Childhood Obesity: Help Children Have “A Different Today For A Better Tomorrow”

Obesity is a costly disease that affects the young and the old. And, it is one that is often unmanaged without professional guidance or the right educational resources, overlooked remaining untreated, and its severity is underestimated. Dr. Travis Stork, a board-certified Emergency Medicine physician, co-host of The Doctors talk show, and author of The Doctor’s Diet describes the notion of “the weight gain emergency”. He explains “the majority of patients in ERs are not there because of trauma or accidents. They are there because of their diets. The biggest emergency in ERs across the United States is the food we willingly, knowingly, happily choose to eat”. (25) Obesity, whether in adults or in children, is a public health crisis leading to its current global epidemic. And, it needs to be treated as any other emergency. “Obesity is a serious and chronic medical disease that requires treatment by a physician or other healthcare provider. It is time for a new conversation about the way society thinks about obesity. It is time for a new paradigm. Only then will the obesity epidemic improve”. (30)

Like other diseases, a person can be treated yet not cured of obesity by putting it in remission. (30) Dr. Primack, President-Elect of the Obesity Medicine Association, explains during an interview with Good Morning Arizona, “Most people who have tried dieting have not been successful. What we’ve learned over the years of treating many patients is that when you start putting together a medical approach, people do well. When we think about other diseases, we don’t go on the internet and say ‘what is the next chemotherapy?’ and just do it ourselves. We go see a specialist. We see a physician. The idea is not to find the next diet. It is to use the techniques that have been proven medically to work for weight”. (6) In their new book, Chasing Diets, Dr. Robert Ziltzer and Dr. Craig Primack, certified Obesity Medicine specialists and Founders of Scottsdale Weight Loss Center in Arizona, emphasize that for a weight loss program to be successful and sustainable, it must be comprehensive having four essential components, namely medical management, nutritional or dietary change, activity plan, and education. They explain this using their chair analogy as follows, “Any time you omit any one of these four components your plan is more likely to fail. Think of it as four legs of a chair. Remove one leg, and you will have a difficult time maintaining balance on that chair”. (30) This is in alignment with the mission of CoreLife, a leader in weight loss health care, namely to “enhance the total health of our community by providing a comprehensive, compassionate, and tailored approach to BMI optimization and lifestyle modification through the coordinated management of medical, nutrition, exercise, and behavior disciplines”. (29)

Dr. Farshad Marvasti (Dr. Shad), a Stanford-trained physician leader and medical educator as well as the Chief Medical Officer of MyShapers, emphasizes that childhood obesity is “a big issue facing our nation and the world”. (14) Today more children than ever before are faced with childhood obesity which is associated with obesity in later years. (10) Healthy children, on the other hand, will become healthy adults. Research has also supported that children of obese parents will most likely become obese themselves. (15) “Our inherited DNA determines many aspects of weight control. Having a single overweight parent doubles the risk of developing obesity. If both parents have obesity, their children have at least a 90% chance of having obesity”. (30) Childhood obesity is a serious matter that is on the rise and it is also putting the children at risk for chronic health conditions and life-threatening diseases. Some of these include asthma, cirrhosis, colon cancer, coronary disease, deep vein thrombosis, degenerative joint disease, depression, dyslipidemia, exercise intolerance, gallstones, hernia, hypertension, hypogonadism in boys, polycystic ovary syndrome in girls, poor quality of life, poor self-esteem, pulmonary embolus, sleep apnea, stress incontinence, stroke, and type 2 diabetes. (13) Imagine if all these conditions were caught early, reduced, or even prevented. Isn’t it true that “children are our future”? Why should they deal with obesity and its negative consequences? Why should they carry this burden? “CHILDHOOD OBESITY through the Eyes of a Child” was created to raise awareness about childhood obesity and to help parents realize that this chronic health condition places a heavy burden on children. (2)

