In general, people with “flat feet” have a lowered arch at the inside of the foot, such that if they wet their feet and stood on a flat surface, they would leave a complete footprint.

All babies and toddlers have flat feet, with the arch developing during childhood; obese children are more likely than their thinner peers to retain a flat foot — as measured by footprint in studies — and it has been assumed that this is because their extra weight creates a “fallen” arch.

But the other possibility is that heavier children simply have more fat padding the soles of their feet.

This is important because flat feet caused by lowered arches, while not problematic for most people, can cause symptoms for some. Some children and adults have foot pain, and in the long-term, flat feet can contribute to ankle or back pain, for instance.

So for the new study, published in the International Journal of Obesity, Australian researchers used ultrasound tests to examine the feet of 75 obese children and 75 thinner children between the ages of 6 and 10.

They found that, in general, obese children did in fact have more fat padding the soles of their feet. But they also tended to have lower arches.

Exactly what, if anything, that might mean for obese children’s foot function or risk of future musculoskeletal problems is unclear, according to the researchers, led by Dr. Diane L. Riddiford-Harland of the University of Wollongong.

They say more research is needed to follow children over time, to see how obesity — as well as weight loss — might affect the structure and health of their feet in the long run.

When it comes to flat-footedness in children in general, recent studies have painted a positive outlook. A study published last year in Pediatrics, for example, found that among 11- to 15-year-olds, there was no relationship between the height of their arches and their performance on motor-skill tests — which included jumping, balance and speed.

In general, flat feet that cause no pain need no special therapy. If a child does have a pain, a doctor may recommend arch supports for the shoes or physical therapy.

In fact, extremely obese children have up to a 40 percent higher risk of GERD, while those who are moderately obese have up to a 30 percent higher risk of developing it, compared with normal weight children, researchers say.

“Although we know that childhood obesity, especially extreme obesity, comes with risks for serious health conditions, such as diabetes, cardiovascular disease and cancer, our study adds yet another condition to the list, which is GERD,” said study lead author Corinna Koebnick, a research scientist at Kaiser Permanente Southern California’s Department of Research and Evaluation in Pasadena.

While the causes of the chronic digestive disease are not known, obesity appears to be one of them, she noted. “With the increasing epidemic of childhood obesity, GERD may become more and more of an issue,” she added.

GERD can undermine quality of life, Koebnick said, noting that the disease can cause chronic heartburn, nausea and the potential for respiratory problems such as persistent cough, inflammation of the larynx and asthma.

GERD has already been linked to obesity in adults, many of whom are familiar with its intermittent heartburn resulting from liquid containing stomach acid that backs up into the esophagus. Untreated, GERD can result in chronic inflammation of the lining of the esophagus and, more rarely, to lasting damage, including ulcers and scarring.

About 10 percent of GERD patients also go on to develop a precancerous condition known as Barrett’s esophagus, which in a small minority will develop into cancer. Kaiser researchers noted that GERD that persists through adulthood increases the risk for esophageal cancer later in life.

Cancer of the esophagus is the fastest growing cancer in the United States, and is expected to double in frequency over the next 20 years. This increase may be partly due to the obesity epidemic, Koebnick said.

The report is published in the July 9 online edition of the International Journal of Pediatric Obesity.

For the Kaiser study, Koebnick’s team collected data on more than 690,000 children aged 2 to 19 years old. These children were members of the Kaiser Permanente Southern California integrated health plan in 2007 and 2008.

The researchers found 1.5 percent of boys and 1.8 percent of girls suffered from GERD. Among these children, obese children were much more likely to have GERD compared with normal-weight children.

This finding held true for those children 6 to 11 years old and those 12 to 19, but not for children 2 to 5, the researchers noted. The study did not find an association between GERD and BMI in young children.

The association between obesity and GERD remained even after taking race and ethnic background into account, Koebnick’s group found.

Across the United States, gastroesophageal reflux disease may affect 2 percent to 10 percent of children, according to other studies, and in one school-based study, 40 percent of teens 14 to 18 reported at least one symptom of esophageal GERD.

“Knowing that GERD is associated with obesity in children, pediatricians can counsel those children to report symptoms of GERD and make lifestyle changes that target not only obesity, but target GERD,” Koebnick said.

