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Baby’s Obesity Risk? Look at the Family (Oh, FFS!)

January 31, 2013

According to this article on MedPage Today, doctors can apply an algorithm to newborns and determine whether or not they’re going to become obese children. Right, because the worst thing in the world is that your child might become “obese” at some point in hir life.

I know y’all are just dying to know what went into creating this algorithm, so here goes:

To build algorithms for predicting that risk, the researchers assessed the Northern Finland Birth Cohort 1986 to develop a calculation based on six traditional risk factors:

  • Mother’s and father’s BMI
  • Birth weight
  • Maternal gestational weight gain
  • Number of household members
  • Mother’s professional category
  • Mother’s smoking before and during pregnancy

In addition, they developed a genetic score built from 39 known BMI/obesity-associated polymorphisms.

Well, let’s see now.

  • Mother and father’s BMI — Can’t do much about that, not permanently anyway, and since a person’s size is about 75% genetic, wouldn’t you also have to look at the mother and father’s parents’ BMI, their grandparents’ BMI, etc., in order to determine if a child’s chances of being fat are genetic or caused by meeting this algorithm?
  • Birth weight — Have they found a way to control a fetus’s birth weight now? Other than the mother smoking during pregnancy, I mean (that is supposed to cause a low birth weight, isn’t it?). How is this related to a child’s chances of becoming fat?
  • Number of household members — Hmmm… what relationship to a child’s size does the number of people in the household have? Are they saying that the more people there are in the household, the better the chances are that a child will be fat? Or maybe it’s the smaller a household is that ups a child’s chances of becoming fat? Sorry, that’s rather difficult to control too, especially if you have other children (or don’t), if you’re taking care of an elderly parent, etc. Household size isn’t something that can just be adjusted willy nilly in order to ensure that your child doesn’t get fat.
  • Mother’s professional category — Now this one I can actually see being part of the equation, as poverty certainly increases the odds of being fat, and there usually isn’t an easy answer for how to get out of poverty.
  • Mother’s smoking before and during pregnancy — This is an iffy one, IMO. Mothers smoke while pregnant for a variety of reasons, and it has been correlated with low birth weights. How is this related to a child’s chances of becoming fat?

Why these six factors, and not some other factors, like the father’s professional category?

They also performed validation analyses in a retrospective cohort of 1,503 Italian children and in a prospective cohort of 1,032 American children.

Overall, all the six traditional risk factors were independent predictors of obesity outcomes.

They found that the discrimination accuracy of their algorithms was “excellent” for persistent childhood obesity (AUROC 0.85, P<0.001).

It was also “clinically meaningful” for the following (P<0.001 for all):

  • Persistent childhood overweight/obesity (AUROC 0.75)
  • Childhood obesity (AUROC 0.78)
  • Adolescent obesity (AUROC 0.75)
  • Adolescent overweight/obesity (AUROC 0.71)
  • AUROC – area under the receiver operating characteristic

So they validated this using 1,503 Italian children, and 1,032 American children. Considering that over 500,000 babies are born in Italy each year, and over 4 million are born in the USA each year, this is a very small sample size to prove that this algorithm is valid (0.028% of Italian children were used, and 0.0025% of American children were used). Statistically significant? Probably not.

The reason for this algorithm?

Taking steps to prevent obesity should start as soon as possible after birth, the researchers said, so assessing the risk for future overweight or obesity in newborns may be an important means of focusing preventive interventions on those who are at risk.

So they want to take steps to prevent children from becoming fat. And just how do they propose to do this? They don’t know how to keep adults from getting fat(ter), so how do they propose to do that for children? Especially since children are growing and changing all the time. Diets are almost guaranteed to make adults fatter in most cases, so what do they propose to do for children? And they want to start this “obesity prevention” in infants, based on a very small sample of children.

WTF is the matter with people? They want to eradicate “obesity” based on the correlation between fat and certain diseases*, and since they haven’t been successful in getting rid of fat adults, now they want to start their “obesity prevention” with babies (because we all know how successful they were with their plan to end childhood obesity, don’t we)?

