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Early Childhood Obesity Prevention Policies (2011)

Chapter:Appendix B: Emerging Issues in Early Childhood Obesity Prevention

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Suggested Citation:"Appendix B: Emerging Issues in Early Childhood Obesity Prevention." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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B
Emerging Issues in Early Childhood Obesity Prevention

There is growing interest in the potential role of exogenous agents—including chemical pollutants, drugs, and microorganisms—that may disturb metabolism in a manner that promotes obesity in young children. These agents are generally thought to be potentially influential through prenatal exposures, but could also be associated with exposures to the child. The committee does not view the evidence linking these agents to childhood obesity as sufficient to influence policy, but it is important to monitor the evidence in this area and promote research whose results could indicate that curtailing these exposures would reduce the risk of early childhood obesity.

Endocrine-disrupting chemicals in the environment have been hypothesized to increase the risk of obesity (Heindel and vom Saal, 2009; Newbold et al., 2008). This hypothesis suggests that these chemicals cause biologic changes in the systems that control adipose tissue development, ultimately causing offspring to be of higher body weight. The mechanisms, though poorly understood, are thought to be parallel to the pathways by which maternal metabolism during pregnancy and tobacco smoke are believed to program the fetus toward having a higher risk of obesity.

A range of drugs have been used in the livestock industry to enhance growth of farm animals (Heindel and vom Saal, 2009). The list of contenders for chemical “obesogens” is extensive, including drugs such as diethylstilbestrol and antithyroid medications and pollutants such as bisphenol A (BPA), phthalates, organophosphates, carbamates, PCBs (polychlorinated biphenyls),

Suggested Citation:"Appendix B: Emerging Issues in Early Childhood Obesity Prevention." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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DDT (dichlorodiphenyltrichloroethane), cadmium, and lead (Heindel and vom Saal, 2009; Newbold et al., 2008). Pollutants that act as endocrine disruptors include agents that are known to alter metabolism in experimental settings and may have analogous effects in adult humans, although there is no direct evidence of effects on infants or children. In one study of participants in the National Health and Nutrition Examination Survey, evidence was found linking levels of phthalates in blood to waist circumference and levels of insulin resistance in adults (Stahlhut et al., 2007). An analogous study in the National Health and Nutrition Examination Survey of polyfluoroalkyls did not find an association of blood levels with body mass index (BMI) or insulin resistance (Nelson et al., 2010).

In 2006, a paper published in Nature reported that microbial populations in the gut differ between obese and lean people, and that when obese people lost weight, the state of their microflora reverted back to that observed in a lean person, suggesting that obesity may have a microbial component (Turnbaugh et al., 2006). In a more recent study, Turnbaugh showed that the microbiota in the human gut can be transferred successfully to germ-free mice; that in germ-free mice transplanted with human fecal microbiota, a high-fat, high-sugar diet durably changes the transplanted microbiome; and that this diet-altered microbiome promotes obesity (Turnbaugh et al., 2009).

The chemicals of concern have a range of endocrine effects and are therefore of health concern independently of whether they influence obesity in children in particular. Regulation needs to take into account the full array of health concerns and target the most sensitive endpoints as the limiting factor in defining acceptable exposure levels. Reducing human exposure to these agents would have no known detrimental effects on health.

Enhanced efforts are warranted to determine whether such agents make a contribution to the marked changes seen in the occurrence of childhood obesity. Such efforts include further mechanistic research, as well as observational studies, to determine whether such exposures during gestation and early childhood are related to increased weight and elevated risk of obesity.

REFERENCES

Heindel, J. J., and F. S. vom Saal. 2009. Role of nutrition and environmental endocrine disrupting chemicals during the perinatal period on the aetiology of obesity. Molecular and Cellular Endocrinology 304(1-2):90-96.

Suggested Citation:"Appendix B: Emerging Issues in Early Childhood Obesity Prevention." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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Nelson, J. W., E. E. Hatch, and T. F. Webster. 2010. Exposure to polyfluoroalkyl chemicals and cholesterol, body weight, and insulin resistance in the general U.S. population. Environmental Health Perspectives 118(2):197-202.

Newbold, R. R., E. Padilla-Banks, W. N. Jefferson, and J. J. Heindel. 2008. Effects of endocrine disruptors on obesity. International Journal of Andrology 31(2):201-207.

Stahlhut, R. W., E. van Wijngaarden, T. D. Dye, S. Cook, and S. H. Swan. 2007. Concentrations of urinary phthalate metabolites are associated with increased waist circumference and insulin resistance in adult U.S. males. Environmental Health Perspectives 115(6):876-882.

Turnbaugh, P. J., R. E. Ley, M. A. Mahowald, V. Magrini, E. R. Mardis, and J. I. Gordon. 2006. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature 444(7122):1027-1031.

Turnbaugh, P. J., V. K. Ridaura, J. J. Faith, F. E. Rey, R. Knight, and J. I. Gordon. 2009. The effect of diet on the human gut microbiome: A metagenomic analysis in humanized gnotobiotic mice. Science Translational Medicine 1(6).

Suggested Citation:"Appendix B: Emerging Issues in Early Childhood Obesity Prevention." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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Suggested Citation:"Appendix B: Emerging Issues in Early Childhood Obesity Prevention." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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Suggested Citation:"Appendix B: Emerging Issues in Early Childhood Obesity Prevention." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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Suggested Citation:"Appendix B: Emerging Issues in Early Childhood Obesity Prevention." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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Suggested Citation:"Appendix B: Emerging Issues in Early Childhood Obesity Prevention." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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Childhood obesity is a serious health problem that has adverse and long-lasting consequences for individuals, families, and communities. The magnitude of the problem has increased dramatically during the last three decades and, despite some indications of a plateau in this growth, the numbers remain stubbornly high. Efforts to prevent childhood obesity to date have focused largely on school-aged children, with relatively little attention to children under age 5. However, there is a growing awareness that efforts to prevent childhood obesity must begin before children ever enter the school system.

Early Childhood Obesity Prevention Policies reviews factors related to overweight and obese children from birth to age 5, with a focus on nutrition, physical activity, and sedentary behavior, and recommends policies that can alter children's environments to promote the maintenance of healthy weight. Because the first years of life are important to health and well-being throughout the life span, preventing obesity in infants and young children can contribute to reversing the epidemic of obesity in children and adults. The book recommends that health care providers make parents aware of their child's excess weight early. It also suggests that parents and child care providers keep children active throughout the day, provide them with healthy diets, limit screen time, and ensure children get adequate sleep.

In addition to providing comprehensive solutions to tackle the problem of obesity in infants and young children, Early Childhood Obesity Prevention Policies identifies potential actions that could be taken to implement those recommendations. The recommendations can inform the decisions of state and local child care regulators, child care providers, health care providers, directors of federal and local child care and nutrition programs, and government officials at all levels.

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