Where Fathers Figure in Childhood Obesity

Father with daughter. Emely/Cultura/Getty Images

There is an extensive, growing literature on the fundamental importance of family-based approaches to obesity treatment and prevention, especially in young children.  But as is often the case, sense reached this conclusion long before science starting catching up.  Two adages nicely encapsulate the relevant, time-honored insight.

The first of these aphorisms, often attributed to Aesop, is some variant on the theme of: “in unity, there is strength.”  The second is of a more certain pedigree.

  Abraham Lincoln said: “A house divided against itself cannot stand.” 

From the intimate perspective of patient care, I can append that I can’t stand to see what tends to happen in such houses.  Frequently over the years I have attempted to help a patient with losing weight, and/or finding health, with an emphasis on dietary improvement - only to see the effort sabotaged by a house divided.  Eating well is challenging enough for most people in the modern world without a family conspiring against it.  When they do, it becomes nearly impossible.  The need to prepare “my food” and “their food” converts the manageable challenge of food preparation into an inordinate burden.  The presence of junk food in the house to satisfy the demands of others will undermine your own resolve.

A house divided will, indeed, fall- under the burden of its own, unwanted weight gain among other things.

The pernicious influences of disunity and division affect us all.

  Spouse can undermine spouse, child can undermine parent.  But most worrisome in an age of epidemic childhood obesity: parent can undermine child.

We might know this sufficiently from the vintage wisdom and profound good sense reflected in our proverbs.  But as is often the case when sense is genuine, we have abundant science to corroborate the claim.

We have long had evidence that obesity in early childhood is prone to persist.  Recent research suggests that weight control problems develop by age 5, or are far less likely to develop at all.  We may also acknowledge that whatever the role of “personal responsibility” in weight control and health, it cannot reasonably be invoked when discussing the behaviors of our youngest children (1).  We may debate the relative salience of culture versus parenting, but clearly the buck does not stop with 3-year-olds.

Studies show, predictably, that parental behaviors pertaining to health and weight directly influence the corresponding behaviors, and outcomes, in our young children.  An ever-growing body of research shows, encouragingly, that families can, and perhaps must, be part of the childhood obesity remedy. One study focused on parental feeding practices found improvements in the weight trajectory of young children with a family-based approach. Another study, just out in Pediatrics, shows that weight in pre-school children is more favorably affected by an intervention that addresses parental weight control in tandem.

There are more studies where these came from, of course, and overwhelmingly, they reaffirm what good sense told us all along about unity, and our houses.

With regard to those houses, we have long accepted that mothers are the gatekeepers of the health residing therein.  Perhaps this can work with regard to routine clinical care, practiced in the context of a parental division of labor.  But based on the wisdom of proverbs, personal observation, clinical practice, and the relevant body of research literature- it simply cannot work with regard to the fundamentals of care and feeding.  Fathers need to get in the game.

This should not be a hard sell to my fellow Dads, once we acknowledge that we are de facto role models for our children; and that obesity and its sequelae are among the more likely and more serious of threats they face.

Protecting hearth and home is time-honored “guy stuff.”  A rousing call of “grab your muskets, fellas” may come to mind.  That call is no less relevant when the marauders are not wolves or bears or outlaws, but diabetes, atherosclerosis, and fatty liver disease.  Fathers, defend your families.

To do so, you will need to take an interest in your own health.  However often it may be repeated, “do as I say not as I do” never works.  If your children don’t respect you, they will not do as you say.  If they do respect you, they will emulate you- and do as you do.  Do right by your own health, and they will be watching, and learning by example.  The converse, of course, is also true.

I am confident the term “father figure” evokes a similar, short set of attributes, or at least aspirations, for us all: strength and gentleness; honesty and fairness; wisdom and love.  Above all, though, is protectiveness.  A father protects his family.  Inescapably, we fathers figure in childhood obesity - by setting an example that makes us part of the solution, or by abdicating, and being part of the problem. 

Here’s to fathers stepping up, being the figures we all wish them to be - and figuring significantly in the defense of the children and families we love, against this modern menace at the door.

Katz DL.  It’s the Kids’ Fault! (But what if it isn’t?...). Childhood Obesity.  2011;7:1-3

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