Academic journal article Environmental Health Perspectives

Environment and Obesity in the National Children's Study

Academic journal article Environmental Health Perspectives

Environment and Obesity in the National Children's Study

Article excerpt

OBJECTIVE: In this review we describe the approach taken by the National Children's Study (NCS), a 21-year prospective study of 100,000 American children, to understanding the role of environmental factors in the development of obesity.

DATA SOURCES AND EXTRACTION: We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis.

DATA SYNTHESIS: Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. The NCS is the largest prospective birth cohort study ever undertaken in the United States that is explicitly designed to seek information on the environmental causes of pediatric disease.

CONCLUSIONS: Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including gene-environment and gene-obesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.

KEY WORDS: bisphenol A, built environment, endocrine disruptors, diet, National Children's Study, obesity, phthalates, physical activity. Environ Health Perspect 117:159-166 (2009). doi:10.1289/ehp.l1839 available via http://dx.doi.org/ [Online 12 September 2008]

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Obesity is the consequence of a chronic net positive energy balance. The prevalence of obesity in American children has trebled in the past 30 years (Ogden et al. 2006; Strauss and Pollack 2001; Troiano et al. 1995). In 2003-2006, 31.9% of 2- to 19-year-olds had a body mass index (BMI) [greater than or equal to] 85th percentile for age and sex (Ogden et al. 2008). This great increase in obesity portends future increases in incidence of heart disease (Bibbins-Domingo et al. 2007), diabetes (Lee et al. 2007), stroke, and possibly cancer (Bjorge et al. 2008.) and is therefore projected to produce the first decline in U.S. life expectancy since the Great Depression (Olshansky et al. 2005). The recent explosive increase in prevalence of obesity reflects a complex interplay among a) changes in individual behaviors; b) changes in community structure, lifestyle, and the built environment; and c) possibly exposures to certain synthetic chemicals, such as endocrine disruptors (EDs), that may have the capacity to disrupt energy balance.

Control of the obesity epidemic will require understanding each of these factors and the interplay among them. This understanding will guide development of multipronged evidence-based strategies for obesity control. The goal of this review is to describe the approaches that the National Children's Study (NCS) will employ to develop understanding of the causes of obesity, especially with regard to environmental factors.

Background

Behavioral change is critical to the prevention and treatment of childhood obesity. Yet interventions against obesity that focus solely on modifying individual behavior to increase energy expenditure and/or reduce caloric intake in individual children have had limited success in sustaining weight loss or preventing obesity (Summerbell et al. 2005). A successful approach to reducing obesity and its comorbidities must also embrace understanding of community-level factors including the social, built, and natural environments. These environmental influences interact with a child's diet, physical activity, genetic makeup, and metabolism (Meaney and Seckl 2004; Moll et al. …

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