Obesity

Introduction

Modern society is raising the most over-weight, out-of-shape generation of children in history and this problem is increasing every year. Childhood obesity in the modern world is an epidemic. One in 10 children are overweight, for a total of 155 million. Approximately, 30-45 million of these children are classified as obese - accounting for 2-3% of the world’s children aged 5-17. Also, 22 million children under five years of age are affected obesity according to previous global estimates based on WHO [World Health Organization] data. Whereas nutritional deficiency is the most prevalent nutritional problem in developing countries, over-nutrition, or obesity, is the number one nutritional disease of children, adolescents, and adults in the West including England and the United States (obesity affects 1 in 5 American children).

In England, 700,000 British school children are obese, according to a current major study that warns of soaring rates of diabetes, liver failure and heart problems among the young. Researchers say that 160,000 children in England are displaying signs that they will develop heart disease and 150,000 have high blood pressure and high cholesterol levels. The research also shows that there are signs of Type 2 (late onset) diabetes in 4,000 of these children. In addition, the research shows that about 58,000 British school children have impaired glucose tolerance, an early sign of increased risk of diabetes. The study calculates that 28 percent of boys and 36 percent of girls in the UK are now overweight or obese and obese children in Europe will top 26 million within four years.

The TCM Perspective

In Traditional Chinese Medicine, the five causes of all illness and imbalance in the human body are improper diet, emotions, lifestyle, external environment and constitution (i.e. genetics). In regards to childhood obesity the most relative of these factors to discuss are diet, lifestyle and genetics. Any explanation of the root causes of the current obesity epidemic must account for its sudden increase. Thus genetic causes are unlikely to be significant. Because while a predisposition to obesity can be inherited, the fact that obesity has increased so much in the last few decades appears to discount genetics as a the main cause. Also, the fact that each succeeding generation is heavier than the last indicates that changes in our diet and lifestyle are playing the key role. Common sense tells us that the recent increase in childhood obesity seems to be linked to the following factors:
  • children are much less active nowadays
  • fatty and sugary foods are more accessible
  • the average portion sizes have become larger
  • the calories per mouthful have increased
In TCM, the digestion is comprised of the spleen and stomach. Improper diet and lack of physical exercise can weaken and impair the digestion. When the digestion is weak, an individual will have difficulty effectively separating the food they consume into “clear” (i.e. nutrients) and “turbid” or waste (i.e. urine and stool) which may also lead to an accumulation of “turbid” materials in the body. When this “turbid” substance accumulates in the body, it is referred to in TCM as dampness and ultimately phlegm when congealed. It is a statement of fact within Chinese medicine that, “Fat people [have] lots of phlegm and dampness.” In fact, fat is nothing other than phlegm, dampness, and turbidity in Chinese medicine. It is also a statement of fact within Chinese medicine that, “The spleen is the root of phlegm engenderment.” In other words, when the digestion is weak this can impair the fluid metabolism of the body causing the retention of fluid in the body known as phlegm-dampness in TCM and fat in modern medicine. Since phlegm and excessive weight is a by-product of a weak digestion, the approach used to treat obesity in Chinese herbal medicine focuses on regulating and strengthening the digestion.


Research Breastfeeding and Protection from Obesity

Study 1: According to a study published in The Lancet (June 8, 2002), babies who are breastfed are 30 percent less likely to experience obesity. There were more than 32,000 children that were 3 to 4 years old included in the study and factors such as birth weight and socioeconomic status were considered.

Study 2: A large study by the Centers for Disease Control and Prevention followed a total of 177,304 socio-economic status children at public health clinics from birth to age 5. The results appearing in the February 2004 issue of Pediatrics proved that breastfeeding for more than 6 months was associated with a healthier weight after the age of four (including underweight probabilities). This study by Dr. Laurence Grummer-Straun and Dr. Zuguo Mei is one of the largest to studies to date, and took into account mothers' weights, and several other factors that might influence the children's weights. After accounting for all of these considerations, the study concluded breastfeeding provides a powerful benefit in promoting ideal weight.

Study 3: A study in the May 16th, 2001 issue of The Journal of the American Medical Association (JAMA) demonstrated that breastfeeding helps to prevent obesity.

A large study from Harvard found that babies who were fed mainly breast milk were significantly less likely to be overweight by the time they were 14 years old. In addition, the longer the child was breast-fed, the lower the chance of developing obesity later.