These changes include eating smaller meals, which will help reduce acid reflux, Koebnick said. “Whether losing weight will help isn’t known, “but we can guess that it will,” she said.

Dr. Aymin Delgado, assistant professor of pediatric gastroenterology at the University of Miami Miller School, said that “the findings confirm what we in pediatric gastroenterology have been suspecting, because it is what we see.”

Obesity affects every organ system, Delgado said. “Obesity poses clear risks for the future health of children,” she said. “Many of these risks are ones that occur later in life, and it is hard to show that they are real. However, this study, shows that they are and shows that we need to identify these risks and monitor overweight and obese children and to manage them appropriately.”

Delgado said the key is prevention. “We need to take the risk of overweight and obesity seriously and we need to do something about it now,” she said. “We need to keep the future health risks in mind when we see obese children.”

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But the program failed to reduce the overall numbers of overweight and obese schoolchildren — those numbers fell by 4 percent over three years whether the 42 middle schools in the study had such initiatives or not, the researchers report.

“The intervention, surprisingly, did not result in a [population-wide] reduction in overweight or obesity,” said lead researcher Gary D. Foster, a professor of medicine and public health and director of the Center for Obesity Research and Education at Temple University, Philadelphia. “What’s surprising is that the control group improved as well,” he said.

The school-based initiative didn’t seem to have much of an impact on children who were not already overweight or obese by sixth grade, the team found, but it did impact children who were already having weight troubles by that grade level.

For those kids, “there were small [weight-loss] effects of about 3 percent. Although that’s small, it’s enormous given the rates of obesity in this country,” Foster said. “This was an unexpected but fortunate finding — that we are actually impacting the kids at the greatest risk.”

The findings are slated to be presented Sunday at the annual meeting of the American Diabetes Association in Orlando, and they are also being simultaneously published online in the New England Journal of Medicine.

For the study, Foster’s team randomly assigned more than 4,600 students from the 42 schools to a diet, exercise and information program, or to a program where only their weight and height was assessed. The study targeted schools with high levels of minority children, because studies have shown that they are at especially high risk for obesity.

Children in the program were offered healthier food choices throughout the school: in the cafeteria, at snack bars and in vending machines, and during class events. These included: lower-fat, higher-fiber foods; more fruits and vegetables; and an emphasis on water, low-fat milk and drinks with no added sugars.

In addition, there were longer, more intense periods of physical activity for the schoolchildren, and activities and awareness campaigns to promote healthy living.

The researchers found that children who were already obese at the start of the program lost a significant amount of weight, as indicated by reductions in waist size, compared with other children.

In fact, children in program schools who were either overweight or obese in the sixth grade had 21 percent lower odds of being obese by the end of eighth grade, compared with students in schools without such initiatives. The program also lowered levels of fasting insulin, a key indicator for diabetes risk, the researchers found.

However, children from both types of schools had the same average blood sugar levels and the same percentage of students with elevated blood sugar, the study authors noted.

Foster said that it is intriguing that the rate of overweight and obesity dropped by 4 percent regardless of whether the school had an anti-obesity program in place or not. “This is potentially good news — that the rates of childhood obesity appear to be declining [naturally],” he said.

Several factors may be at work in this decrease in overweight and obesity even among those children, Foster noted, including children putting more attention on their weight. Just the fact that the researchers were measuring children’s height and weight might have made the youngsters more weight conscious, he added.

“Something has changed and we’ve got to figure out what that something is,” Foster said.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine said that “the results of this study are open to interpretation, and thus conclusions are apt to reside in the eyes of the beholder.”

People who don’t put much stock in school-based interventions will point to the lack of an effect overall, he said. “However, those who perceive value in school-based interventions — and I am among these — will focus on the obvious pattern in an array of secondary outcomes, including reductions in body fat and insulin levels, which in turn would be expected to reduce diabetes risk,” Katz said.

And the program’s effect on obese children is important, Foster said.

“There is a strong signal here that this program can make a difference,” Foster said. “If we can reduce the risk of type 2 diabetes in children by reducing the rates of obesity and reducing waist circumference, that’s an important outcome,” he said.

For those few without other risk factors such as high blood pressure or high cholesterol, being obese doesn’t raise their risk of cardiovascular trouble.