Why not try to end this “vicious cycle of childhood obesity”? (26) Four steps to achieving healthy weight include: “1. empower yourselves with up-to-date knowledge on childhood obesity; 2. make sure no junk food or bottled sugary drinks are kept in your fridge; 3. place importance on an active lifestyle, have family outings together (quality time with your children) and exercise together; and 4. limit the time for computer games and television”. (26) When we break the “vicious cycle of childhood obesity”, then adult obesity and its sequelae can be prevented. (26) There are genetic predispositions associated with obesity and being aware of them can help children make necessary changes in their lifestyle. Drs. Ziltzer and Primack discuss the notion of “obesities”, which is the reason why people following the same weight loss plan using diet, medication, and exercise may lose weight at a different speed. “Obesities are genetic diseases that manifest with phenotype (appearance) of obesity or overweight. Just as there are many types of cancer, there are many types of obesity”. (30) Studies done on genes affecting obesity have come to important conclusions some of which are briefly described below.

A common variant that is seen in childhood obesity, as well as in adult obesity, is INSIG2 or the “insulin gene”, which plays a role in fat metabolism and insulin resistance. (23) Variants in ADIPOQ, which is known as the “fat burn hormone gene”, are associated with obesity and type II diabetes. The reason being adiponectin is a protein hormone that controls glucose levels and the breakdown of fatty acids. (21) Mutations in the PCSK1 gene are linked to obesity due to the effect on BMI and POMC processing. Variants of this gene also have an effect on insulin, due to a rise in the circulating proinsulin level and defective glucose homeostasis. (4, 22, 27) Variants in PPARG have been associated with obesity. The reason being PPARG controls the genes involved in lipid storage and metabolism as well as insulin sensitivity. (17, 18)

A common variant is the FTO gene, which was the first “obesity risk gene” discovered. This gene promotes food intake and is associated with emotional eating or binge eating behavior. (5) Variants in DRD2 and OPRM1, both considered “addictive genes”, are linked to emotional eating as well as binge eating disorder. DRD2 is known as a “dopamine gene” and it has a role in the reward pathways in the brain. The reason being when you eat your favorite food, the level of dopamine increases affecting these pathways, which leads to euphoria. The issue arises when one’s favorite food is high in sugar or fat, leading to an increase in dopamine, activating the reward system in the brain, and thus resulting in food addiction and obesity. The OPRM1 gene is involved in the opioid neuronal circuits, which when activated, lead to an increase in dopamine, resulting in the “rewarding value” of food. It is also associated with fat intake and therefore affects the risk of obesity. (7, 11)

A rare defect in the MRAP2 gene has been found to contribute to early childhood obesity. This gene codes for a “satiety protein” and thus affects a child’s intake of food and the ability to feel full. A variant in MC4R, which has a direct relationship with MRAP2, leads to a delayed signal to the brain. In other words, there is less sensitivity to the “satiety signals”. In addition, children who lack the MRAP2 gene are at risk for early childhood obesity because they tend to overeat. However, this can be prevented with a healthy diet and exercise regimen. (1, 12)

Mutations in the LEP gene have been associated with a monogenic form of childhood obesity. Leptin, also known as the “hormone of energy expenditure” or the “starvation hormone”, has a role in body fat mass, appetite, and energy expenditure; and with other genes, it affects hunger and satiety through the central nervous system. The LEP/leptin receptor system (LEPR) is involved in this process so true deficiency would lead to obesity in the first few months following birth. (8) The LEP gene works with Ghrelin, the “hunger hormone” or the “appetite-stimulating hormone”, and both of their receptors are in the same area of the brain. The level of ghrelin increases before meals and decreases after meals; and, it is one of the reasons for snacking and overeating. In addition, ghrelin is released in times of stress, which explains the cause of emotional eating and potential weight gain. Both leptin and ghrelin are involved in weight maintenance. Furthermore, leptin resistance and increased ghrelin lead to obesity. (9) Because the production of leptin occurs at night, people who experience “short sleep” have large appetites and are at risk for overeating. Therefore, those who sleep less than seven hours every night, that is “short sleep”, are at risk for obesity. Researchers have also discovered these genes that play a role in the circadian rhythm, namely CLOCK, SLC6A4, and GRIA3, affect the number of hours of sleep. (24, 28)

