Mythologies in treatment of childhood obesity

childhood obesityWe all know that obese children tend to be inactive. This leads to the “obvious” conclusion that the solution to childhood obesity is simply more exercise. But what if that conclusion is totally wrong?

There is no mistaking that obesity and lack of physical activity are linked. But which comes first? The answer appears to be obesity (1). A study published online in the Archives of Disease in Childhood followed young children over a four-year period carefully measuring their physical activity with accelerometers to measure physical activity for seven consecutive days as well as their percentage of body fat using DEXA scans. What they found was that physical inactivity was not related to the increased accumulation of body fat, rather they found that increased body fat was the cause of decreasing physical activity. This is also the situation with adults (2-5).

So why do so many researchers believe that inactivity leads to fatness? Because it just has to be the answer. This belief persists in spite of numerous studies that demonstrate that increased physical activity has little impact on reducing childhood obesity (6). This is a classic case of don't confuse me with the facts, since in my heart I know I am right.

This is not to say that exercise has no benefits in obese children. In fact, the same authors had published an earlier study indicating that while intense exercise had little impact on fat loss, there is a significant benefit in reducing insulin resistance (7).

The implications of this study in children are immense. In essence, increasing public expenditures to increase physical activity will not address the childhood obesity epidemic no matter how much money you throw at the problem. Instead you have to focus on reducing calorie intake. However, this decrease in calorie consumption is not going to be accomplished by increased willpower, but by increasing satiety (lack of hunger) in obese children.

As I pointed out in my most recent book, “Toxic Fat,” if you want to increase satiety, you must reduce cellular inflammation in the brain (8). That is best accomplished by a combination of an anti-inflammatory diet coupled with high-dose fish oil.

Of course, as an alternative, you could always consider gastric bypass surgery.


  1. Metcalf BS, Hosking J, Jeffery AN, Voss LD, Henley W, and Wilkin TJ. “Fatness leads to inactivity, but inactivity does not lead to fatness.” Arch Dis Chil doi:10.1136/adc.2009.175927
  2. Bak H, Petersen L, and Sorensen TI. “Physical activity in relation to development and maintenance of obesity in men with and without juvenile onset obesity.” Int J Obes Relate Metabl Disord 28: 99-104 (2004)
  3. Petersen L, Schnorhr, and Sorensen TI. “Longitudinal study of the long-term relation between physical activity and obesity in adults.” Int J Obes Relate Metabl Disord 28: 105-112 (2004)
  4. Mortensen LH, Siegler Ic, Barefoot JC, Gronbaek M, and Sorensen TI. “Prospective associations between sedentary lifestyle and BMI in midlife.” Obesity 14: 1462-1471 (2006)
  5. Ekelund U, Brage S, Besson H, Sharp S, and Wareham NJ. “Time spent being sedentary and weight gain in healthy adults.” Am J Clin Nutr 88: 612-617 (2008)
  6. Wareham NJ, van Sluijs EM, and Ekelund U. “Physical activity and obesity prevention: a review of the current evidence.” Proc Nutr Soc 64: 229-247 (2005)
  7. Metcalf BS, Voss LD, Hosking J, Jeffery AN, and Wilkin TJ. “Physical activity at the government-recommended level and obesity-related outcomes.” Arch Dis Child93: 772-777 (2008)
  8. Sears B. “Toxic Fat”. Thomas Nelson. Nashville, TN (2008)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

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About Dr. Barry Sears

Dr. Barry Sears is a leading authority on the impact of the diet on hormonal response, genetic expression, and inflammation. A former research scientist at the Boston University School of Medicine and the Massachusetts Institute of Technology, Dr. Sears has dedicated his research efforts over the past 30 years to the study of lipids. He has published more than 30 scientific articles and holds 13 U.S. patents in the areas of intravenous drug delivery systems and hormonal regulation for the treatment of cardiovascular disease. He has also written 13 books, including the New York Times #1 best-seller "The Zone". These books have sold more than 5 million copies in the U.S. and have been translated into 22 different languages.

12 thoughts on “Mythologies in treatment of childhood obesity

    • The problems of obesity, dental care, and diet is just as important to adults. Our Zone Cruises address all of those concerns every year for a one-week immersion course into Zone Living.

      The problem is not the teaching, its the execution of the knowledge after they leave the ship and head home.

  1. It is my opinion that for children to recover from obesity, the parents must first begin the process. Children learn best by following, and living in a healthy, in respect to food, environment. Any whole food lifestyle will do. I personally think that sugar, ground grains, excess manufactured oils have no place in healthy human diet, unless they are of normal weight and of good health.

  2. Dr Sears,

    What you say is right but what is it about food that is causing this increased weight. I didn’t eat great as a kid and was quite slim. I did a moderate amount of exercise but nothing exceptional. I have seen kids eat correctly according to your formula of 40% protein, 30% carbs and 30% fat with a good amount of exercise and still be quite heavy. Is it the quality of the food?

    • It is the growing impact of omega-6 fatty acids on not only the current diet (thus increasing cellular inflammation), but the impact of the omega-6 fatty acids in the fetal programming of the child before birth. That’s the scary part.