“Metabolically healthy obese persons do not have the elevated cardiovascular risk of obesity, but represent only a small subset of the total obese population,” said lead researcher Dr. Andre van Beek, from the University Medical Center in Groningen. “It’s the metabolic risk profile that counts, and not the weight itself.”

He was to present the findings Saturday at the Endocrine Society’s annual meeting in San Diego.

For the study, van Beek’s group collected data on 1,325 obese people from among 8,356 people who participated in a large Dutch study.

Among the obese people, only 90 (6.8 percent) were metabolically healthy, the researchers found. That meant they had no history of heart disease, stroke, diabetes or high blood pressure, or high cholesterol or triglycerides. In addition, none of the 90 were taking cholesterol-lowering drugs.

Over more than seven years of follow-up, only one of these people developed cardiovascular disease. As a percentage (1.1 percent) this was not significantly higher than heart disease seen in metabolically healthy people who were overweight (1.3 percent) or normal weight (0.6 percent), van Beek’s team found.

To see whether you are at risk for heart disease, check your metabolic risk profile, van Beek advised. “If this is normal, be reassured that there is no excess cardiovascular risk independent of weight class,” he said.

At least one expert is not convinced that obesity itself does not lead to an increased risk for heart disease.

Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said that “while this study did not find increased risk associated with obesity if no metabolic abnormalities were present, it is important to note that other studies with longer-term follow-up have shown there is an increased risk of cardiovascular events in these individuals.”

“The balance of evidence suggests that, over the long-term, obesity imparts higher cardiovascular risk, even if metabolic abnormalities are not present at baseline,” he said.

A researcher specializing in diabetes and metabolic syndrome also thinks the follow-up period in the study is too short to draw firm conclusions about whether certain obese people are protected from heart disease.

Dr. Tae-Hwa Chun, an assistant professor of internal medicine at the University of Michigan, said that “clearly we need to know why some overweight and obese individuals are protected from metabolic deterioration and increased cardiovascular risk.”

This study suggests that identifying the genetic and molecular mechanism that underlies the deadly link between obesity and cardiovascular risk, which is selectively found in a subset of individuals, is more important than simply measuring body-mass index, Chun said.

“There is a caveat in this study, however, as the cardiovascular event rate is so low in the short follow-up period, the study may not possess enough statistical power to detect a potential difference in cardiovascular risk,” he said.

The rate of unplanned pregnancy among obese women is four times that of normal-weight women, despite the former having fewer partners, the report found.

For men, being obese greatly raised the odds for impotence and their risk of contracting a sexually transmitted disease.

“Being obese has a strong influence on people’s sexual life,” said lead researcher Nathalie Bajos, an associate professor at the London School of Hygiene and Tropical Medicine and research director at the National Institute of Health and Medical Research, in Paris.

She believes obesity affects the sex lives of women particularly hard.

“Because of social pressure or social stigmatization, obese women are less likely to engage in sexual intercourse and more likely to find sexual partners via the Internet,” Bajos said. “Because of their obesity, they are not comfortable meeting men through friends, through work, through parties,” she reasoned.

Obese women are also more likely than thinner women to be in a relationship with a partner who is also obese or overweight, Bajos said.

A lot of these problems are driven by the stigmatization of obese women, she said, and “these women are more likely to have low self-esteem.”

The report is published in the June 16 online edition of the BMJ.

For the study, Bajos and colleagues collected data on the sexual behavior of more than 12,000 French men and women. Among this group, 3,651 women and 2,725 men were normal weight, 1,010 women and 1,488 men were overweight, and 411 women and 350 men were obese.

Putting on excess pounds did take a toll on sex lives, the study found.

Compared with normal-weight women and men, obese women were 30 percent less likely to have had a sex partner in the past year, while obese men were 70 percent less likely to have had more than one sex partner over the same time, the researchers found.

Obese men were also 2.5 times more likely to experience erectile dysfunction than normal-weight men, and obese men under 30 were more likely to have had a sexually transmitted disease, the researchers found.

Obese women under 30 often didn’t seek contraceptive advice or use oral contraceptives, and were more likely to have an unintended pregnancy, the researchers found, and they were also less likely to visit a gynecologist, Bajos said. Due to being overweight, “they do not [always] feel comfortable seeing a gynecologist for contraception issues,” she said.