Choosing a healthy lifestyle is the first line of defense against obesity. Dr. Arya Sharma, founder and Scientific Director of Obesity Canada, explains during an interview with the Canadian Obesity Network, “It’s not that lean kids [aren’t sedentary], it’s just that kids who are genetically predisposed to obesity are far more likely to pack on the pounds when spending hours in front of the TV than kids who are genetically less obesity-prone. From a prevention and treatment perspective, this means that overweight and obese kids will have to work much harder at changing their lifestyles”. (3) How much more important is it that we focus on healthy habits especially if we have a predisposition for obesity? Part of the solution for childhood obesity is involving the parents. (14) One way parents can be role models for their children is by making healthy eating and physical activity a priority. They can inspire, motivate, and empower their children and help them understand the importance of choosing a healthy lifestyle. There are various online platforms as tools for this journey of a lifetime. One that is ideal, safe, evidence-based, innovative, proven effective, and now in a scalable format is the MyShapers program, which is an interactive platform making it more engaging for the children in the 6–11 age group. (20) This self-paced program with remote access allows both parents and their children to gain valuable nutrition education, physical activity management, and behavior modification. MyShapers child weight management program enables children to go through the stages of change in a fun way; and, they experience behavioral modification through an evidence-based approach. Laura Conrad, founder and CEO of MyShapers, describes this “better eating and activity program for children” as follows, “MyShapers uses fun videos and lively characters including animated fruits and vegetables to bring our nutrition and fitness lessons to life. We want families to make small lifestyle changes that add up to a lifetime of good health”. (19) With the knowledge that is learned in this program, the children will have the opportunity to also apply it in their everyday life. In addition, they develop healthy habits that last for a lifetime and help them build self-esteem. Dr. Shad emphasizes, “When we think about solutions, we have to think about involving the entire family. As a practicing Family Medicine physician, as a Clinical Associate Professor of Family Community and Preventive Medicine, I can see how MyShapers can be a novel innovative solution to the needs of our time. And we have to do this not just for us, but for our children and for the next generation”. (14) Why keep waiting and seeing the incidence of childhood obesity rising? Why not start now and make a difference for these children? We need to respond to this “weight gain emergency” quickly. We can help fight childhood obesity and put an end to this public health crisis and global epidemic, by taking action now and creating an opportunity for the children to have “a different today for a better tomorrow”.

References

1. Asai, M., Ramachandrappa, S., Joachim, M., Shen, Y., Zhang, R., Nuthalapati, N., & Ho, C. (2013). Loss of function of the melanocortin 2 receptor accessory protein 2 is associated with mammalian obesity. Science, 341(6143), 275–278

2. Asham, N. (2018). Childhood obesity through the eyes of a child. Retrieved from https://www2.slideshare.net/NermeenAsham/childhood-obesity-through-the-eyes-of-a-child-239129496

3. Beauchamps, R. 2018, ‘L’obésité génétique Fat Genes’, Montréal enSanté, Summer 2018, p. 49

4. Benzinou M, Creemers JW, Choquet H, Lobbens S, Dina C, et al. (2008) Common nonsynonymous variants in PCSK1 confer risk of obesity. Nat Genet 40: 943–945

5. Castellini, G., Franzago, M., Bagnoli, S., Lelli, L., Balsamo, M., Mancini, M., & Stuppia, L. (2017). Fat mass and obesity-associated gene (FTO) is associated to eating disorders susceptibility and moderates the expression of psychopathological traits. PloS one, 12(3), e0173560

6. DoctorPrimack. (2019, Feb 6). Arizona family chasing diets book launch interview from feb 2 2019 Craig Primack MD. Retrieved from https://www.youtube.com/watch?v=l156rwN5bSk

7. Emotional eating genes. Retrieved from https://www.gbhealthwatch.com/GND-Emotional-Eating-Genes.php

8. Funcke, J. B., von Schnurbein, J., Lennerz, B., & Lahr, G. Monogenic forms of childhood obesity due to mutations in the leptin gene. Molecular and Cellular Pediatrics. 2014