Obesity Starts Early On…

Study 1: Obesity and the First Week of Life

According to a study from the Children's Hospital of Philadelphia, published in the April 19, 2005 Circulation, how a baby eats in their first week of life may help predict the likelihood of obesity. In the study, 653 formula-fed babies were each measured on seven different occasions while they were babies then contacted the participants again when they were adults in their twenties or thirties. About 32 percent of those included in the study had become overweight adults and the study found that for every 3 ½ ounces of increased weight gain in those first 8 days of life, there was a 28 percent increased chance of becoming overweight as an adult. Furthermore, weight gain during the first 112 days (3-4 months) was also connected with later weight problems, but less significant then the first 8 days. Dr. Alan Greene suggests that perhaps during that first week, babies are setting their internal sense of how much is "normal" for them to eat, how much it takes for them to feel full. He adds “those who eat too much during the first week may be programmed to eat too much later, without even noticing. Thankfully, breastfeeding normally leads to correct amount and pacing of feeds during that first week.” This well-known pediatrician reminds us “with formula-fed kids, care should be taken not to over- or under-feed, as we learn more about the implications of those early days, weeks, and months.”

Study 2: Chubby Babies

Babies who gain more than 8 to 10 pounds in the first four months are more than twice as likely as their peers to be obese when they hit their twentieth birthdays, according to research published in the June 2003 issue of the American Journal of Clinical Nutrition. Our babies are born with an inner sense that tells them when they’re full. This inner sense that we all had (at one time) acts as a regulator, telling babies how much they must eat in order to develop at the rate that suits their individual needs. Our job as parents is to provide our babies access to nutritious foods and to allow them to decide when they have drank or eaten enough. As a result of many years of over eating, many parents have lost touch with this inner regulator and, in turn, we often encourage our children to doubt when they have consumed enough.

Study 3: British Children's Waistlines Growing by an Inch Each Decade

Data collected from 3,000 British children reveals that waist sizes in children as young as six have increased significantly over the past 10 years, especially in girls aged two to three. "These findings should urge healthcare agencies and schools to continue to work vigorously towards promoting healthier lifestyles, including increased physical activity particularly for young children" say the researchers, reporting in the latest issue of the International Journal of Obesity.

The Link Between Parental Smoking, Obesity, and Diabetes

A mother’s choice to continue smoking throughout her pregnancy may affect her unborn child for the rest of his/her life. The January 5, 2002 issue of the British Medical Journal reports an analysis of 17,000 births during one week in March in 1958. Medical records were revisited when those babies were 33 years old. The analysis showed that those whose mother’s smoked had almost a 40% more likelihood of being obese, and more than a 300% increased likelihood of having developed type 2 diabetes at an early age.

Obesity Creates More Health Problems Than Smoking

Over the past decade, though smoking has declined, the chance of a person becoming obese has doubled. A 2004 study has found that health problems such as diabetes, heart disease, arthritis, strokes, and certain cancers are 40 percent more likely to occur in an obese person rather than a smoker or problem drinker. This study further revealed that those who are significantly overweight have 36 percent higher health care costs and pay 77 percent more on medications than people in good health.

Lifestyle and Diet In view of the sudden rise in weight levels - which is a worldwide trend as reflected in the new word "globesity" – lifestyle and dietary factors must be the prime cause of modern obesity. Common sense tells us that the recent increase in childhood obesity seems to be linked to the following factors:
  • children are much less active today
  • fatty and sugary foods are more accessible
  • average portion sizes have become larger
  • calories per mouthful have increased
Exercise and Activity Levels & Obesity Stimulating and Structured Play Spaces Important

A study published in the April 2001 issue of the American Journal of Public Health reported that children were 400% to 500% more likely to be physically active if they had access to stimulating play spaces that are dependably safe (i.e. supervised by adults). Middle school kids were found to be more active if their play space included sport related equipment such as basketball nets, tennis courts and volleyball nets. This study demonstrates that safe, stimulating and structured play spaces in our schools, parks, neighborhoods, and homes can improve the health of future generations.

Exercise’s Effect on Fat!