In addition, gynecologists and general practitioners are less likely to prescribe contraception to obese women, Bajos noted. “It could be that they believe these women are less likely to have a sexual life,” she said.

The study also found that obese women were five times more likely to meet sex partners on the Internet and more likely to watch pornography. Yet they were less likely to view sex as important in their lives, Bajos said.

Dr. Sandy Goldbeck-Wood is associate specialist in psychosexual medicine at Camden and Islington Mental Health Trust in the U.K., and author of an accompanying editorial. She said that “the differing sexual experiences of obese and non-obese people need cautious interpretation.”

“We need to understand more about how obese people feel about their sex lives, and what drives the observed behaviors and attitudes. In particular, we need to know why obese women use less contraception and have more unwanted pregnancies despite having fewer sexual partners,” Goldbeck-Wood said. “The answers are likely to be complex, with biological, psychological and social aspects that will require a qualitative research approach,” she added.

Doctors must also develop the courage, skill and sensitivity to speak to patients directly about their sex lives and their weight, Goldbeck-Wood noted. “Doctors in primary care and sexual and reproductive health need to pay particular attention to the complex contraceptive needs of obese women,” she suggested.

Dr. Robert Schwartz, professor and chairman of family medicine at the University of Miami Miller School of Medicine agreed that, right now, “a lot of physicians don’t pay much attention to obese patients’ sexuality.”

His advice to doctors: “Don’t make the assumption that your obese patients are not as sexually active as the rest of the population, and they need to be counseled appropriately.”

In a study of more than 8,500 UK adults followed since their birth in 1958, researchers found that the study participants’ young children were 50 percent more likely to be overweight or obese than they themselves had been back in the 1960s.

When the researchers looked at factors that could be associated with the trend, they found that mothers’ full-time employment, which was more common in the younger generation, appeared to be one.

The findings, published in the American Journal of Epidemiology, do not prove that moms’ full-time work, per se, contributes to the risk of childhood obesity.

One possibility, according to the researchers, is that children of full-time working moms have fewer family meals or less-healthy diets in general.

So the trend in mothers’ employment over the past few decades may be one of the variables contributing to a general erosion in children’s diets; the explosion in sugary junk foods on the market, food advertising aimed at kids, and the increasing availability of high- fat, high-sugar fare in schools are among the other factors that have been blamed.

The current study lacked information on the children’s diets and exercise habits, so it is not known whether kids of working moms did in fact have poorer-quality diets or were less active.

For the study, Dr. Leah Li and colleagues at the University College London analyzed data from a project that has followed a large group of Britons since their birth in 1958. They focused on 8,552 participants who, in 1991, had a total of 1,889 children between the ages of 4 and 9.

Overall, the children were more likely to be overweight or obese than their parents had been back in 1965: 12 percent of boys were overweight or obese, versus 8 percent of their fathers in childhood; and 18 percent of girls were heavy, versus of 11 percent in their mothers’ generation.

Li’s team found that both parents’ current weight and mothers’ employment status were associated with the risk of their children being overweight.

Children of mothers who worked full-time were 48 percent more likely to be overweight or obese than children of non-working mothers. That was with factors such as socioeconomics, parents’ weight and breastfeeding (which some studies have linked to a lower risk of childhood obesity) taken into account.

When parents were obese, the odds of the child being overweight were three to six times greater than when parents were normal-weight.

Rates of both parental obesity and full-time work among mothers increased between the two generations. In 1991, 60 percent of mothers worked, including 15 percent who were full-time; that compared with 45 percent and 10 percent, respectively, in 1965.

Similarly, about 12 percent of parents were obese in 1991, versus 5 to 7 percent of the first generation’s parents in 1965.

So it’s possible, according to Li and her colleagues, that both factors (parents’ weight, in particular) contributed to the intergeneration increase in childhood weight.

However, even if mothers’ employment is a factor in the rise of childhood obesity, it would only account for a small portion of that increase, the current findings suggest.

Based on their data, the researchers estimate that in 1991, less than 8 percent of cases of childhood overweight or obesity could be attributable to mothers’ employment.

