New Study: Eating Patterns and Childhood Obesity

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Eating patterns may play a larger role in childhood obesity than we had previously believed. Get the background in the post, Eating Patterns and Childhood Obesity, then check out this latest study...

The Study:

Data among 43 rural and 34 peri-urban Shuar children in Amazonia Ecuador was collected to evaluate school-aged children’s diet and calorie expense during early market exposure and transition to overweight and obesity. The children in this study lived in an isolated region and mainly relied on hunting, fish, foraging, and small-scale horticulture for food. Children in the peri-urban sample resided in a regional market center and had access to roads, a hospital, stores, restaurants, and other market luxuries.

Information on income and access to running water was collected to evaluate variation in market integration in households. Children’s physical activity was also measured through wearable devices. Biomarkers in finger-prick blood samples were used to monitor immune activity. Doubly-labeled water-stable isotope-tracking was utilized to measure the children’s resting energy expense. These are gold standard, participant-friendly methods.

Study Discoveries:

  • Peri-urban children average 65% more body fat than rural children, with more than a third of peri-urban children classified as overweight compared to no rural children.
  • Peri-urban children eat more than four times as many market-acquired items as rural children.
  • Peri-urban and rural children have similar levels of physical activity.
  • Peri-urban children spend 108 calories per day less than rural children while at rest. This is related in part to 16-47% lower levels of immune activity.
  • Measures of market integration, immune activity and physical activity have no detectable impact on children’s overall energy expenditure, with peri-urban and rural children spending roughly the same number of calories.
  • Variation in consumption of market foods, but not in daily energy expenditure, is related to children’s body fat.

This study is the first to look at children’s calorie expense across market integration in one population while also using diet, physical activity, and immune activity. The discovery of no effect of market integration on measured daily energy expense matches earlier reports in adults and infants, according to study author Samuel Urlacher.

The researchers believe this study provides evidence that altered dietary intake and not reduction in calorie expense is increasing childhood obesity in several populations. While physical activity is still necessary for a healthy lifestyle, the study is in line with growing evidence that a poor diet is the lead factor in the development of obesity and adiposity in children.

The researchers will conduct further studies by collecting longitudinal data to evaluate a child’s lifetime development of obesity and other metabolic diseases such as cardiovascular disease. More detailed dietary information will be collected and other lifestyle and biological factors will be used to find causal relationships. Most importantly, researchers want to find the best ways to apply their research to enhance children’s health in low- and middle- income countries.

Tips for professionals:

As childhood obesity remains a growing issue in the US, dietitians and healthcare providers can do their part through parent education. These tips may help your audience:

  • Be a role model for your children. Drink water, not soda or sports drinks.
  • Keep healthy food on hand such as seasonal fruits and vegetables and whole grains.
  • Teach children how to shop and cook their own food.
  • Limit exposure and intake of fast food.
  • Reduce high-calorie snack intake.
  • Don’t give in to marketing geared towards children.
  • Introduce new foods one at a time and encourage kids to try them.
  • Don’t reward children with treats.
  • Stay active with your children. Go for walks, hikes and bike rides.
  • Focus on health, not weight, in your children’s diet.

By Lisa Andrews, MEd, RD, LD


Urlacher SS, Snodgrass JJ, Dugas LR, Madimenos FC, Sugiyama LS, Liebert MA, Joyce CJ, Terán E, Pontzer H. Childhood Daily Energy Expenditure Does Not Decrease with Market Integration and Is Not Related to Adiposity in Amazonia. J Nutr. 2021 Jan 18:nxaa361

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