06/21/2011 11:52 EDT | Updated 08/21/2011 05:12 EDT

Should Childhood Obesity Programs Treat the Parents?

This post is not about offering to 'involve' parents in the treatment of their overweight and obese offspring.

No! This post is actually about whether, instead of the kids, their overweight or obese parents should themselves be seeking treatment.

I pose this question simply because it appears to me that the knee-jerk response to the burgeoning childhood obesity is to target the kids and hope that this will eventually prevent adult obesity.

Unfortunately, while it is true that overweight and obese kids more often than not grow into overweight and obese adults, we have yet to see any childhood obesity intervention translate into lower rates of adult obesity.

This may not really be all that surprising, because our current adult obesity epidemic can hardly be blamed on the notion that these were all once obese kids.

My own adult obesity program is full of adults, who, as kids, played outside, rode their bikes to school, came home to home-cooked dinners, and went to bed at 8:00 p.m.. Being a skinny active kid certainly didn't work for them.

Rather, I am much more inclined to assume that today's childhood obesity epidemic is directly and causally related to today's adult obesity epidemic. Whatever is causing obesity in today's adults is likely to be the very cause of obesity in their offspring.

So if adult obesity is in fact the 'root cause' of childhood obesity, then the only hope to address this root cause would be to perhaps treat the parents.

Indeed, genetics aside, it is mom and dad, who in the end determine both the household foodscape and activity levels. If mom and dad don't like fruits and vegetables, it is unlikely that these will be served to their kids. If mom and dad don't exercise, it is unlikely that their kids will exercise. If mom and dad spend most of their time in front of the TV or computer, it is hard to expect the kid to play outside. If mom and dad can't cut out the sugary pop, ice cream, cookies and chocolate, it is unlikely that their kids will say "no." If mom and dad can't break the fast-food and dining-out habit, it is unlikely that junior will have regular home-cooked meals.

So any household obesity intervention needs to begin by looking at the parents. This, of course is where things get difficult, because the drivers of weight gain in the parents may not be that easily amenable to change.

Without doubt, for many families, unhealthy eating and lack of activity simply reflects a lack of time, which, in turn, often reflects a money problem (both parents work to pay the bills, unhealthy foods are cheaper than healthy choices).

But this may not just be about time and money. Mom's preference for sweets and chocolate could be her way of self-medicating her depression or counteracting the blood sugar-lowering effect of her diabetes medications. Dad's lack of energy could just be from his untreated sleep apnea or the sheer physical exhaustion from schlepping his weight around the construction site.

Mom's obsession with her child's shape and size could just be an expression of her own life-long struggles with weight and body-image. Dad's addiction to chips and pizza may simply be his way of coping with giving up cigarettes and alcohol.

Not addressing these underlying 'root causes' of excess weight in the parents is unlikely to markedly change the environment or instill healthy habits in their kids.

In fact, several studies now show that the key to addressing childhood obesity may lie in focusing on the parents themselves.

Perhaps the most extreme example of this comes from a Quebec study that looked at the impact of moms undergoing bariatric surgery on their kids' weights. In this large case series, with observation periods up to 18 years, obesity rates among children born to mothers after bariatric surgery dropped to only 17 per cent from obesity rates of 41 per cent among the children born to the same mothers before surgery.

Interestingly, even when the post-surgery group was matched to women of similar BMI at the time of conception, the post-surgery kids were still half as likely to obese than their offspring born before surgery.

While drastic, it may be worth noting that so far no other intervention has ever been shown to cut childhood obesity rates by half - definitely nowhere close to what could be expected by educating kids and parents on healthy eating or removing pop machines from schools.

Indeed, there is now increasing evidence supporting the notion that the most promising and effective prevention of childhood obesity may require limiting weight gain during pregnancy. This is because we now know that increased maternal weight (and age?) can markedly alter in-utero gene-expression in the developing fetus (epigenetic programming) and thereby very much determine the future offspring's obesity risk. In the light of these findings, interventions that set in once the kid is born may simply turn out to be 'palliative' at best.

If changing mom's weight is the best way to reduce her kid's obesity risk, then childhood obesity prevention efforts would call for preventing and treating obesity in moms rather than 'fiddling' with the kids.

This is not to say that dad's weight may not be as important. Although this issue has been less studied, it does not take a rocket scientist to figure out that obese dad with his 'hungry-man' appetite and passion for watching endless hours of hockey on TV may not be the best 'role model' for his son. Again addressing dad's obesity may well be the only way to actually hope to have any lasting success with the kids.

Simply put -- to use a far-from-simple analogy -- as long as parents can't kick their smoking habit -- teaching the kid to inhale less is unlikely to be all that successful.

Unfortunately, as with smoking cessation, many parents will likely need professional help with their own obesity.

The bottom line here is that any attempt to address childhood obesity without also addressing adult obesity is unlikely to lead to any major breakthroughs in Canada's obesity prevention efforts.

The importance of involving the parents has now been well recognized and has led to the 'family-centred' approach used in most pediatric obesity programs across Canada.

Perhaps the next step is to not just involve the parents but to actually treat them.