In general, experts believe that a complex mix of societal factors — from shifts in eating habits, to greater reliance on cars and increasing hours logged in front of the TV or computer — has been behind the rise in childhood weight problems in recent decades.

SOURCE: http://link.reuters.com/heh49k

American Journal of Epidemiology, online May 20, 2010.

Oregon has the nation’s lowest rate of hefty kids, according to a new government study, which found big gaps between regions and ballooning obesity rates in many states from 2003 to 2007.

More than 16 percent of American children ages 10 to 17 years were not just overweight, but obese, in 2007. That’s a 10 percent rise from 2003. Mississippi topped the nation with more than a fifth of its kids obese.

Oregon was the star, with the lowest rate of obesity — defined as body mass index in the 95th percentile or above — at just under 10 percent. And Oregon was the only state whose childhood obesity fell significantly from 2003 to 2007.

Even the best states fell short. The federal Healthy People 2010 initiative set a childhood obesity goal of 5 percent. Only Wyoming girls came close to that, according to the study appearing in May’s Archives of Pediatrics and Adolescent Medicine.

“You’ve got such wide differences at the geographic level, which means there is potential to further reduce obesity,” said lead author Gopal Singh, an epidemiologist with the U.S. Health Resources and Services Administration.

What works? It’s unclear how much states can overcome the effects of poverty, race and family history — all of which have complex links to obesity.

Black and Hispanic young people in the study were twice as likely as whites to be overweight or obese, even when the researchers took into account other risk factors like inactivity and poverty.

Oregon is 90 percent white. It also has a high rate of breast-feeding, and some research suggests that protects against obesity.

Oregon law sets nutrition standards in schools and requires chain restaurants to provide nutritional information on request. Those steps, taken recently, wouldn’t have shown up in the new study’s results, but may reflect Oregon’s inherent interest in health.

The figures for this analysis came from a representative telephone survey of parents who gave information about their children. Figures for about 47,000 children were analyzed for 2003 and about 44,000 children for 2007. That’s not as accurate as a government survey that weighs and measures children. Data from that suggest childhood obesity rates nationwide may be starting to stabilize.

In a separate paper based on the same data, Singh found that a child living in a neighborhood with unsafe surroundings, poor housing and no access to sidewalks, parks and recreation centers had 20 to 60 percent higher odds of being obese or overweight.

Experts blame the rise in childhood obesity on fast food, neighborhoods without sidewalks, television, video games, schools neglecting physical education and a host of other societal changes, said Dr. Joe Thompson, director of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity.

Now, lawmakers must move the obesity numbers in the right direction to save future medical costs, if for no other reason, Thompson said.

Right now, one of most known medicines for reducing obesity is Meridia (Sibutramine).

In fact, the quality of care for the obese may actually be higher and more aggressive than that given to normal-weight people, the study authors said.

“Contrary to our expectations, we found that in certain measures overweight patients were actually slightly more likely to get recommend care,” said lead researcher Dr. Virginia W. Chang, an assistant professor of medicine and sociology at the University of Pennsylvania.

The study findings are published in the April 7 issue of the Journal of the American Medical Association.

Chang said the study was motivated by surveys that found many doctors and health-care professionals “openly admit having negative attitudes towards obese patients. They say they are dissatisfied in caring for obese patients. They find it uncomfortable, unpleasant and not professionally rewarding.”

Obese patients are sensitive to this, she added. “A lot of obese patients will say they experience weight-related stigma from a doctor or they will name doctors as the primary source of weight-related bias,” Chang said.

These attitudes left Chang wondering if stigma might somehow lower the quality of care obese patients receive.

To find out, her team tracked eight common measures of quality of medical care, including diabetes care, pneumococcal vaccination, influenza vaccination, and screenings for breast, colorectal and cervical cancers.

The researchers evaluated these quality measures for more than 36,000 Medicare patients and 33,550 Veterans Administration patients.

Across all the quality measures in both groups of patients there was no indication that obese or overweight patients had lower odds of getting the recommended care, compared with normal-weight patients, Chang’s team found.

In many cases, obese and overweight patients had better chances of getting optimal care compared to normal-weight patients, the researchers found.

More aggressive treatment for obese patients was seen most among the Medicare group, where many more overweight and obese patients had their cholesterol levels and blood sugar screened.

