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HEALTHY
EATING

Childhood

Obesity:

An Unresolved Public

Health Problem

By John Menchaca, MD

Childhood obesity continues to be a major public health problem for obesity. Another option for the physicians involved with the
1-2
for at least the past forty years and continues to worsen. Multiple ap- mother’s first baby and its well-baby care is to become involved with
proaches have been tested to prevent and treat obese children both at the mother’s postpartum period. Obviously, there would have to be
home, school, or both, though all with poor results. It is well recog- additional reimbursement for the physician’s involvement over the two
nized that many of the obese children will eventually become obese to three years between the pregnancies. A final, third option, is more
adults with several complications. These well-documented complica- vigorous health education in middle and high school for both males
tions including diabetes, cardiovascular disease, liver disease, increased and females. This would make it so when they move on to parenthood,
2,3
cancer, and dementia. Hence, there is a need to explore other thera- both young mothers and fathers will be at optimum status at the time
peutic approaches. of conception.
In the past two decades, attention has been focused on the role of the In summary, what we have done and are trying now has not suc-
prenatal period on the development of childhood obesity. To the dis- ceeded. We must consider other approaches to help stem the tide of
appointment of many, interventions during the pregnancy have not childhood obesity and, by default, adult obesity.
2,3
yielded satisfactory results.
In recent years, attention has turned to the periconceptional period, John Menchaca, MD is a member of the Bexar County Medical
which is three months before conception to the end of the first Society.
5
trimester of the pregnancy. Animal studies are very encouraging. Fur-

thermore, studies on the donor sperm in in vitro fertilization proce- References
dures have demonstrated that sperm from obese male donors are 1. Ogden, C.L. et al: Trends in Obesity Prevalence Among Children and Adolescents
abnormal and are associated with obesity in the offspring resulting in the United States 1988-1004 through 2013-2014 JAMA 2016 Jun 7; 315(21)
2292-2299
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from the pregnancy. The role of maternal obesity has been likewise 2. Al- Khudairy et. al: Diet, physical activity, and behavioral intervention for the treat-
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well documented. Preliminary clinical studies of interventions on ment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database
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obese mothers before conception are very encouraging. There are nu- Syst. Rev. 2017 (6) CDO 12691
3. Colquitt, Jill L. et. al. Diet, physical activity, and behavioral intervention for the
merous studies underway to confirm that interventions that improve treatment of overweight or obesity in preschool children up to age of 6 years.
the weight and nutritional status of the obese mother will help mini- Cochrane Database Syst. Rev. 2016 May 2016 (3) CDO 12125.
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mize the risks for the offspring to become obese in their later years. 4. Meyer, D.M. et al: Evaluation of Maternal Dietary n-3 LC – PUFA Supplementation
as a Primary Strategy to Reduce Offspring Obesity; Lessons from the INFAT Trial
The most difficult, if not impossible task, is to identify the mother and Implications for Future Research. Front. Nutri. 2020 7: 156
before she gets pregnant so intervention measures can be initiated. One 5. Nichols, L.M. et al: The Early Origins of Obesity and Insulin Resistance, Timing,
approach is contacting the mother after she has her first baby, initiating programing, and Mechanisms. Int. J Obesity 2016 40: 229-238
6. Sultan, S. et al: Male Obesity Associated Gonadal Dysfunction and the Role of
interventions to improve her weight and nutritional status before she Bariatric Surgery. Front. Endocrinol. (Lausanne) 2020 vol 11 p 408
gets pregnant with her second baby. Our obstetrical colleagues could 7. Catalano, P.: Reassessing strategies to improve pregnancy outcomes in overweight
stay in touch with the mother in-between the first and second preg- and obese women. 2019 vol 7: pp 2-3
8. Erickson, M.L. et. al: Rationale and Study Design for Lifestyle Intervention in Prepa-
nancies to hopefully improve her weight and nutritional status before ration for Pregnancy (LIPP): A Randomized Controlled Trial. Contemporary Clin-
she gets pregnant. This would hopefully minimize her offspring’s risk ical Trials 94(2020) 106024

26 SAN ANTONIO MEDICINE • May 2021