Science & Sensibility, Lamaze International’s “Research Blog About Healthy Pregnancy, Birth & Beyond,” just posted an essay of mine titled “Unintended Consequences: Cesarean Section, the Gut Microbiota, and Child Health.” It’s an explanation of the probable link between cesareans and childhood asthma, eczema, and other chronic health problems. Stop by and have a read!
Category Archives: Obesity
I recently wrote a guest post for Lamaze International’s excellent Science & Sensibility blog. The subject was the study by Huh and colleagues about the association of cesarean birth and childhood obesity. (See my own blog post about the study here.) Interesting discussion going on. Please weigh in if you feel so inclined!
Does cesarean birth put a baby at increased risk for obesity in the future? Seems a little far-fetched at first glance, but Dr. Susanna Huh and her Harvard colleagues just published a study that makes the link a bit more “near-fetched.” (The study itself is available here.)
Huh’s team found that children born by cesarean section were twice as likely to be obese at 3 years of age than were those born vaginally. This relationship held up even when factors like the mother’s weight, ethnicity, age and how many babies she’d already had were taken into account. Interestingly, it didn’t make a difference whether the cesarean was performed before or after labor started.
The study wasn’t designed to look at the reasons for the increased risk in obesity, but the Harvard team suggested several possibilities:
The first is the alteration of the gut microbiota–the sum total of all the bacteria found in the human bowel–caused by a cesarean birth. (More detail on that here and here.) This alteration can lead to low-level inflammation in the bowel which is associated with obesity.
The second possibility is that cesarean birth is just a stand-in for something else that’s happening at the same time. In this case, Huh and colleagues wonder about all the antibiotics given to women who are having cesareans. Antibiotics are known to alter the gut microbiota, but research results are mixed as to whether this is a lasting effect.
Finally, it’s possible (though unlikely) that all of this has nothing to do with the gut microbiota. There are hormones and other factors related to inflammation that surge in a mother’s bloodstream (and her baby’s) during labor, and these, obviously, are missing if a mother undergoes a cesarean before she starts labor. The lack of maternal stress response during labor could adversely impact the development of the newborn immune system, leading to the inflammation associated with obesity.
My best guess: it’s a big moosh of all of the above, plus other factors no one has even dreamed of yet. In the meantime, the issue of increased obesity risk is one more thing physicians and pregnant women should consider before deciding on how a baby is to be born.
It’s a complicated matter, this business of hatching healthy humans…
There’s an excellent documentary tonight on obesity in the U.S.: The Weight of the Nation (8:00 pm, HBO). From the Robert Wood Johnson Foundation:
The documentary is part of a public service campaign that encourages action at the personal, community, and national levels to prevent obesity. To raise awareness of the obesity epidemic and support action to reverse it, HBO is providing free online access to the entire documentary, as well as topic-specific segments, action steps, discussion guides, and other materials at http://theweightofthenation.hbo.com/. The series also will be viewable on YouTube.
Check it out–it promises to be a remarkable show.
Here’s a Brazilian study that claims cesarean section isn’t a risk factor for obesity, which contradicts other studies that suggest an association between the two. Interesting finding, but this will need to be confirmed in other countries. There may be something about Brazil–cultural factors like diet, for example–that may overshadow cesarean birth’s alleged obesity risk.
Bottom line: obesity is a complex topic, and there are obviously many factors involved. Cesareans still seem likely to be a contributor, but to what degree remains to be seen.
One of the topics I’ll be focusing on in 2012 is the role that early childhood stress plays in the development of disease later in life.
This is a relatively new and fascinating corner of the research world, with the original research being performed by Drs. Vincent Felitti and Robert Anda, who demonstrated the link between adverse childhood events (ACEs, as they’re commonly known) and chronic health issues in adulthood in the 1990s.
Felitti and Anda studied seven categories of adverse childhood experiences: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The results of their 1998 study, which involved 9,300 southern California Kaiser Permanente patients, were startling:
“Persons who had experienced four or more categories of childhood exposure [ie, adverse childhood events], compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, ≥50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity.”
In a number of follow-up studies the relationship has held true, and recent advances in neuroscience have helped to explain the link. So how do ACEs lead to later chronic illness? Why do some people emerge from traumatic childhoods largely unscathed, while others succumb to drug abuse and violence? And most importantly, what can be done to lessen the effects of ACEs on a child’s future health?
Those are subjects for future posts. In the meantime, here’s a link to a Salon interview with the authors of “Scared Sick: The Role of Childhood Trauma in Adult Disease”, a new book on the subject. The Q and A with the authors is worth a read.
It’s a bit of a movie stereotype: the stressed-out lead character
(usually female) gulping a pint of Haagen-Dazs mint chocolate chip while pouring out her heart to her plucky (usually thinner) friend. Boyfriend trouble! Lost job! Fashion failures! It all leads inevitably to the freezer.
Turns out that it’s true. Stress, especially when it’s chronic, can lead to impulsive eating and obesity, even in young kids. How? A new study published in the journal Pediatrics seeks to answer that question.
Researchers in rural upper New York state measured the body mass index (BMI) of 244 white nine year-olds, then rechecked their BMIs four years later. They also tallied a stressor score for each child: a combination of nine items that included poverty, single parent status, housing problems, family turmoil, and exposure to violence.