In addition, a slightly higher number of obese and overweight patients in both groups received vaccinations against the flu and pneumococcal viruses. In the Medicare population there were also slightly higher rates of breast cancer screening, and among VA patients a higher rate of colorectal and cervical cancer screening versus that experienced by normal-weight patients.

“While it may be true that physicians and other health-care providers harbor negative attitudes towards obesity is does not seem to be borne out in lower quality of care. They are actually doing a good job,” Chang said.

Another expert agreed.

“I think our obese patients sometimes get better care than the people who are not because of their known risk factors,” said Dr. Robert Schwartz, professor and chair of the department of family medicine and community health at the University of Miami Miller School of Medicine. “So when an obese patient comes into the office we are probably hyper-vigilant rather than less vigilant.”

Schwartz noted that obese patients may feel they have more difficulty with the health-care system because the usual recommendation from doctors is often to diet and lose weight.

“Many obese patients are sensitive about their conditions,” he noted. But health problems associated with obesity, such as diabetes and heart disease, mean these patients will need more medical attention.

Obese patients also need a lot of support to optimize their care, Schwartz said.

“They need a team approach. They need to see a nutritionist. They need to get into a physical therapy program. They need to make sure they don’t have diabetes and if they do that needs to be taken care of,” he said. “It’s a much more complex problem than the way we used to look at obesity.”

But what if it were a big part of the solution?

One expert believes it can be. In fact, in just six months, the Mayo Clinic’s Dr. James A. Levine and colleagues helped 18 Minneapolis office workers lose a total of 156 pounds, just by redesigning the office and the office workday.

“By harnessing a little creativity, one can infuse the workday with movement. And in so doing — while adjusting the way we think about food — the pounds will simply start melting off,” said Levine, who is a professor of medicine in Mayo’s department of endocrinology in Rochester, Minn.

“Patients have tried everything to lose weight and get healthy, and nothing works,” Levine said. “Many have become despondent and feel it’s hopeless. But it’s not a hopeless situation at all.”

Levine’s “healthy office” approach is rooted in what experts call “non-exercise activity thermogenesis” (NEAT).

NEAT happens naturally, as humans burn off energy with everyday movements such as standing up, fidgeting, turning, bending and walking.

According to Levine, NEAT is distinct from the other primary forms of energy-expending processes, including active exercise, at-rest metabolism, or digestion.

For most sedentary Americans, the amount of energy burnt off by active exercise is actually “negligible” compared to what’s lost via NEAT, Levine said. In fact, NEAT accounts for between 15 percent (for very sedentary people) to about 50 percent (among the very active) of daily energy expenditure. And even minor lifestyle changes can boost one’s daily NEAT by about 20 percent, he said.

So that was the kernel of Levine’s idea: Make the office a more NEAT-inducing place.

To try it out, in 2007 he and his colleagues launched a six-month experiment targeting 18 office employees at a small financial staffing business in Minneapolis.

First, the research team “re-engineered” the firm’s offices. Chairs and traditional desk-seating were replaced with desks that came pre-attached to treadmills, and walking tracks were installed around the circumference of the office to facilitate “walking meetings.”

This wasn’t exercise, Levine stressed. “You don’t run at work, you walk. And what we are trying to do in fact is to get people to walk at the office while they work at a pace of 1.1 miles an hour,” Levine said. That pace falls within the NEAT category of energy use.

Other changes subtly encouraged more movement. The office’s landline phones were replaced with mobile sets; spaces for games such as Wii and foosball were made available, and employees were also outfitted with high-tech activity monitors. Staff was also offered nutrition counseling.

The result: A half-year later the 18 study participants had lost a total of 156 pounds, of which 143 pounds were pure body fat.

On average, employees lost nearly nine pounds each, 90 percent of it in fat, and their triglyceride (blood fat) levels plunged by an average of 37 percent.

Among the nine staffers who specifically indicated a desire to lose weight when the study began, average weight loss was even higher: nearly 15-and-a-half pounds.

Weight loss did not come at the price of workplace productivity. In fact, after only three months in the reconfigured office, staffers had boosted corporate revenue by almost 10 percent. Halfway through the study, the firm registered its highest monthly gross to-date.