Duke University announced on May 28, 2003 the results of their 5-year randomized study on body fat. Two kinds of body fat accumulate in the human body as we gain weight: subcutaneous fat (under the skin) and visceral body fat (in and around the organs). A huge increase in visceral fat was found to play a serious role in the worldwide rise in obesity as well as being a contributor to diseases in middle childhood. The Duke STRRIDE project (Studies of Targeted Risk Reduction Interventions through Defined Exercise) looked carefully at the effect of exercise on visceral fat and before and after CT scan results were astounding. Over an eight month period, those in the study who did not exercise regularly increased their visceral fat by a frightening 8.6 percent (even though their weight only increased by about 1 percent). Those with moderate exercise kept their visceral fat stable. Those with higher levels of exercise had a significant 8.1 percent decrease in their visceral fat within only eight months! These results were achieved through exercise alone and diet was not altered. Getting busy pays off!

Sedentary Preschoolers

A study in the July 17, 2004 Lancet followed the daily routines of three-year-old children, and found that these toddlers spent most of the day sitting around. Surprisingly, the children in the study averaged only 20 to 25 minutes a day of active play. This amount of activity is only about a third of the (conservative) 60 minutes a day usually recommended. This study reveals that perhaps adults may need to provide structured activity for some toddlers in order to get them moving. Once an active lifestyle becomes a daily part of a child’s well being, the habit is likely continue throughout their lifetime!

Children Need More Play!

We know that obesity in children is an epidemic worldwide. HHS Secretary Tommy G. Thompson’s report, "Physical Activity Fundamental to Preventing Disease," estimates that more than a quarter of a million Americans die each year as a result of a sedentary lifestyle. Though children are supposed to be vigorously active for 60 minutes per day. The National Institute of Child Health and Human Development (NICHD, February 2003) found that children averaged only 25 minutes per week at school. Children spend so much of their life at school, it is a national crisis that there is not enough time in any school for vigorous physical activity. It is also important that parents do their part in ensuring their children don’t fall victim to childhood obesity and the various diseases that accompany it.

Exercise Guidelines Out of Touch?

Physical activity guidelines may be out of touch with today’s children because the guidelines were based on adults. The CDC and the American College of Sports Medicine only recommends that Americans get 30 minutes of moderate physical activity daily. A study in the September 2001 online issue of Pediatrics used heart monitors to actually measure the activity levels of 1900 children ages 3 to 17. The children averaged 30 minutes daily of high intensity exercise plus another 60 minutes of moderate exercise which is more than 3 times the recommended level. In a time when childhood obesity is becoming an epidemic we need to develop specific criteria for children to help them and their parents become aware of how much activity children need to be healthy.

Walking to School

A study, published online August 17, 2005 in the British Medical Journal, 120 students (from four different classes) aged 13-14 were recruited to wear devices that measured the amount of moderate-to-vigorous physical activity (MVPA) throughout the day. Naturally, those that walked to and from school had significantly more total physical activity per day and met the recommended 60 minutes MVPA per day. An interesting fact that was revealed found the walkers tended to be more active during the rest of their day. Even those who walked just one way each school day enjoyed substantial benefits over those that rode in cars or buses. Previous research has produced similar results in 10-year-old children.

TV in Child’s Bedroom Increases Risk of Obesity

A Columbia University of New York research team demonstrated that having a TV in a preschooler's bedroom increased viewing time by about five hours per week, and therefore increased the risk of obesity by 33%. The American Academy of Pediatrics advises limiting viewing time to 1 to 2 hours per day.

Exercise Shown to Reverse Heart Disease in Obese Kids

The research study of 35 obese children between the ages of 6 to 16 years old lasted 8 weeks. Every participant exercised for one hour, three times a week. By examining the endothelium (the lining of the blood vessels) at the end of the 8 week exercise program, and again 2 months later after the completion of the study, the researchers determined a lower degree of atherosclerosis. The results showed significantly improved endothelial function after completing the program but these improvements disappeared two months later if the children returned to their pre-study activity levels.

Nutrition and Obesity Calcium

Some evidence suggests that small changes in the calcium levels of fat cells can change signals within the cell that control the making and burning of fat. Moreover, a recent study supports this theory by showing that calcium is important for maintaining an ideal weight. An April 2003 FASEB study done at the University of Tennessee found that people who included nonfat yogurt in the diet while trying to lose weight lost 22 percent more weight, 61 percent more fat, and 81 percent more stomach fat (an inch more off the waistline). Both groups in the study ate 500 fewer calories per day. One group had the typical amount of calcium in the American diet (500 mg a day). The treatment group received enough yogurt to supply their calcium requirements – and achieved better results.