Where is this hatred of fat going to end? What’s the illogical conclusion to this bullshit? If a person is genetically programmed from before birth to be bigger than the “norm,” until someone comes up with a way to identify every gene that causes obesity, and a way to turn those genes off without doing harm to the fetus involved, I’m sure obesity is here to stay. I’m also sure that those efforts would be better spent on finding ways to improve peoples’ lives so they have opportunities to be as healthy as possible without shame and stigma attached to whatever body they happen to have.

*Diseases that thinner people also get and from which they also die.

15 Comments leave one →
  1. January 31, 2013 10:02 am

    From the available evidence, these risk factors make sense to me. We know obesity is genetic, or at least makes one genetically susceptible; there are some studies on birth weight and long-term obesity rates, but I’m not sure how reliable they are; household members could actually be related to poverty because poorer families are more likely to cohabitate (check out this chart from this study); mother’s professional status is probably because fat women are more stigmatized than fat men; and smoking definitely has an affect on birth weight, and according to one long-term study of 33 years, although children of smokers had low birth weights, at age 33 men have a 50% higher risk of being obese and women. But then again, one third of maternal smokers have lower education levels than non-smokers, as well as three times more likely to be single parents (PDF).

    So, as risk factors go, these make sense, particularly when you look at the relationship to poverty, as you said. But then the solution, it seems, is not to “prevent obesity,” but to prevent poverty.


  2. JeninCanada permalink
    January 31, 2013 10:55 am

    Upping the minimum wage to something people could actually live on would prevent a whole host of problems related to poverty and I think we’d see enormous changes in a positive way very quickly. But eradicating poverty would mean admitting that some people don’t have it as good as other people and looking at WHY certain people are making more than other people for the same work. ie racism and other problems.

  3. Kala permalink
    January 31, 2013 12:08 pm

    Regarding the risk factors: although something may not make rhetorical sense to a person, that doesn’t mean that it doesn’t make mathematical sense.

    The entire paper is about modelling. This is how this sort of thing is evaluated: we have the 6/7 factors (let’s refer to them as predictors, and very often they start out with more than these and prune useless ones away, as I’ll describe in a second) . They took data, and used it to build a model, which is ultimately a mathematical equation that should describe the relationship between the predictors(risk factors) and the response (outcome variable of interest), and this equation should not yield too much error when comparing it back to the original data. What this means is that the equation that you ultimately get should be able to replicate something close to the original data. It’s unlikely that this model is anywhere near perfect, but it’s generally the best we can do with the depth and breadth of data that we have.

    Then each predictor is evaluated to see whether its contribution is statistically significantly different from zero. If that significance level is reached, then we can say the predictor is significant and we leave it in the model. The simplest way to do this, if our sample of data is sufficiently large (in this study it’s large enough) is to take confidence intervals (take this at face value, definition for CI requires some nuance) about the contributions each predictor makes to the response. (In the simplest sense, with linear* models, you can think of the contribution as a weighting applied to each predictor, but many models are nonlinear so it’s a little different there). If that confidence interval includes zero, then we can not say that the contribution is statistically significantly different from zero, and we will probably remove it from the model. These authors would not have included these risk factors into their model if the risk factors were not statistically significantly different from zero.

    This is of course not the end all-be all of modelling or anywhere close, but I thought it might provide some understanding of what they were doing with the risk factors that were listed.

    *Also fyi for clarification, linear doesn’t mean linear in the sense that it means a line. Linearity is a mathematical concept, and in fact the equations for lines are linear, but lines don’t encompass all linear equations.

  4. fatology101 permalink
    January 31, 2013 2:00 pm

    OHH!!!! I can just scream. Poor, rich, black, white, Italian has nothing to do with being obese. My gosh. It is 100% heridity. NOthing else. It is in our DNA just like being tall or short or bald. This is where science needs to start. It is all about the hormones you are born with. You know it and I know it, there are skinny poor people and fat poor people. It is not do to our inviorment that we are fat or skinny. Help me out with this guys. I based my whole book on it. I am not in a position (financially wise) to market my book. I am poor and Oprah is rich and we are both fat. So what!!? I agree with you Vesta 44. Great blog. Thanks

    • Kala permalink
      January 31, 2013 3:20 pm

      Fatology, with all due respect, I have to say that I think you’re completely incorrect. It’s a known phenomena that obesity is far more common among the poor than it is among people who exist is higher socioeconomic strata. This is likely due a large number of environmental reasons: food access, food quality, stress, overwork, culture, public safety, school resources, and on and on the list goes.