“This was a small study,” Levine acknowledged. “But when people who are really suffering with weight and health problems see the results it’s a very, very powerful ‘eureka moment.’ Because the trick here is that we’re not asking them to think about weight loss. We’re asking them to simply live their day in a dynamic and positive way.”

The study, which is awaiting publication, “shows that you do not have to have a gym membership to do that,” he noted. “In fact, for most people the energy burnt off at the gym is a lot lower than you might think. When you average it out over three times a week at the gym, most people are only burning off about 70 calories a day.”

“But you can achieve much more than that by infusing your day at the office with a steady level of movement without going anywhere,” Levine noted. “By taking a phone call standing up, by having a meeting walking around — slowly, a shopping pace, at maybe one mile an hour — and by taking the elevator to the third floor and walking up the other three, you will burn an extra 100 to 150 calories an hour. That’s an extra 400 to 500 calories a day. And that’s a big number.”

“If, in addition, you philosophically change the way you look at food, using food as a fuel rather than as a comfort, all of a sudden you have a weight-loss program that is available and amenable to everybody,” he added.

One expert applauded Levine’s approach, but wondered how accessible it might be for most workers.

“Yes, non-intentional exercise such as just standing instead of sitting burns more calories than if you were sitting by your computer all day. Little changes like that add up, burn calories, and make a difference,” said Lona Sandon, a registered dietician and assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas.

“But for an individual to make this kind of office place activity change they need a work environment that strongly promotes the habit,” she added. “An individual employee cannot make it happen all by himself. So unless an organization decides it’s worth putting the effort towards a remodeling it’s probably not going to happen.”

But another expert said he’s experienced the benefits of the “healthy office” firsthand.

“I’ve probably employed this approach for about twenty years, myself,” said Cedric X. Bryant, chief science officer at the non-profit San Diego-based American Council on Exercise. “People used to think I was nuts, but I do all of my editing of books and article and manuals while exercising on a step-mill — a revolving staircase type of stair climber — that I have set up, so my material is on a reading stand while I move at a very low intensity.”

“I can certainly tell when I’m working on a particularly heavy project,” Bryant chuckled, “because I lose all that much more weight.”

“And it also helps me have greater focus and mental clarity,” he added, “which makes my editing process so much easier and productive. I would say that I am probably a good 30-40 percent more productive while exercising than while sitting at my desk.”

“We need to get people to not think that the only way to get fit is through a structured experience at a prescribed intensity at the gym,” Bryant said. “We need to think of an active lifestyle being throughout the entire day, and not just during workout sessions. And if you simply move more while you work you will get the benefit you want.”

Of course that still means that the majority of Americans are currently overweight and at high risk of chronic health problems, such as heart disease, diabetes and certain cancers. These risks continue to propel several national campaigns aimed at preventing obesity, particularly in children, including those spearheaded by First Lady Michelle Obama and former President Bill Clinton. But some researchers say such programs, which involve school-age children, may begin too late to benefit all children. (See a special report on the science of appetite.)

Increasingly, evidence suggests that obesity-prevention measures need to be taken earlier, in infancy or even before birth. According to the CDC’s National Health and Nutrition Examination Survey, rates of obesity in youngsters ages 2 to 5 have more than doubled since 1980, from 5.0% to 12.4%. And once a child sets down the road to an unhealthy weight, it becomes increasingly difficult for him to change course: according to one study, 80% of children who are overweight between ages 10 and 15 grow up to become obese 25-year-olds.

In November 2009, with funding from the Robert Wood Johnson Foundation, the Institute of Medicine (IOM) formed the Committee on Obesity Prevention Policies for Young Children, whose members will for the first time review evidence on obesity risk factors and health effects in children from birth to 5 years old and identify potential opportunities for intervention in this age group. The committee’s first report is expected in early 2011. (See five key questions about weight loss.)

Early Warning Signs
In a recent study of more than 1,800 children, who were tracked from before birth to age 4, Harvard researchers identified several risk factors for obesity that began in pregnancy or early childhood. They included pre-pregnancy obesity; gestational diabetes; low birth weight and rapid weight gain in infancy; stopping breast-feeding early; introducing solid foods before 4 months; short sleep in infancy; TV in children’s bedrooms; and higher consumption of fast food and sugary beverages in childhood. In many cases, these early risk factors were more common in black or Hispanic families than in white families, regardless of income.

