Children become obese as a result of “tiny, imperceptible mistakes” their parents make in feeding them over years, a major international conference on paediatrics has heard.
Parents don't generally overfeed their children but may supply them with more calories than they need over time, according to Prof Russell Viner, president of the Royal College of Paediatrics and Child Health in the UK. Just a spoonful of surplus butter daily can lead to a person putting on a kilo in weight in a year, he pointed out.
Poverty is the ultimate cause of childhood obesity, and major risk factors such as diet, exercise, smoking in pregnancy and high maternal body-mass index are all “downstream” from it, he argued.
Prof Viner said society needed to “get away from parent-blaming” and take a social determinant approach to obesity. Today’s obesogenic environment is a “monster” most parents cannot fight.
“For most obese children, if you put them into the world of the 1950s, they would not be obese. So how can we argue their parents’ behaviour is abuse?”
Prof Viner was speaking against a motion that “Obesity is a form of child abuse” at the Europaediatrics 2019 conference in Dublin’s Convention Centre.
Dangerous disease
Speaking in favour of the motion, Prof Francesco Chiarelli, from the University of Chieti in Italy, described obesity as a dangerous disease and said families and society were failing to prevent the harm involved.
Many parents “don’t feel the problem is there” and misperceive their own, and their children’s, weight, he said.
He pointed to studies showing child obesity rates were highest among families with “authoritarian” parenting styles, but lowest among those with “authoritative” – firm but loving – styles.
He also highlighted a small Swedish study in which the weight of obese children dropped after they moved to a foster home where an authoritative parenting style was applied, with limits set for intake of sweets and food portions, and support provided for physical activity.
But Prof Viner said children “go in and out” of obesity as they develop between the ages of two and 10. “Our definitions are statistical but we can’t create statistical diseases. The strongest cause of disease and ill-health in our children is poverty. Yet we don’t believe poverty is a disease.”
Less violent
Modern high-income societies were less violent or abusive than societies in the past and their food environment was much more positive, given the history of famine until recent times, he said. The “downside” of this is a rise in the availability of energy-dense food, but it was “a step too far” to see this as abusive.
“We need to change the environment, [as] changing behaviour is too hard.”
Young people are often unable to discriminate between different media and types of information and are vulnerable to the images conveyed
The audience of healthcare professionals split fairly evenly on the motion, in two votes taken before and after the speakers’ presentations.
In a presentation on fad diets and adolescents, Orla Walsh, consultant paediatrician at Temple Street Children's University Hospital, highlighted the role of the media in contributing to a rise in eating disorders.
Young people are often unable to discriminate between different media and types of information and are vulnerable to the images conveyed, she said. Media portrayal of dieting, often featuring celebrity endorsement, tended to promote unrealistic standards.
While not a new phenomenon, fad diets were usually not long-lasting in effect, and could have serious physical and psychological effects.
Dieting is the most important predictor of developing an eating disorder, she pointed out.
