Submitted to: Childhood Obesity
Publication Type: Other
Publication Acceptance Date: 3/20/2019
Publication Date: 3/29/2019
Citation: Baranowski, T., Motil, K.J., Moreno, J.P. 2019. Behavioral research agenda in a multietiological approach to child obesity prevention. Childhood Obesity. https://doi.org/10.1089/chi.2019.0052.
DOI: https://doi.org/10.1089/chi.2019.0052

Interpretive Summary:

Technical Abstract: Serious limitations have been found in the simple energy balance model (energy in – energy out) as the single or primary biological strategy for virtually all child obesity prevention interventions. Experts have criticized it for not reflecting the likely multifactorial nature of obesity. A substantial number of other possible, even likely, causes of obesity have been identified. Since the simple energy balance model is easy to understand and target, behavioral scientists have taken the initiative to identify factors that influence energy in and energy out, and design, implement and evaluate behavior and/or environmental change interventions to prevent obesity accordingly. Unfortunately, most of these obesity prevention interventions have either not worked, or had small effects, not nearly enough to halt the epidemic. In the process, a serious disconnect has developed between advances in biological and in behavioral sciences in regards to obesity prevention. Several investigators have proposed multi-etiological approaches to understanding obesity onset and thereby its prevention. Priority among the biological etiologies for behavioral obesity prevention research in early childhood must be established, based on their relative contribution to and severity of obesity. Subsets of children develop obesity at different ages, suggesting that identifying such subsets and determining the size of the subsets and operational etiological influences would be an important approach. Analyses of large electronic health records might be a first step in identifying the subsets. In a multi-etiological approach, any particular child may be subject to influence by multiple etiologies simultaneously. It isn't clear how each etiology interacts with each other or with a complex dynamic energy balance model (including neurological and hormonal influences). Diverse etiological influences on obesity may be mediated by diet, physical activity or sedentary behaviors, reintroducing behavioral factors in the multiple etiological approach, but based on different biological models. Interventions for each causal factor related to the development of obesity can be designed, implemented and evaluated. For targeted groups of children (e.g. specific schools or daycare centers in specific cities), the risk of obesity must be estimated for each potential etiology to apply the most likely to be effective interventions (likely multiple). These procedures need to be developed and tested.