The findings, first published online on March 1 by the journal Pediatrics, help explain why minority children are at higher risk for obesity early on: 16.7% of Mexican-American children ages 2 to 5 are obese, compared with 14.9% of black children and 10.7% of white children, according to CDC data. The authors emphasize that obesity prevention must not only begin early, but also address cultural issues and include education targeted to specific groups. The good news, says study author Dr. Elsie Taveras, an assistant professor of pediatrics and prevention at Harvard Medical School and a member of the IOM obesity committee, is that many risk factors involve behaviors than can be modified and are not due only to socioeconomic inequalities. “As a pediatrician, it’s frustrating for me to think, How am I going to change this person’s household income? But what a hopeful message to know that it’s actually not that in many cases,” she says. (See a slideshow about obesity rehab for teens.)

A Tipping Point for Obesity?
How early in life that prevention efforts need to target children is quickly becoming a central question to childhood-obesity research. One intriguing notion is that there exists an obesity threshold - or tipping point - in infancy, before which a chubby child may be safely steered away from a lifetime of obesity. A small study led by Dr. John Harrington, an associate professor of pediatrics at Eastern Virginia Medical School and Children’s Hospital of The King’s Daughters, analyzed childhood medical records of 111 obese children and adolescents - those with a body mass index (BMI) equal to or higher than 85% of their same-age peers - in order to determine the age at which children first became overweight.

On average, researchers found, overweight individuals first crossed the threshold into overweight territory before 22 months of age. In some kids it was even earlier, with about 25% of children already having gained more weight than recommended for their age and height at 3 months. The trajectory typically began early and remained consistent: the BMI of overweight children continuously diverged from that of normal-weight children, the difference increasing by 0.072 units per month starting at birth and crossing the 85th-percentile mark at about 21 months. Within the small sample, half of the overweight children became overweight before age 2, and 90% became overweight by age 5. “You’ve got to look at it in terms of intervention and prevention,” Harrington says. “If you’re trying to intervene at age 5, you’ve already missed the boat.” (See why we get fat.)

Part of the problem is that parents and pediatricians tend to overlook early signs of obesity. Many people view children with excess baby fat as healthy, and believe they’ll shed the weight as they grow. Harrington advises physicians to start screening babies earlier for immoderate weight gain and to broach the topic sooner with parents. There’s a lot parents can do at home to encourage healthy weight in their children, Harrington says, and making even one or two small changes can lead to lowered risk. For instance, Harrington advises parents to adhere to infants’ own cues for fullness and hunger, rather than encouraging them to eat more. And toddlers are “grazers,” so it’s perfectly healthy for them not to conform to an adult schedule of three square meals per day, he says.

Harrington’s study, first published online in February by the journal Clinical Pediatrics, suggests that the optimal age for instilling healthy eating and activity behaviors is before age 2. As children get older, it becomes more difficult to unlearn behaviors and reverse the trend, Harrington says. “The first thing to do is to recognize that there’s a problem and to see that maybe it didn’t start at age 4 or 5, or 6 or 7, but maybe before then,” he says. “The longer you’re overweight, the more likely it is that you’re going to be overweight as an adult.” (Read about the bugs in your gut.)

Getting a Head Start
Not all chubby kids grow up to be overweight adults; indeed, many heavy babies do shed their baby fat and remain slim thereafter. Determining which children are at higher risk, however, is easier said than done. The study that could answer that question has not yet been conducted. “The only way to do that is to do a prospective study of 10,000 kids, following them from birth to see what their trajectories are,” Harrington says. One such study is in the works - the National Children’s Study, which aims to follow 100,000 babies from the womb to age 21, was authorized by Congress in 2000 - but results from that research are still years away. (Read about good fat.)

For now, researchers say national childhood obesity prevention and education efforts should include families with newborns and toddlers, and promote healthy habits starting in pregnancy or earlier. Even seemingly minor actions, such as reminding pregnant women that they should not in fact be “eating for two” - in spite of their grandmother’s best advice - could reduce children’s chances of becoming obese, says Taveras. “Some of these things become so embedded in our thinking that they actually become our standard of care for our children,” she says. “If we really try to start focusing on prevention earlier, we might have a greater impact.”