Whole Grains

A study in the August 2002 issue of The American Journal of Clinical Nutrition analyzed data from the large, ongoing Framingham Offspring Study. The study found a strong correlation between the amounts of whole grain consumed over a four year period, and healthier weight, healthier waist-to-hip ratio, and decreased risk for diabetes.

Fast Food (Part One)

CARDIA (The Coronary Artery Risk Development in Young Adults study) followed more than 3000 children in Birmingham, Chicago, Minneapolis, and Oakland for 15 years and found a strong association between eating fast food more than twice a week and the development of obesity and type 2 diabetes in teens and young adults. An analysis of their fast food intake was published in the January 1, 2005 Lancet. Ultimately, those who ate fast food more than twice a week gained an extra 10 pounds and had a two-fold increase in insulin resistance in comparison to their peers.

Fast Food (Part Two)

On any given day, more than 30 percent of children in the U.S. will eat fast food, according to a Harvard study in the January 2004 issue of Pediatrics. There were 6000 children included in this study. Those who did eat fast food consumed, on average, 187 more calories, 9 more grams of fat, 24 more grams of carbohydrates and 26 more grams of sugar. These differences add up to about 6 pounds of extra weight per year in an average child (those who eats fast food 2 or 3 times a week). Though these kids consumed more calories, they actually consumed less food per year due to the lack of nutrious foods in their diet.

Dieting May Cause Weight Gain

A Boston study of 16,000 boys and girls aged 9 to 14 showed that despite being more active and consuming fewer calories, those who tried various diet plans actually gained more weight in the long run. Two explanations for this finding were that dieting children are more likely to engage in binge eating and that dieting alters a child's metabolism in a way that actually increases weight gain. This is not the first time that research has found these results. In order to achieve our healthiest potential, we must change our lifestyle.

Importance of Eating Breakfast

A large study in the Journal of the American Dietetic Association confirms the importance of eating breakfast. This study tracked almost 2,400 girls for 10 years, and found that the girls who ate any breakfast at all had a lower body mass index [BMI] than girls who skipped breakfast. The girls who ate cereal for breakfast had the lowest body mass index and those who skipped breakfast tended to fill up on high calorie junk foods during lunch and dinner. Actually, skipping breakfast was found to slow down metabolism. The best way to start the day is with a healthy breakfast rich in protein and complex carbohydrates and some exercise. This will boost your metabolism and your energy levels for the rest of the day.

Carbohydrate Type, Not Amount, Linked to Obesity

Researchers at the University of Massachusetts Medical School have proven that it’s not the total amount but rather the type of carbohydrate that is related to how much an individual weighs.

The study followed 572 people for one year and discovered that people with a higher body mass index [BMI} -- a measure of weight that factors in height -- tended to eat more refined carbohydrates. Refined carbohydrates which are often found in processed foods and have a higher glycemic index (i.e. white bread, pasta etc.). These types of carbohydrate cause a rapid increase in blood sugar, whereas, complex carbohydrates (i.e. whole grains, fruits and vegetable) do not have such a high glycemic index.

(American Journal of Epidemiology, February 15, 2005)


TCM Clinical Trials

Study 1

This abstract is from the article "The Treatment of Pediatric Simple Obesity with Wen Dan Tang (Warm the Gall Bladder Decoction)" by Li Shu-xia, Jiangxi Review of Chinese Medicine, #4, 2003. Of the 30 cases of pediatric obesity enrolled in this study, all were between 7-13 years old. Each of these cases was classified as either mild, medium, or severe obesity. Patients who had mild obesity had a body weight 20% above normal, medium obesity meant being 30-50% above normal body weight, and severe obesity meant a body weight more than 50% above normal. Endocrine function was tested to differentiate simple obesity from obesity due to endocrine dysfunction. All patients enrolled in this clinical trial were administered the Chinese herbal formula called Huang Lian Wen Dan Tang (Coptis Warm the Gall Bladder Decoction). This formula was modified based on the patient’s clinical presentation. Ten days equaled one course of treatment, and an interval of five days was taken between each course of treatment. Of the 30 children who were initially enrolled in this study, two would not take the Chinese herbal medicine. However, there was a reduction in the severity of the obesity in the remaining 28 children after 2-3 courses of treatment. During treatment, the patients reduced their weight by 3-6 kilograms. The herbal formula was combined with physical exercise and a regulated diet. A follow-up visit showed the weight loss was maintained for six months.


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