      The science is pretty clear on this. You could make a reverse proposition to explain noted phenomena, that perhaps all those fat poor people are poor because they’re fat, as a kind of commentary on how our society treats fat people. But I don’t think that the evidence supports that premise. But the fact remains that poor people are more likely to be fat than richer people. So you must pick an explanation, that it is either that poor people are fat because they’re poor, or that fat people are more likely to be poor because they’re fat. I obviously accept the former.

      If you based a book on the notion that what I said above is a fallacy, then let’s just say that I don’t expect your book to appeal to anyone who takes a more scientific tilt to things.

      • LittleBigGirl permalink
        February 2, 2013 12:56 am

        It seems pretty naive and simplistic to label economics as the only factor in a person’s weight. That’s just as ridiculous as saying being fat causes diabetes – skinny people get diabetes too. There are fat rich people and thin poor people. If outside influences don’t have a 100% predictable effect on a person’s weight (i.e. being poor automatically makes you fat), it makes sense to look to the inside of the individual for answers.

        The thing people seem to forget is there is no one explanation for fat: anyone who is fat can be fat for any number of reasons. The reasons are many, varied, and can change at any point in a person’s life. Just as there is no silver bullet “cure” for fat, there is no Rosetta Stone to explain every instance of weight gain. I think the influence and convergence of outside factors makes it almost impossible to scientifically test what the root cause of fatness is (if there even is one). Theories about factors of weight gain go back as far as whether a baby is breast fed or not. Once a baby is sent out into the world on their individual trajectory, there is no way to know if their eventual weight was a genetic inevitability – especially since studies show that attempts to control weight only throw it out of whack. This is why vesta44’s post today is so important to consider – if scientists try and interfere with a baby’s projected (and purely speculative and unproven) weight, they risk damaging the child’s metabolism and possibly making the weight gain a self-fulfilling prophecy.

        I have read Fatology’s book and find it very insightful. I don’t know if I agree with her above statement that it is “100% heredity,” simply because few science-minded people would claim an absolute. I agree heredity obviously plays a part, as do other aspects of body chemistry like metabolism and hormones.
        Unless you can explain why there are poor people who don’t get fat and rich people who don’t lose weight, I don’t consider your assertions to have any more “scientific tilt” than Fatology’s.

        • Kala permalink
          February 2, 2013 9:31 am

          Did you even read my comment in full?

          “It seems pretty naive and simplistic to label economics as the only factor in a person’s weight”

          Where did I label economics as the only factor in a person’s weight? I didn’t. Fatology was saying that ” It is 100% heridity. NOthing else. It is in our DNA just like being tall or short or bald.”

          This statement is so freaking incorrect that I nearly choked on my drink when I read it. There are obviously environmental and as well as heredity determinants of body type. So right off the bat, I went to the point that Fatology’s belief is instantly refuted by the widely observed result that socioeconomic status affects obesity prevalence. I quite clearly never said that socioeconomic status was the only or even the main determinant of body type. I said that fatness absolutely varies with socioeconomic status, to counter her point that no such thing occurs.

          Also “Unless you can explain why there are poor people who don’t get fat and rich people who don’t lose weight”

          I never supposed anything so simplistic. That’s all on you and your misinterpretation of my comment. Just because someone is more likely to have an outcome in one group of people, in comparison to another, doesn’t mean that there are no people of the outcome in the less likely group, and everyone in the more likely group has the outcome.

    • January 31, 2013 3:40 pm

      The hereditary nature of obesity is more about susceptibility than expression. When you live in a world where food is affordable for everyone, then the people with a genetic predisposition (due to hormones) will be heavier. When you live in a world that restricts access to food for the poor, then those genetic predispositions will not be trigger and they will not be as heavy. Perhaps as they age they will gain weight, but they won’t be heavier, younger, which is what we’re seeing today. Now, the obesity rates have leveled off, which suggests that the environmental changes that flipped our genetic switches may have had as much impact as they’re going to, but we don’t know for sure.

