IJE Advance Access originally published online on June 9, 2006
International Journal of Epidemiology 2006 35(4):1100-1101; doi:10.1093/ije/dyl109
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Letter to the Editor |
Obesity prevention: life course approach vs continuing environmental ‘detoxification’
Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK.
* Corresponding author. E-mail: m.j.pallan{at}bham.ac.uk
Editor—In their editorial, Lawlor and Chaturvedi1 devote much attention to the potential for obesity prevention by brief intervention at critical periods of development, particularly the perinatal period, infancy, and puberty. This approach to obesity prevention appears interesting, but there are issues that need to be considered. First, although no definition of ‘brief intervention’ is given, the implication is that a short-lived, relatively simple intervention delivered at a critical period in a person's life, could have a long-lasting impact on the likelihood of developing obesity. The rationale for this approach is provided by animal studies and studies in children looking at reducing the risk of specific diseases by brief pharmaceutical interventions delivered at critical developmental periods. Obesity is not a specific disease, rather a condition that gives rise to a whole range of health-related consequences including premature mortality. The aetiology of obesity has the final common pathway of an imbalance between energy intake and energy expenditure, but there are a whole host of interrelating factors (biological and environmental) that contribute to this imbalance. So the expectation that a brief intervention targeted at a particular developmental period can significantly alter the risk of developing obesity may be underestimating the complexity of this problem.
Second, it is widely recognized that biological (especially genetic) factors cannot explain the rapid and sustained increase in obesity worldwide. Responsibility must, therefore, be attributed to the evolution of the so-called ‘obesogenic’ environment.1,2 As Ebbeling et al.3 elegantly state, research into new behavioural, environmental, and pharmacological approaches for the prevention and treatment of obesity in children is required, but the epidemic of childhood obesity is unlikely to be resolved without concerted political action to detoxify the obesogenic environment in which we live. The life course approach provides some valuable clues to when the critical periods of intervention might be but it would be sad if attention is focused mainly on biological determinants.
Conflict of Interest: none declared.
References
1 Lawlor DA, Chaturvedi N. Treatment and prevention of obesity—are there critical periods for intervention? Int J Epidemiol 2006;35:3–9.
2 Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prevent Med 1999;29:563–70.[CrossRef][ISI][Medline]
3 Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473–82.[CrossRef][ISI][Medline]
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  D. A LAWLOR and N. CHATURVEDI Author's response to comments by Pallan, Cheng and Adab, and Hawlins and Law Int. J. Epidemiol., August 1, 2006; 35(4): 1102 - 1102. [Full Text] [PDF]
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