Reversing the Pediatric Obesity Epidemic: Using a Developmental Cascade Perspective to Guide Preventive Intervention

Introduction. Pediatric obesity is a serious public health concern due to its prevalence, long-term consequences, and economic costs. Pediatric obesity researchers have long-recognized that pediatric obesity can be best understood within an eco-developmental framework. However, as noted by Harris et al. (2012), a more comprehensive developmental model of pediatric obesity than is currently available is needed to better inform prevention efforts that coordinate multiple systems and influences. The developmental cascade (DC) perspective is one such developmental model that has been critical to effective prevention of youth delinquency, substance use, child maltreatment, and other problems. DCs refer to the interactions and transactions that occur over time, across and within levels, and among domains, that result in cumulative consequences and spreading effects (Masten & Cicchetti, 2010). The challenge of obesity prevention renders it time to reconceptualize obesity prevention through a theoretical lens that increases understanding of how the accumulation of risk factors propel children down an unhealthy path. The paper evaluates the existing empirical support for a comprehensive DC model of pediatric obesity and explores its implications for prevention science.

Method. A two-stage structured review was conducted, January 2015 and May 2016, using Web of Science for peer-reviewed articles published in the years 2004–2014. The search returned 1425 studies, 307 met inclusion criteria after review. A hypothesized developmental cascade model was refined based on the findings of the review.

Results. The model includes 26 core constructs, in four developmental periods spanning prenatal to late adolescent-early adulthood, with myriad potential cascade “pathways.” Single “links” between core constructs and child weight were examined and the identified evidence supporting each link is provided.

Conclusions. In terms of prevention, the final DC model provides a basis for testing hypothesized cascades with multiple intervening (i.e., mediating) variables that can be used to identify potential targets for preventive intervention that are specific to developmental periods. Given the dearth of existing research that examined pathways with single or multiple intervening variables, the cascades themselves (i.e., connections of multiple links) can only be hypothesized from this model and associated literature review. Existing research is highly focused on two-point longitudinal studies. Future work will need to be designed to collect data over time in a manner conducive to studying DCs and epidemiologically based preventive intervention trials (Kellam & Rebok, 1992) should also be used to inform the development of a DC model of obesity.