Of Dreams and Reality

Spotting the obese infant

1. To date there is no generally accepted ‘means for the quantitative characterisation’ (for want of a better expression) for an obese infant.

A gain in weight by a six months old infant that exceeds 5.34 kilograms (11.748 pounds) was proposed by P.B.Crawford and his associates (Am.J.Clin.Nutr.27:706, 1974) to be the best index for obesity at that age.

[Note: The limitations of such an index in the context of obesity prevention {see Obesity simplex: Infant obesity (1)} are obvious].

2. Perhaps a significant discrepancy between length (height) and weight (as compared with established growth charts) is of more practical use.

The following figures for boys read from one such chart (Am.J.Clin.Nutr. 32: 607-629, 1979) will be used to illustrate this:
a) Age: 3 months
b) Length (height) range: 57 to 65 centimetres (22.44 to 25.59 inches).
c) Weight range: 4.318 to 7.27 kilograms (9.5 to 16 pounds)

Example1.
Assessing weight status for a 3 months old boy (George)
d) Age: 3 months
e) Length (height) = 58 centimetres
[Note: This is near the bottom of the range]
f) Weight = 7 kilograms
[Note: This is near the top of the range]
Conclusion:
George may be considered obese.

Example2.
Assessing weight status for a 3 months old boy (James)
g) Age: 3 months
h) Length (height) = 64 centimetres
[Note: This is near the top of the range]
i) Weight = 7.25 kilograms
[Note: This is near the top of the range]
Conclusion:
James may be considered not to be obese.

[Note:
a) There are many growth charts and there are slight differences here and there.
b) When used as illustrated in the examples above they are just as good as each other].

Obesity simplex: ‘Infant obesity’ (1).
Early infancy: When the foundation of obesity is laid down.

Introductory remarks
Much adult obesity has its origins in infancy, childhood and adolescence. Therefore the prevention of obesity begins in infancy.

A. In two papers published independently in 1970 by:
(1) J.Hirsch and J.L.Knittle (Fed.Proc.29:1516) and
(2) E.E.Eid (Brit.Med.J.2:74)

(a) It was concluded that:

Infants who are over-nourished (i.e. their rate of growth is higher than usual) at the stage when adipose tissue (‘body fat’) cells are rapidly increasing accumulate more fat cells than infants whose rate of growth is more carefully controlled.

[Note:
1) The rate of growth generally is highest in the first few months of life.
2) It would not be unreasonable to suggest that the rapid formation of adipose tissue cells could occur at that time].

(b) It was suggested that:

This surplus of adipose tissue cells persists throughout life carrying with it persistent problems (‘potential for the problem’) of obesity (overweight).

B. Science Daily (Nov. 14, 2001) has reported that a research team (N.Settler, B.Zemel, S. Kumanyika and V. Stallings) at The Children’s Hospital of Philadelphia have suggested that:

(a) The first four to six months may be a period for the establishment of weight regulation.

(b) Rapid weight gains during infancy could lead to childhood obesity, more specifically:

(c) Rapid weight gain during the first 4 months of life is linked to an increased risk of being overweight at age 7 (regardless of birth weight and weight at 1 year) and:

(d) An increase in weight gain of 100 extra grams per month increases the risk of being overweight at age 7 by more than 25%.

[Note:
The first 4 to 6 months are thus critical both:
1) In the context of rapid formation of adipose (fat) cells and
2) Establishment of weight regulation].