      What is more fascinating about the weight/economic link is that wealthy fat people do better, healthwise, than poor fat people. And that’s due entirely to the social determinants of health. So really, unless you’re talking about the extreme ends of weight, then income influences our health more than weight does. But there is no one factor that influences weight. We’re swimming in an environmental and genetic soup, and it is virtually impossible to point to any one variable and say “That’s the one that made us fat!” It’s just too complicated.


  5. vesta44 permalink
    January 31, 2013 2:08 pm

    I just wondered about the usefulness of it when there really isn’t any way to prevent obesity. If you’re meant to be fat, you’re going to be fat, no matter what you do (in most cases). I realize that applying this algorithm to my pregnancy, circumstances at the time, and whether or not my son was fat as a child is anecdata, but I think I met most of their criteria for my son to be an obese child and he wasn’t (in fact, for most of his childhood, he was underweight and over-tall for his age). My BMI went from 24.9 to over 45, he weighed 9 lbs 7 oz when he was born, I gained over 150 lbs during my pregnancy, I was the only member of my household, I was on welfare so I was poor and only had a high school education at the time, I had smoked off and on before I got pregnant but hadn’t smoked in months when I got pregnant and didn’t smoke while I was pregnant. My son is now 37 years old and he’s still not fat (he’s probably overweight, by the BMI, but probably only by 15 lbs or so).
    Unless and until they can figure out how to negate the genetic factor for size, I don’t think any interventions they can come up with are going to do much good to end obesity for anyone. And putting infants on a diet of any kind is so not a good idea, so the only other options there are, that I can see, is to make sure that people who are going to have kids don’t live in poverty, have good jobs, and don’t smoke. And is our government (or any government, for that matter) really willing to end poverty? Are they really willing to do the work, spend the money it’s going to take to ensure that everyone has the education it takes to get a job paying a living wage, make sure that enough of those jobs exist, and that there are no barriers of any kind to getting and keeping those jobs (sexism, racism, ablism, etc)? I don’t think so, not when it’s easier to blame people for their circumstances, and tell them “Go on a diet, you fat fucks, and your lives will magically improve”, “Get a job, you lazy, good-for-nothings”, “Get an education, you dummies”, and every other blaming, shaming statement that’s been said to anyone who isn’t cis, male, white, and rich (and mostly thinner).

    • Kala permalink
      January 31, 2013 3:08 pm

      There are countless things for which we have no solutions, or no solutions that would be likely to be implemented, that we still study and try to predict. Also, the model is more complicated than you are giving it credit for. You looked at some risk factors, and qualitatively assessed that you’ve hit them all, but this is the actual predictive model for childhood obesity:

      Risk for childhood obesity = e(-10.61+0.12 x maternal BMI + 0.18 x paternal BMI -0.31 x number of household members – 0.69 x maternal occupation + 0.61 x gestational smoking* + 0.75 x birth weight) / (1 + e(-10.61+0.12 x maternal BMI + 0.18 x paternal BMI -0.31 x number of household members – 0.69 x maternal occupation + 0.61 x gestational smoking* + 0.75 x birth weight))

      You could plug the terms of your pregnancy into this equation, and your output would be a risk. But in the end, a risk is still just a probability. Your probability of winning most gambling games is small, but plenty of people still win. On the flip side, your probability of a certain health outcome could be very high, and you still may very well not wind up with the outcome.

      I also don’t agree with that idea that obesity is impossible to prevent in those that were “meant to be fat”. It’s hard to evaluate at this point who or who is not meant to be fat, there is no concrete way of knowing. Clearly there are genetic factors that make it very likely if not inevitable that some people will wind up larger folks. However, I would think it highly unlikely that all or even most currently obese children would naturally, removing certain environmental influences, have been fat.

