Six “C’s” for Childhood Obesity Prevention

By Ru Liu

Almost 1 in 5 children and teenagers aged from 6-19 years has obesity in the United States. Children with obesity are more likely to have high blood pressure and cholesterol, breathing problems, type 2 diabetes, and psychological and social problems. Childhood obesity is an urgent public health concern, and it is not a simple one to tackle. A group of researchers from the STRONG Kids Program at the University of Illinois at Urbana-Champaign proposed a new ecological model, the Six-Cs model, to help explain the complex nature of childhood obesity and overweight contributors and guide future intervention efforts.


1st C – Cell

A baby is born. Let’s call her Jenna. Already, Jenna is more or less susceptible to being overweight or obese than the hundreds of other babies that were born at the same time as her, based on her genetic make-up. The cell level represents the biological and genetic predispositions an individual inherits at birth. Many genes have been associated with childhood obesity. The baby lying next to Jenna turns out to have rare variants in the BBS1, BBS9, and GNAS genes, which puts them at a higher risk for excessive body weight than Jenna.


2nd C – Child

The child level represents child characteristics including sleep, energy intake, physical activity level, gender, pubertal timing, money-spending habits. Now Jenna is in high school. She is struggling to get enough sleep because of too much homework. On top of that, she has a habit of watching Netflix for at least 2 hours before bed. Many studies have found that the shorter sleep lasts, the higher body weight a child tends to have. How might lack of sleep lead to increased weight? One possible explanation is that the longer you stay awake, the more likely you are to eat that extra piece of sugary pastry even when you are not hungry. Lack of sleep can also affect hormones that are responsible for appetite and hunger regulation. It has also been proposed that children who sleep less tend to be less physically active. Additionally, being a female and African American, Jenna’s gender and race put her at higher risk for being overweight.


3rd C- Clan

The clan, AKA the family, we grow up in has a profound impact on our emotional and physical development. The clan level represents familial characteristics. Parent encouragement of child activity and healthy eating, parent nutrition knowledge, and family meal climate all contribute to child’s body weight. Jenna’s mother is a dietitian, who encourages healthy eating in the family. Jenna has been taught to love vegetables since she was young. Jenna’s parents also make sure they always eat dinner together as a family without any screen or media use. On the weekends, the three of them often go to play tennis in a nearby park. Jenna has strong family support to maintain a healthy weight.


4th C – Community

The community level includes local transportation, neighborhood safety, community socioeconomic status, community food restrictions, school meal programs, and accessibility of food outlets. Jenna’s old neighbor, Jackson loves basketball. However, he recently moved, and the new neighborhood doesn’t have basketball courts. In fact, it is surrounded by buildings, busy streets, and narrow sidewalks, which makes running outside a challenge for Jackson. In Jackson and Jenna’s old neighborhood, there are two big grocery stores within walking distance that have great selections of fresh vegetables and fruits. However, Jackson’s family now have to drive 30 minutes to the nearest grocery store. With their busy schedule, they now cook less and eat out at the chain fast food restaurants around the block more. Jackson’s new community characteristics have placed challenges for his family to maintain healthy weight.


5th C – Country

The country level represents state and national characteristics such as government funding of exercise and nutrition campaign, media food marketing, media body portrayals, and the health care system. In Illinois, where Jenna and Jackson reside, there are many state-wide programs targeting childhood obesity prevention. For instance, the Illinois Junior Chefs Program is a state-wide educational nutrition program that teaches children cooking skills. Media food marketing has an even wider reach. Burger King, Pizza Hut, and McDonald’s are some of the many fast food and processed food companies that recruited popular celebrities to promote their products.


6th C – Culture

The culture level is about gender-role expectations concerning exercise, cultural beauty standards, special occasion eating practices, and norms for oversized portions.  Jenna’s family is out having dinner one day, and Jenna’s mother can’t help but noticing how much bigger the portion size is now compared to 10 years ago. Indeed, hamburger portion size has tripled; bagels, muffins and pasta dishes have grown to twice their original sizes over the past 50 years. It is not hard to find cookies that are as big as an adult’s palm nowadays. Unfortunately, most of us don’t notice the gradual increase in portion size, and we are prone to eat more when presented with more food.


The Six-Cs model dissects the complex layers of childhood obesity. The contributors for this epidemic are multilayered, and it is necessary to promote education, advocacy and intervention on all levels in order to start solving this issue.


Peer-edited by Laura Smith

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