The study found that children with higher total stress scores at age 9 were more likely to be obese at age 13. Chronic stress seems to gradually erode the ability to self-regulate, particularly to delay gratification. This finding agrees with other recent research that shows that stressed kids eat more high fat and sugary foods than their non-stressed friends.
It’s becoming clearer with each new study that chronic stress has a number of effects, all of them bad, on children’s health. Obesity is just one consequence. The health effects of early childhood stress may be lifelong, too–more on that soon.
Kellogg’s Honey Smacks cereal contains how much added sugar by weight?
Answer: Sorry, trick question. The correct answer is ‘none of the above’, because Honey Smacks is actually more than 50% added sugar by weight.
Now, you’d probably expect that from a cereal with the somewhat misleading word ‘Honey’ in its name. (Remember when they used to be called ‘Sugar Smacks’? Ah, for those simpler, more bluntly marketed times of yore…) But Honey Smacks is far from alone in turning breakfast into dessert.
In a study recently released by the Environmental Working Group, two-thirds of the 84 popular cereal brands surveyed exceeded federal guidelines for sugar content. And that includes 25 cereals manufactured by General Mills, which, you may recall, was a “Premier Sponsor” of the recent annual meeting of the American Dietetic Association.
Absolutely unsurprisingly, cereal manufacturers are fighting the federal guidelines–which are voluntary, by the way–tooth and nail. I don’t have a quote from the manufacturers to give you, but if I did it would no doubt run along the lines of cursing the socialist nanny state the U.S. has become,
and reasserting the God-given right of American parents to turn their children into diabetics before they are old enough to vote. (Cue the flags.)
Yes, parents can certainly read the nutrition facts printed on the cereal box and make intelligent nutrition choices, but wouldn’t it be better if they didn’t have to wade through a minefield of unhealthy choices (masterfully marketed to their kids) in the first place? The sad fact is that cereals such as these are mainstays in the diet of many American school kids, and in many areas of the country it’s not easy to find healthy alternatives.
Unfortunately, the Environmental Working Group didn’t include a list of low-sugar cereals, which would be a helpful aid to harried and hurried parents at the market. I’ll try to dig one up and report back.
Do you have a healthy cereal alternative you’d like to recommend?
In case you had any question about what really motivates our nation’s legislators (hint: $), here’s an article from today’s NY Times that should provide the answer: Congress Blocks New Rules on School Lunches.
Current school lunch rule:
- A slice of pizza counts as a vegetable, as long as there’s some tomato paste on it.
Proposed new school lunch rule:
- A slice of pizza counts as a vegetable, as long as there’s 1/4 cup of tomato paste on it.
This (and other proposed rules that would reduce fat, salt, and white potato consumption, among other things) sent the companies who produce the lion’s share of the food consumed by American students into a raging tizzy. These companies include, you may not be surprised to learn:
- ConAgra (maker of such nutritious fare as “Lamb Weston quality french fries” [a.k.a. fat + salt + white potatoes], and “Kid Cuisine All-American Fried Chicken”: 540 calories, with 37% of “daily value” for total fat and cholesterol; 31% of sodium; and 54 grams of carbs–all neatly packed in a microwaveable plastic tray),
- Del Monte Foods (with its nearly infinite variations on canned fruit in syrup), and
- Coca-Cola (’nuff said).
You know you’re dealing with a sleazy bunch of lobbyists when John Keeling, executive vice-president of the National Potato Council, can straight-facedly say that his organization is committed to protecting “school districts, parents and taxpayers” from this massive government attempt to deprive the nation’s kindergarteners of their deep-fried lard. Or words to that effect.
Another thoughtful spokesman, this time Corey Henry of the (and its subsidiary–I’m not making this up–the National Frozen Pizza Institute), said that the proposed rules made no sense, since that much tomato sauce on a slice of pizza would be gross, and kids would just throw all that good vegetable-equivalent pizza in the trash, and then starve to death during arithmetic. Oh, and the terrorists would win, too. (Okay, he didn’t put it exactly like that, but I stand by my paraphrase…).
Somehow (hint:$) these earnest spokespeople managed to twist enough congressional arms to block the legislation. Democracy in action!
It must be incredibly difficult to be a healthy school lunch advocate at times like these, but thank God people keep at it. Some examples of advocacy are here, here, and here. There are many, many more organizations fighting the kind of legislative craziness we’re seeing at present, and some of them are likely right in your community. If you have one you’d like to spotlight, please send me the information and I’ll post it.
I realize I’ve been neglecting older kids lately, what with all the home birth posts…
This post tags on to a previous post about night-owl teens being more prone to obesity. Now a study published in the journal Chest shows that sleeping less than 8 hours a night on weeknights is associated with obesity in adolescent boys, but for some reason not in girls. There’s a chicken and egg element to all this, as usual. The authors speculate that poor sleep may lead to hormonal changes that promote obesity. But obese kids tend to have poorer quality sleep in general–they’re more prone to sleep apnea, for example. So is it the lack of sleep that leads to obesity, or is it being obese that causes teens not to sleep well? Given the boy-girl difference, I suspect its hormonal.
No matter the reason for the sleep-obesity link, this is one more study that shows the importance of adequate sleep for kids.