Preventing Childhood Obesity: Article Analysis

According to the article “Preventing Childhood Obesity: What Are We Doing Right?” by Thomas A. Farley, MD, MH, and Deborah Dowell, MD, MPH, from the American Journal of Public Health in April of 2014, childhood obesity rates have declined in the last decade. After decades of increases in the rate of childhood obesity beginning in the late 1970’s, new data shows that that the rates have been declining in New York City since 2002. The question still remains, what has led to this decrease in obesity rates among children. Many of the policy changes were implemented in the late 2000’s after the decline had already begun. The authors conclude that the most likely explanation for this phenomenon is a combination of several factors that when separate cannot account for the decline, but when pieced together seem to each play a role in the observed decrease in childhood obesity rates.

The sample studied and discussed in the article was restricted to children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and public school students in New York City. Though the sample size was large, most likely a fair representation of the New York City population, it would be interesting to see if these same trends were apparent in other

populations. States such as Alabama are regularly given a bad reputation for high amounts of obesity, and I think it would be interesting to see if declines were also observed during this time frame. It is pointed out in the article that personalized BMI reporting might have raised awareness and concern among parent in New York City, but had no effect on parents in California. This difference in response to BMI reporting makes me believe that what works in one location is not guaranteed to work in another. I would like to have seen how this data collected in New York City compares to other regions of the United States.
According to figure 1 on page 1580, there has been a decrease in childhood obesity since 2002, with the sharpest declines generally occurring between 2004 and 2006 and then leveling off. Though the rate has not increased since 2006, with the exception of a slight peak in seven to ten year old public school students, it has remained relatively stagnant when compared to the drops observed from 2004-2006. Policy changes aimed at combating childhood obesity began to be implemented in the late 2000’s, just as the declines began to slow. The WIC food package was changed in 2009 to allow for a wider variety of healthy food, daycares began to limit juice consumption in 2007, the “Eat Well Play Hard” program to promote physical activity began in 2008, and calorie counts showed up on menus in 2008. Have these policies really caused a decline in obesity rates among children, or have they just kept the rates from rising? It seems to be the latter, because even though the rates have not risen, they look to have leveled off.
According to the article breastfeeding is associated with a decreased risk of childhood obesity, although the decrease may be the result of unmeasured variables.

It is necessary to remember that just because there is a correlation between breastfeeding and lower rates of childhood obesity, it doesn’t necessarily imply causation. The breastfeeding rate began to rise in New York City in the 1980’s, but childhood obesity was also increasing at the same time. The fact that data from the 1980’s shows a positive correlation between breastfeeding and childhood obesity, whereas data from the 2000’s shows a negative correlation, most likely means that breastfeeding was not the cause of decreased obesity

rates.
The authors admit that they did not have data on calorie consumption among New York City children, but assume that parents changed what they were feeding their children based on media messages that they saw. The authors make several assumptions, such as assuming that parents saw the media messages, which in turn prompted them to reduce their child’s calorie intake. While these are all logical assumptions, the authors made sure to note that they did not have all the data necessary to support their claim or inference.
Overall, I have few criticisms for the article. The authors clearly pointed out when there was contradictory data, as with breastfeeding, or when the dates did not seem to line up. Though this article does not arrive at a solid concrete conclusion as to why the obesity rates in New York City have been decreasing, it does give several possible explanations and explains why they might not fully explain this observed phenomenon. I cannot fault the authors not being able to come up with a conclusion because there are so many variables at play that may or may not have affected obesity rates, that it is nearly impossible to pinpoint the variable to was effective.