Turning the Tide: From biology to behavior, the Center for Healthy Weight tackles childhood obesity on all fronts

By Jennifer Yuan
Wednesday, September 1, 2010

For the first time since the Civil War, average life expectancy in the United States could drop by as much as five years—just one of the human costs of an alarming rise in health problems associated with obesity.

Increasingly, the crisis begins in childhood. As many as one in three U.S. children are now overweight, according to the Centers for Disease Control and Prevention. And harmful conditions that were previously rare in children—high cholesterol and blood pressure, diabetes, liver disease, obstructive sleep apnea, and orthopedic disabilities—are occurring much more frequently.

Obesity is a complex problem, explains Thomas Robinson, MD, MPH, the Irving Schulman, MD, Endowed Professor in Child Health at Stanford University.

“Factors ranging from individual biology and behaviors, to broader social, economic, and environmental pressures contribute to childhood obesity and its consequences,” he says. “There is no single cause—and there is no single solution.”                

Thomas Robinson, MD, MPH, leads the Center for Healthy Weight's innovative, multi-disciplinary efforts.

Robinson directs the Center for Healthy Weight at Lucile Packard Children’s Hospital. An interdisciplinary initiative, the Center links efforts across five distinct areas at Packard and Stanford: state-of-the-art patient care, innovative research, community prevention programs, professional education, and advocacy.

“Our combined breadth and depth make us unique among other academic or clinical obesity centers around the country,” says Robinson. “Being an interdisciplinary Center at a premier children’s hospital and medical school, on the campus of a world-renowned University, gives us unparalleled strengths and opportunities.”

The Center includes clinical specialists in pediatrics, surgery, psychology, and nutrition; researchers in the basic sciences, public policy, clinical research, and prevention science; and experts in health education and public health advocacy—all working with patients, families, local community groups, public schools, and national and international organizations to address the childhood obesity epidemic.

“Bringing these resources together allows us to create exciting synergies and collaborations,” Robinson says. “We’re positioned to produce scientific breakthroughs and meaningful advances in patient care and public health.”

A Sneak Attack on Weight

In one tactic, the Center is developing innovative, solution-oriented approaches to help children prevent and control excess weight gain. Using randomized controlled trials (considered the gold standard for research), Robinson and his colleagues have shown, in real-world settings, that theory-driven prevention programs for preschool through college students can significantly improve eating behaviors, increase physical activity, reduce sedentary behaviors, reduce weight gain, and improve cardiovascular health.

Most traditional prevention and weight loss programs teach diet and exercise, trying to persuade individuals to do the “right” thing. Unfortunately, research shows that this approach has limited success with children. Robinson’s team takes a more indirect approach: focusing on fun and motivation, rather than diets and exercise.

As it turns out, engaging children in activities that are enjoyable and motivating in and of themselves, without dwelling solely on weight loss as the intended goal, is more likely to change health behaviors.

In East Palo Alto, a group of students is playing on a sports team designed specifically for overweight children. For the kids, it’s a chance to feel proud about learning new athletic skills, enjoy time outside, and hang out with friends. According to some, it is the first time in their lives that they have actually enjoyed sports.

Meanwhile, in Redwood City, more than 120 young girls are engaged in a folklorico dance program. They gather after school to learn dazzling choreography and important cultural traditions, culminating in public performances complete with colorful costumes.

In both programs, the children are physically active because they enjoy it, rather than because it is good for them. And these interventions are reaching kids where they are: at school and in their neighborhoods. As a result, the participants are losing weight—without even thinking about it.

“We call these ‘stealth interventions,’” says Robinson. “From the kids’ perspective, weight loss is just a side-effect of a fun activity, but not the primary, or even a conscious, motivation.”

Advocating for Healthier Communities

Epidemics cannot be controlled at the level of the individual,” says Lisa Chamberlain, MD, MPH, assistant professor of pediatrics. “That’s true for cholera, and it’s true for obesity.” Chamberlain co-directs the Center for Healthy Weight’s advocacy efforts. What’s needed, she says, is better policy and greater awareness of the broader issues that contribute to the problem of obesity. Food prices, advertising, city planning, family life, public schools, and television are all culpable.

Robinson concurs. “The obesity epidemic is caused by an interaction of our biology with a toxic environment, one in which calories are plentiful, inexpensive, and highly marketed, and where we have engineered physical activity out of our lives,” he says. “To turn back this epidemic, we have to make it easier to maintain energy balance at home, at school, and throughout our communities.”

In short, treating the environment is an essential part of treating the individual.

Inside Packard and Stanford Hospitals, signs posted next to the elevators now encourage visitors to “Take the stairs.” The cafeterias are offering more healthful dining options, and the vending machines are stocked with smarter snack choices. The goal is to make the Hospitals themselves more healthful places to heal.

Beyond the walls of the medical center, the Center for Healthy Weight team is actively involved in local initiatives and regional coalitions such as Healthy Silicon Valley, the Get Healthy San Mateo County Task Force, and the East Palo Alto Community Health and Safety Roundtable Partnership.

“Through these collaborative efforts, we are working to make healthier food available in schools and communities, provide opportunity for safe and supervised physical activity, and help create community environments that make it easier for individuals to maintain healthy lifestyles,” explains Candace Roney, executive director of community partnerships for Packard Children’s.

At the national and international level, Robinson is an influential voice in the fight against obesity. He is widely known for his landmark studies on reducing television viewing, and the powerful influence of fast food marketing on children’s food preferences. In addition, the National Institutes of Health’s new Childhood Obesity Prevention and Treatment Research program recently awarded a multi-year grant to Robinson and his team to design a pediatric weight control program that could be replicated nationwide.

Robinson was one of the authors of the Institute of Medicine’s report, Preventing Childhood Obesity: Health in the Balance. This national action plan recommends sweeping changes by all levels of government, the food industry, media, health-care professionals, schools, and parents, and includes proposals such as increasing afterschool programs, building more city parks, and establishing media and advertising guidelines to promote healthy weight.

“We are calling for nothing less than a revolution in the way we think about nutrition and physical activity in all aspects of our society,” says Robinson. “It’s not too late to turn the tide and give our children the best chance to become healthy adults.”