9. Ghrelin: how to control this ‘hunger hormone’ in order to lose fat. Retrieved from https://draxe.com/ghrelin/

10. Gordon-Larsen P, The NS, Adair LS. Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obesity.2010;18(9):1801-–804

11. Heber, D., & Carpenter, C. L. (2011). Addictive Genes and the Relationship to Obesity and Inflammation. Molecular Neurobiology, 44(2), 160–165

12. Hornung, L. (2013, July 22). Childhood obesity gene identified. Retrieved from http://sciencenordic.com/childhood-obesity-gene-identified

13. Hypnotic weight loss helps control childhood obesity. Retrieved from http://hypnosisconnection.com/hypnosis-for-childhood-obesity/

14. Laura Conrad. (2018, Oct 8). MyShapers childhood obesity prevention. Retrieved from https://www.youtube.com/watch?v=CMFMrMhG_HA&t=2s

15. Liu, Y., Chen, H. J., Liang, L., & Wang, Y. (2013). Parent-child resemblance in weight status and its correlates in the United States. PLoS One, 8(6), e65361

16. Mansoori A, Amini M, Kolahdooz F, Seyedrezazadeh E, Obesity and Pro12Ala Polymorphism of Peroxisome Proliferator-Activated Receptor-Gamma Gene in Healthy Adults: A Systematic Review and Meta-Analysis. Ann Nutr Metab 2015;67:104–118

17. Mattevi, Vanessa & Zembrzuski, V.M. & Hutz, Mara. (2007). Effects of a PPARG gene variant on obesity characteristics in Brazil. Brazilian journal of medical and biological research = Revista brasileira de pesquisas médicas e biológicas / Sociedade Brasileira de Biofísica et al. 40. 927–32. 10.1590/S0100–879X2006005000114

19. MyShapers About Us. Retrieved from https://myshapers.com/about-us/

20. MyShapers Online Nutrition and Activity Program. Retrieved from https://myshapers.com/home/

21. Obesity, type 2 diabetes and the ADIPOQ gene. Retrieved from http://www.gbhealthwatch.com/GND-Obesity-T2DM-ADIPOQ.php

22. Pieter Stijnen, Bruno Ramos-Molina, Stephen O’Rahilly, John W. M. Creemers; PCSK1 Mutations and Human Endocrinopathies: From Obesity to Gastrointestinal Disorders, Endocrine Reviews, Volume 37, Issue 4, 1 August 2016, Pages 347–371

23. Prakash, J., Mittal, B., Srivastava, A., Awasthi, S., Srivastava, P., & Srivastava, N. (2017). Common genetic variant of insig2 gene rs7566605 polymorphism is associated with severe obesity in north India. Iranian biomedical journal, 21(4), 261

24. Rabin, R. (2018, January 30). Binge eating at night? Your hormones may be to blame. Retrieved from https://www.nytimes.co/2018/01/30/well/eat/binge-eating-at-night-your-hormones-may-be-to-blame.html

25. Stork, T. (2015) The doctor’s diet. New York, NY: Grand Central Life & Style

26. Tan, A. (2016, November 23). Fighting childhood obesity — a clarion call. Retrieved from https://mypositiveparenting.org/2016/11/23/fighting-childhood-obesity-a-clarion-call/

27. Wang, L., Sui, L., Panigrahi, S. K., Meece, K., Xin, Y., Kim, J., … Leibel, R. L. (2017). PC1/3 Deficiency Impacts Pro-opiomelanocortin Processing in Human Embryonic Stem Cell-Derived Hypothalamic Neurons. Stem Cell Reports, 8(2), 264–277

28. Weight loss and short sleep. Retrieved from https://www.gbhealthwatch.com/Science-Weight-Loss-Short-Sleep.php

29. Why CoreLife? Retrieved from https://corelifemd.com/about-us/#ourmission

30. Ziltzer, Z. & Primack, C. (2019) Chasing diets: stop the endless search and discover the solution. Dublin, OH: Telemachus Press, LLC