Challenging the ‘cute chubby baby’ notion

Dr Bass’s article on “Factoring the Metabolic X Syndrome” in the latest issue of Contemporary Pediatrics provides us with information on the emergence of Metabolic X syndrome in the pediatric/adolescent populations, previously a syndrome seen only in adults. How can we, as nurse practitioners (NPs) prevent children from developing the symptoms for a diagnosis of Metabolic X Syndrome? The syndrome includes factors such as insulin resistance, elevated fasting glucose levels, obesity, increased lipid levels, and inflammation. Contemporary Pediatrics’ editorial response, “Met X and the Toxic Shopping Cart,” describes the viewpoint that Met X Syndrome begins in the shopping cart and suggests ways for behavioral change. So how can we, as NPs, work towards a resolution of this problem?

The “babies out grow it” fallacy

Does the solution require a paradigm shift to re-think parental and providers’ viewpoints of overweight and obese infants and toddlers?  ‘Chubby infants are so cute…they will outgrow their baby fat’, are common statements when someone sees an overweight infant or toddler. Evidence shows that childhood obesity is established at the moment of conception.¹  A pregnant woman with a high body mass index provides an intrauterine environment that supports overweight and obesity in the fetus.² Dietary selections throughout pregnancy also impact the developing fetus.²  The ways infants and toddlers are fed throughout the first 1000 days of life significantly impacts the risk of being overweight or obese at 6 years old, and establishes the pattern of overweight and obesity for the individuals’ entire lifespan. Can this cycle of establishing obesity as a way of life be prevented? The answer is YES…. Childhood overweight and obesity are preventable!

Putting evidence into practice

Based on the above evidence, interventions need to begin at the time of conception or even before conception when women of childbearing age have a routine physical. Additionally, it is imperative that providers critically analyze anthropometric measurements in the first 1000 days of life and immediately implement strategies to establish patterns to normalize weight gains for infants and toddlers at each health care visit. Simply strategies, such as measuring chest circumference can help. Aksboshi et al. found a positive correlation between the chest circumference in 3 to 4-month old infants’ and the prediction of obesity at 3-years old.³ Additionally, studies have shown that exclusive breastfeeding supports normal weight gain in the first 6 months of life.

Prevention beats treatment

While I agree that all health care providers need to be vigilant in diagnosing Metabolic X syndrome, and the need to include treatment strategies, it just seems so much easier to prevent obesity by holding both health care providers and parents accountable for the weight gain of infants and toddlers. Parents, babies and toddlers trust us. Let’s not let them down. Let’s begin with primary prevention strategies and be accountable for the healthy growth of infants and toddlers to spare them the burden of a lifelong battle with obesity.

References

1.     Yajnik, C.S. (2014). We sometimes forget that an individual is born at conception and not at delivery.  Ann Nutr Metab, 64,(suppl 1) 8-17.

2.     Haschke, F. et al. (2014). Infants born to overweight/obese mothers show accelerated growth during the first year of life even when breastfed, and fast growth is known to be an antecedent of later obesity. Ann Nutr Metab, 64, (suppl 1): 19-24.

3.     Akaboshi, I., Kitano, A., Kan, H., Haraguchi, Y., Mizumoto, Y. (2010). Chest circumference in infancy predicts obesity in 3-year-old children. Asia Pac J Clin Nutr, 21, 495-501.