying message implied by previous data, that moderate alcohol intake is good for health, is particularly important in France, which has one of the highest average individual alcohol intakes in the world.
The researchers also stress that the findings from observational studies need to be viewed with caution, so they assessed a number of key factors not taken into account by previous research. These key, but generally unexplored, factors included mental wellbeing, subjective health status and social factors.
What did the research involve?
All the people in the study underwent a clinical examination between 1999 and 2005, which included measurements blood pressure, waist circumference, cholesterol, respiratory function and heart rate. Also recorded were tobacco use, physical activity, personal medical history, current medications, social status and occupation. Stress and depression scores were assessed using validated questionnaires, and people were also asked to estimate their own health status.
Alcohol intake was quantified as the number of standardised glasses of pure alcohol (10g a glass) consumed each day, and different types of alcoholic drink were also recorded. People were divided into four groups according to their alcohol consumption: never, low (less than 1 glass a day), moderate (1-3 glasses a day) or high (more than 3 glasses a day). Former drinkers were analysed as a separate group. Established statistical techniques were used to analyse the relationship between alcohol intake and all the other factors. The results were adjusted to account for the influence of age and were also broken down by gender.
What were the basic results?
The researchers found that:
13.7% of men and 23.9% of women did not drink at all. Total alcohol intake increased with age in both sexes. Apart from people aged under 30, most people drank wine. They found that women who drank moderate amounts of alcohol had lower body mass index, waist circumference, blood pressure and blood lipids, including LDL (“bad”) cholesterol. Men who drank moderately had lower body mass index, heart rate, blood pressure, some blood lipids (triglycerides) and fasting glucose levels, plus lower stress and depression scores.
Men who drank little or moderately were also more likely to have better self-assessed health status, social status and respiratory function. In both sexes, alcohol intake was strongly associated with higher levels of HDL (“good”) cholesterol, a finding which was independent of the type of alcoholic beverage consumed.
How did the researchers interpret the results?
The researchers concluded that moderate and low consumption of alcohol was strongly associated with several clinical, social and biological characteristics that point to overall better health status and a lower risk of cardiovascular disease. Importantly, they say, few of these factors seem causally related to alcohol consumption.
They point out that social status was “strikingly different” across the groups, with moderate alcohol consumption being a “powerful general indicator” of social status. Risk factors that have never been taken into account before, such as social and professional status, anxiety score and heart rate, were all more favourable in moderate consumers.
Their results, they say, raise the possibility that the seemingly protective effects of moderate alcohol consumption found in previous research may have been due to the researchers not fully taking account of possible confounders.
This research adds a note of caution to the results of previous studies. It concludes that moderate alcohol consumption may be a marker of better health and lower cardiovascular risk rather than a cause of these improvements.
The study's strength is that it is based on a relatively large cohort and that standardised, validated methods were used to collect clinical and biological information. The main weakness of the study is its cross-sectional design, which means that people were not followed up over time to see if they developed disease. This also meant that deaths from heart disease, for example, were not reported.
Another limitation is that alcohol intake was based on self–reported data. This leaves a possibility for error as accurate recall of alcohol consumption is notoriously hard in this type of study. Future research in this area will ideally follow people over time and carefully measure possible risk factors to establish whether alcohol has any direct, causal role in protection from heart disease.
Overall, this study has implications for public health. As the researchers say, its results suggest that it is premature to promote alcohol consumption as an independent factor for cardiovascular protection, as some have proposed based on past research.
A referral to Nastaran Habibi should be made when your patient needs more intensive dietary, nutritional and lifestyle behavior education than you can provide in your office environment. Nastaran can help particularly when the patient is in the preparation, action or relapse stages of change.
A consultation generally includes a diet and lifestyle assessment, and nutrition education and counselling. Nastaran will review your patient’s medical and social status, including biochemistry and othe relevant test results, dietary and family history and home environment. In addition she will take anthropometric measurements and collect information on the patient’s individual food preferences and cultural, socio-economic and lifestyle needs. Taking into account the patient’s own goals, knowledge, skills and access to resources, Nastaran will custom design a program for your patient based on the principles of Medical Nutrition Therapy. She integrates self-management training regarding information on nutrient content, food choices, and meal preparation based on each patient’s particular and unique circumstances. Initial appointments are more than 1 hour.
What happens next:
- You will receive a formal report assessing your patient’s nutritional, physical activity and lifestyle status including Nastaran’s recommendations for improvement, possible barriers to success and guidelines for evaluating progress.
- During the 45-90 minute follow-up visits, Nastaran will review your patient’s progress, provide further education, encourage continued adherence to the plan and identify any obstacles to success.
In order for your patient to qualify for a Medicare rebate, referral must be through an Enhanced Care Plan. Referrals outside Medicare will still qualify for a Health Fund rebate.