Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 2003 Jan 11;326(7380):102.

Preventing obesity

Prevention starts in infancy

Carol M Campbell 1
PMCID: PMC1124986  PMID: 12521978

Editor—Crawford in his editorial on population strategies to prevent obesity has not mentioned an important factor in the aetiology of obesity: the method by which infants are fed.1

Von Kries et al found that a history of three to five months of exclusive breast feeding was associated with a 35% reduction in obesity at the age of 5 to 6 years, which was not accounted for by social factors, lifestyle, etc.2 They discuss the evidence for a programming effect of breast feeding in preventing obesity and being overweight in later life. Gilman et al found that infants who were fed breast milk more than infant formula milk, or who were breast fed for longer periods, had a lower risk of being overweight during older childhood and adolescence.3 graphic file with name campbec.f1.jpg

These results are consistent with those of the DARLING study, which showed that infants who received no milk other than breast milk in the first 12 months were lighter than formula fed infants, though of similar length and head circumference.4 This study also found that energy intake of breastfed infants was lower than that of formula fed infants, even after the introduction of solids; the authors say that comparatively low energy intakes are a function of self regulation in breastfed infants.

Breastfeeding mothers also lose weight after pregnancy more effectively than those who feed artificially, an advantage seen over at least the first 12 months of breast feeding.5

Vigorous marketing of junk food is often implicated in the obesity epidemic. What about inappropriate marketing of infant formula milk? In the United Kingdom, with its limited legal restraints, manufacturers can and do actively promote infant feeding bottles, teats, and follow-on formula milk to the public in contravention of the international code of marketing of breast milk substitutes. This recently drew comment from the UN Committee on the Convention on the Rights of the Child. In its observations of 4 October 2002 the committee recommended that the United Kingdom takes all appropriate measures to promote breast feeding and adopt the international code of marketing of breast milk substitutes in light of its low rates of breast feeding.

Measures to promote and support breast feeding, including legislation and promotion of artificial feeding, seem to be a rational approach to preventing obesity.

References

  • 1.Crawford D. Population strategies to prevent obesity. BMJ. 2002;325:728–729. doi: 10.1136/bmj.325.7367.728. . (5 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Von Kries R, Koletzko B, Sauerveld T, von Mutius E, Barnert D, Grunert V, et al. Breast feeding and obesity: cross sectional study. BMJ. 1999;319:147–150. doi: 10.1136/bmj.319.7203.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Gilman MW, Rifas-Shiman SL, Camargo CA, Berkey CS, Frazier AL, Rockett HRH, et al. Risk of overweight among adults who are breastfed as infants. JAMA. 2001;285:2461–2467. doi: 10.1001/jama.285.19.2461. [DOI] [PubMed] [Google Scholar]
  • 4.Dewey KG, Heinig MJ, Nommsen LA, Peerson JM, Lonnerdal B. Growth of breast fed and formula fed infants from 0-18 months: the DARLING study. Pediatrics. 1991;89:1035–1041. [PubMed] [Google Scholar]
  • 5.Dewey KG, Heinig MJ, Nommsen LA. Maternal weight loss patterns during prolonged lactation. Am J Clin Nutr. 1993;58:162–166. doi: 10.1093/ajcn/58.2.162. [DOI] [PubMed] [Google Scholar]
BMJ. 2003 Jan 11;326(7380):102.

Hidden sugars in foods undermine strategies to reduce obesity and diabetes

Kristin Becker 1

Editor—In tackling the increasing obesity and diabetes problem described by Crawford in his editorial,1-1 the focus needs to be on getting to the root of the problem, not on weight reduction programmes when the damage is already done. We need fundamental changes to food production, not just in labelling.

Trying to find sugar-free foods in shops and supermarkets is like running an obstacle course. It is easy to identify sweets as culprits, but what about the hidden danger of sugar in savoury foods and foods thought to be healthy, such as breakfast cereals, fruit juices, salad dressings, and yoghurts? I make my own fruit yoghurts as it is impossible to buy them unsweetened.

Sugar conditioning starts with baby foods and drinks, and once a child has acquired a sweet tooth, non-sweetened foods are not so attractive. The food industry needs to take more responsibility and have the courage to offer unsweetened products, and the government needs to encourage this practice.

References

BMJ. 2003 Jan 11;326(7380):102.

Doctors underestimate obesity

Gema Frühbeck 1,2, Alberto Diez-Caballero 1,2, Javier Gómez-Ambrosi 1,2, Javier A Cienfuegos 1,2, Javier Salvador 1,2

Editor—The hazards of excess body weight have been clearly established by epidemiological and clinical studies as reviewed by Hitchcock Noël and Pugh.2-1 We agree that obesity can be easily identified and that patients who are mildly or moderately overweight may be overlooked. A recent study has shown that about a quarter of overweight patients were thought to be of normal weight by their primary care doctors.2-2

Despite its high prevalence,2-3 obesity is documented by doctors only in a small proportion of patients, indicating that this life threatening condition is considerably under-reported in medical records.2-4

Similarly, a retrospective analysis found an apparently low rate of obesity in hospital outpatient departments treating conditions related to obesity (4% in cardiology, 5% in rheumatology, and 3% in orthopaedics) in comparison with the true prevalence (30% in cardiology, 20% in rheumatology, and 25% in orthopaedics).2-5 The large disparity between apparent and true prevalence is evidence that opportunities for diagnosing and treating obesity are being missed.

Surprisingly, doctors readily accept the need to treat the consequences of obesity (such as type 2 diabetes mellitus, hyperlipidaemia, hypertension, etc), but the disease itself, which is recognised as a diagnosis under ICD-9 code 278.0 (International Classification of Diseases, 9th revision), is often ignored. Body mass index defines differing degrees of obesity and being overweight, and clinical protocols can be adapted easily to record weight, height, and the resulting index. This simple measure could guide clinicians towards more appropriate referral.2-5

Doctors are called on to play a key part in successfully tackling the obesity epidemic through an early competent diagnosis accompanied by thoughtful and evidence based interventions. The gaps in screening, recommending treatment, and appropriate referral need to be addressed.

References

  • 2-1.Hitchcock Noël P, Pugh JA. Management of overweight and obese adults. BMJ. 2002;325:757–761. doi: 10.1136/bmj.325.7367.757. . (5 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2-2.Caccamese SM, Kolodner K, Wright SM. Comparing patient and physician perception of weight status with body mass index. Am J Med. 2002;112:662–666. doi: 10.1016/s0002-9343(02)01104-x. [DOI] [PubMed] [Google Scholar]
  • 2-3.Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults 1999-2000. JAMA. 2002;288:1723–1727. doi: 10.1001/jama.288.14.1723. [DOI] [PubMed] [Google Scholar]
  • 2-4.Hauner H, Köster I, von Ferber L. Frequency of “obesity” in medical records and utilization of out-patient health care by “obese” subjects in Germany. An analysis of health insurance data. Int J Obesity. 1996;20:820–824. [PubMed] [Google Scholar]
  • 2-5.Cleator J, Richman E, Leong KS, Mawdsley L, White S, Wilding J. Obesity: under-diagnosed and under-treated in hospital outpatient departments. Int J Obesity. 2002;26:581–584. doi: 10.1038/sj.ijo.0801945. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES