The Effect of Prenatal and Postnatal Care on Childhood Obesity

In 2001, the surgeon general reported that health problems resulting from obesity would rival the number of diseases and deaths resulting from smoking. The report also warned that if this problem remained unabated, many health care achievements made in the 20th century would be undermined (U.S. Department of Health and Human Services [HHS], 2001). In light of this sobering estimate, childhood obesity has become a major public health problem in the United States. Estimating from past and current trajectories, the rate of obesity will continue to increase before it stabilizes. The latest report from the Centers for Disease Control and Prevention (CDC) (2011) shows that the rate of childhood obesity has tripled since the 1980s, with about 12.5 million (approximately 17 percent) obese children ages two to 19. The risk for obesity is particularly high for children who come from low-income or minority families. To make matters worse, Bell et al. (2011) noted that the obesity rate is continuing to increase, and children who already are heavy are getting heavier. Obesity may have several harmful consequences for children. Obese children are vulnerable to various health risks. For instance, many will likely develop high blood pressure and high cholesterol, which increase the risk for cardiovascular diseases. Obesity is also associated with type 2 diabetes through glucose intolerance and insulin resistance (Bell et al., 2011; Daniels, 2009). Furthermore, obese children could face social stigma, which can lead to discrimination and loss of self-esteem (Vamosi, Heitmann, Thinggaard, & Kyvik, 2011). Financially, the burden associated with obesity for individuals and society can be substantial. Though there are no specific data on the costs of obesity in children alone, when looking at costs for children and adults together (both medical costs and the cost of lost productivity from premature death and restricted labor activities associated with obesity), the total economic cost was $147 billion in 2008 dollars (Finkelstein, Trogdon, Cohen, & Dietz, 2009). Although the knowledge base on adult and adolescent obesity is increasing and several state and federal policies are in place to manage this problem, studies of early-onset childhood obesity are less common. However, a number of epidemiological studies have indicated that the risk for childhood obesity is highly associated with pre- and postnatal factors such as mother's weight during pregnancy, smoking, breast feeding, and child care--among other factors (Cnattingius, Villamore, Lagerros, Wikestrom, & Granath, 2012; Harder, Bergmann, Kallischnigg, & Plagemann, 2005; Ino, Shibuya, Saito, & Inaba, 2011). These and other studies seem to support the premise that the risk for obesity is rooted in prenatal care and continues through various phases of childhood development. As a result, we examined the impact of prenatal and postnatal characteristics on childhood obesity. LITERATURE REVIEW Obesity, like many other health problems, results from a complex interplay of biological, social, and behavioral factors. Biologically, Neel (1962)postulated in his thrifty gene hypothesis that some people are more disposed to gaining weight because evolutionary processes have increased fat stores as a reaction to food scarcity. If that is the case, natural selection may have favored and preserved individuals whose genes are able to minimally metabolize energy over the many cycles of abundance and scarcity. Though studies are still preliminary and genetic mechanisms are not yet fully understood, a number of researchers have identified several common genetic markers they believe might contribute to childhood obesity and various forms of fat storage around major organs (Hamilton et al., 2010; Han, Lawlor, & Kimm, 2010). Although it seems clear that genetics are linked to adiposity, social and behavioral factors are an equal or even more important element. …