  3. Dr. Sears has commented in his early books about the gift of genetics. I have a family riddled with type 1 and type 2 diabetes. Before the Zone, I was 50 pounds overweight and starving all the time. I would wake up an hour before my alarm and go downstairs to ‘self-medicate’ my gnawing hunger with straight carbs – usually toast and jam – so that I could get back to sleep. My husband is 6’3″ and 180 lbs. He maintains his young adult weight with no effort. In addition, he has a sweet tooth that drives him to consume deserts and many delicacies in astounding portions. His weight, blood sugar, cholesterol, physical stamina and good health are a phenomenon. He is of that 25% of the population that incredibly fortunate to be resistant to the effects of CHO surges.

    As a youngster, I was pretty active. We ate sensibly, though not nearly ‘Zone’ meals – even then protein was pricey. I suspect that our youth’s ‘epidemic’ is a perfect storm of genetics, the convenience of fast food and prepared snacks, high stress levels, decreased exercise and a dearth of the neighborhood freedoms that we were afforded, alongside the technological entertainment that keeps kids sedentary. When we created spare-time or afterschool activities, 50 years ago, they were ALWAYS linked to meeting someone via bicycle (with NO parental oversight) or going to the lake to swim. Those things were just a given. Now, parents hover, transport and struggle with the fears of their communities – whatever that is. Big changes. I don’t think we can saddle the children or their diet with all the responsibility for this.

    • Sheryl, interesting concept with some agreement, however, my sister and I were both in the same home, same parents, same meals. My sister started gaining weight around 8 years old (grew up in the late 60′s in suburban neighborhood of Arlington, VA) – and she did not go out and run and play outside like I did. She had the same access to the same foods as I did. My mother cooked incredible meals and nothing of zone quality. She cooked Russian and French foods (that is what we were) and hardly ever ate fast food or McDonalds for that matter. Yet, my sister steadly gained weight. She hated to run, jump or play with me and our neighborhood friends, nor ride a bike or most physical activity. She ballooned out. I was no skinny minny but I was never pegged by my doctor as fat. So, so many theories but there are so many other factors as well, including mental that many people fail to bring up. She had an emotional problem due to my dad and it just escalated as the weight poured on and others mocked her for it. Back in the 60′s and 70′s one rarely saw fat kids or teens, now it is common, and very sad. I had lost weight with the zone diet (27-30 pounds) and I still deal with fat that is accummulated around my middle which I struggle with. This is genetics but I know I am working in the right direction nonetheless and will not give up. Also, I am 53 and my teenage son asks me what it is that I actually want!!! (he is fit, lean and weight lifts!) My husband is fat and does not seem to get the idea that it is unhealthy to be that way. What can I do?? Ultimately at this point, it is up to each of us. Kids however, should not be eating fast food and all that processed food too. This is the big culprit of our society: convenient, fast and processed foods. It is killing this next generation of people. My sister is now a diabetic and digustingly obese and it makes me sad. Both my parents are dead and both had heart conditions too. My dad lived pretty long, 84 years but my mom died right after her 75th birthday.

    • Unfortunately, the data is clear that obesity leads to inactivity as opposed to inactivity leading to obesity. A bigger difference is that kids were not as hungry 50 years ago as they are today even though they were exercising more.

  4. It’s the food. My sister-in-law starts her kids out in the morning with Pop Tarts; then spaghetti with garlic bread for dinner. They put the kids on a treadmill to try and keep their weight down. They also refuse to believe it’s the food. I was at my favorite Greek restaurant tonight, eating lemon sole–and 2 servings of vegetables instead of vegetables and white rice pilaf–re-reading the Anti-Inflammation Zone. An integrative medicine doc recommended I get rid of all animal protein in my diet, due to the history of hormonal cancer in my family. I did and felt awful. I gained 15 pounds–13 of it seemed to land in my midsection. I feel so much better eating whole foods and following The Zone (adjusting it to allow 1 additional carb in my situation). I track my food almost daily on Days I feel my best, my carbs never exceed 47%.

    • You have now got a dietary program that now works with your biochemistry and genetics. Next step is reducing the intake of omega-6 fatty acids to reduce the levels of cellular inflammation.

  5. I agree with the above post by Sheryl McDevitt. It is the perfect storm for all Americans, both young and old. If you notice, when you see an over weight kid they are usually in the company of over weight parents, and they all look like they are proportionally over weight by the same amount. That means they are all eating the same things and over consuming by the same amount. That sort of suggests a timing component too, they are spending the same amount of time eating because of hunger, tension, and/or boredom. Scientists should start to clock boredom time not just exercise time to get the full picture. Eating is usually social, takes very little effort, tastes interesting and good (most of the time) and is necessary, but easily overdone. We have lots of other needs going unmet, simply draped over with another potato chip or slice of cake, causing a chemical cascade that starts a crazy cycle of seeking but not finding satiety. Fill up on the good stuff (but don’t get stuffed) everyone clean up the kitchen, and go do something interesting, fun, or just get jobs done. P.S. TV makes people cranky and bored after a time.

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