I was born small for gestational age; so were my diabetic brother and obese sister. My mother like many in the 1950s was instructed by her obstetrician to limit pregnancy weight gain to <20 lbs. She was also told that continuing her one-pack-a-day cigarette habit would aid with this goal. We were Roman Catholics, so birth control was out of the question. Breastfeeding was out of vogue, and pediatricians recommended infant formula as a substitute. My mother promptly became pregnant just months after each new birth. Thus, my siblings and I were born over 4 years with underdeveloped muscles and metabolically deranged organs, and then denied the compensating benefits of breastfeeding. This phenomenon was not uncommon.
My aunt followed in her sister's footsteps as did many women across the U.S. The combination of prenatal tobacco use, infant formula, and frequent pregnancies—i.e., the obesity trinity—synergistically created the first generation of nutritionally programmed youth, the baby-boomers. Suburban living, value-priced fast food, cable TV, and computers sealed their fate. Now in their 50 and 60s this generation has the highest prevalence of obesity in history, triple that of their parents. Of more concern are their obese children, many programmed due to maternal obesity and gestational diabetes. It is their offspring, the grandchildren of baby-boomers, who are perhaps the most vulnerable. These are the preschoolers with significant obesity, the 6–12-year-olds with metabolic syndrome and the obese adolescents with hypertension, type 2 diabetes or non-alcoholic fatty liver disease, so resistant to treatment that the only solution may be bariatric surgery. More alarming are the severely obese, insulin-resistant teenage girls who will ultimately provide the optimal fetal environment for the next generation of metabolically programmed newborns.
So, what's the answer? How do we deprogram the obesity trinity? There are three critical areas to focus our efforts. The first is the newly expectant mother. Her actions during pregnancy and the 2 years that follow will determine her child's metabolic future. Thus, intense nutrition and physical activity behavioral counseling and education should begin during the very first visit to the obstetrician and continue until the child enters preschool. The second opportunity is prior to puberty when the metabolism will likely be set for the remainder of the child's life. Preschoolers should be provided opportunities at home, in school, and throughout the community to engage in free play most of their waking hours including climbing activities to promote muscular strength. They should also be offered appropriately portioned, nutrient-dense foods in designated areas away from media distractions. Environments must be altered to support these initiatives. One cost-effective method is requiring that, prior to receiving building permits, developers include green space for organic gardening, local farmers’ markets, parks, and walking and bicycling trails. Lastly, high-quality weight-management programs, which offer intense behavioral counseling, must be available for families with already obese youth. Obese adolescent girls would benefit the most as it is critical that they develop a healthy metabolism during the years leading up to motherhood to ensure a healthy future for their children.
Note: Dr. Sothern attributes her healthy weight and that of her two daughters, Samantha, 26 years and Allyson, 17 years, to lots of outdoor free play during childhood, participation in synchronized swimming, volleyball, martial arts, gymnastics and dance during adolescence, regular aerobic AND strength training during adulthood, dining to New Orleans jazz and candlelight as a family, and a diet rich in fruits, vegetables, and Louisiana seafood most days per week. ■
Author Disclosure
No competing financial interests exist.