  6. The Real Cie permalink
    February 1, 2013 5:03 am

    I leave the statistics for those of you with left brains that haven’t been pithed, unlike mine. I’m a math moron.
    I weighed just six pounds at birth.
    I’ve always been prone to gaining weight. Both of my parents were average weight. My brother is considered “obese” according to the BMI charts, but he’s extremely muscular, whereas most of mine appears as adipose tissue. I’m physically active, so I know there’s muscle under the fun stuff. It just doesn’t show as much!
    My grandparents on my father’s side were both of average weight. His maternal relatives could eat like the proverbial hog and never gain an ounce. He inherited that tendency.
    My mother struggled with her weight later in life, but isn’t “obese.” Her parents were both average weight. However, my mother’s maternal grandmother weighed 300 pounds. She was hardly inactive–she owned a farm. That’s a tough row to hoe, one might say. She was a short, stocky, very tough woman.

  7. LittleBigGirl permalink
    February 2, 2013 1:13 am

    The one thing I can’t tell from this post or from the study cited is whether the scientists involved think being heavier or lighter at birth increases your risk of becoming fat. I was born 2.5 months early. My father said he could fit me in one hand. I was 1lb if I was lucky. My mother was thin until after she had me (had 3 boys before I came along). My dad was always thin. Mom used to hate how he could eat crap and not gain weight or have blood pressure problems. Two of my 3 brothers are overweight. They all grew up in the same house, ate the same food…I doubt the two that are fat weighed that much more when they were born but I don’t know for sure. I see in my school pictures that I didn’t start to get chubby until about 3rd grade. But I also had an ED. And PCOS…
    You know, I”m pretty sure that if the docs at the hospital when I was born had told my parents that I was somehow at risk for becoming fat, my parents would have said “So the fuck what?!? Just make sure she makes it out of that goddamn incubator!!”

  8. February 5, 2013 9:33 am

    But preventing poverty would be admitting that poverty exists, that there are institutionalized oppressive factors within society that contribute to it, and that those who have more didn’t necessarily “earn” it all in a just and fair manner. It’s much easier to point fingers and blame the individual, the family, the family history, etc.

  9. Fab@54 permalink
    February 8, 2013 8:56 am

    What about mothers who were active, healthy, and THIN / AVERAGE in weight when they were carrying their kids…. and got fat after the child bearing? I was NOT obese when I had my three kids, although I gained and retained (some) weight between each one.
    I had one at 19, the second one at 23, and the third and last at 27.

    I gained just over 60 lbs with my first. He weighed 8.8 lbs at birth.
    I probably retained about 25 lbs of those 60.
    I gained about 35 lbs with my second pregnancy- she weighed 8.12 at birth.
    I lost just about all the 35 pregnancy lbs soon after she was born, though.

    However, in the 3 yrs between child no. 2 and pregnancy no. 3, I started to put on weight.
    BUT I gained a mere 17 lbs during my 3rd pregnancy. Yet, she was the heaviest baby of the three- at 8.14 lb.

    My son, who was the lightest of the three at birth, is getting heavier as he gets older (he’s 36 now) but I don’t think he’s obese.
    The middle child is the heaviest, just tipping into the obese category (I would guess).
    Today the thinnest adult is my third- the heaviest baby – yet, she’s not even chubby.
    She absolutely takes after her Dad and his family- taller and thinner than mine.

    Me? I gained the vast majority of my current weight AFTER these three pregnancies/children. I’ve gained most of my last 100 lbs since turning 50 – about 6.5 yrs ago.

    Their dad? He’s 6′ tall, and about 192 lbs. Up until his bypass surgery 3 years ago, he never weighed more than 175 — EVER. And he ate like a horse; and prior to surgery ate all the “bad” foods like fried chicken, fast food, snacks, candy, etc- with abandon! Sure, that along with smoking 2 pks a day for 40 yrs probably contributed to his clogged arteries … but he Never gained weight!

    I was by far way healthier than my husband- AND way fatter! Where’s the mathematical logic in that?

  10. February 9, 2013 12:51 pm

    Most obesity is a physiological reaction to previous caloric restriction. The evidence is right in front of us but no one names it. Calorie restricted infants will end up as fat children and everyone will be amazed except for a few. I hope the childhood obesity warmongers receive due penalty for the harm they are planning.

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