Uscript Author Manuscript Author ManuscriptAnn N Y Acad Sci. Author manuscript; available in PMC 2016 July 01.Wahlqvist et al.Pagesimply lived in an environment that provided fewer calories and included more physical activity for all.”100 The huge business of dangling tempting palatable choices before the eyes of children participating in parental food shopping exerts real purchase LCZ696 pressure on the parent in industrialized nations. Although this specifically refers to affluent overnutrition, there are substantial similarities with underresourced populations everywhere. Physical activity–In a recent systematic review, Hall et al. created a mathematical model of childhood growth at ages 5?8, predicting the energy equivalents of healthy and obese children of both sexes and proposing the magnitude and timing of treatment that might inform policy: “At the population level, the excess weight of US children in 2003?6 was associated with a mean increase in energy intake of roughly 200 kcal per day per child compared with similar children in 1976?0.”101 Clearly, there is a need for reasonably simple methods to increase daily expenditure by 200 kcal/day in school children. Just as there are few studies of mechanisms maintaining leanness, remarkably little attention is paid to maintaining wellness or fitness. Prevention and quality-of-life aspects of medical care and patient satisfaction have only recently emerged as significant goals of the medical?industrial complex, yet are the ultimate Enzastaurin supplement determinants of sustainability of proposed remedies. Conflict between econometric public health models and care of individual patients (i.e., between policy and medical practice) is based on the dilemma of choosing between investing in prevention versus paying to reduce extant suffering. Effective global policies, if achievable, cannot mitigate the differential distribution of natural resources and impoverishing, unpredictable catastrophes, thus arguing for local policies except to address truly global threats (e.g., anthropogenic climate change, pollution, and depletion of unrenewable resources). The goal of reversing maladaptive behavior requires durable adherence to health-sustaining behaviors (habits) that can realistically be sustained on the individual level. Such habits are easiest to establish during the period of greatest neuroplasticity starting in the womb and continuing through pubarche, where the intrauterine environment is the most sensitive and responsive.102 Solutions? The magnitude and scope of the problems are well-known and authoritatively documented with impressive supporting information (Wahlqvist). New knowledge about contributions to the problem have surfaced: remote patrilineal inheritance of famine-induced genomic changes (Rizzo), outcomes of unintended pregnancies (Finer), RNA damage in sperm (Krawetz), effects of urbanization on the microbiome (Dominguez-Bello), food choices during gestation (Menella), and disturbances of satiety responsiveness in children engendering behavioral susceptibility (Wardle). New tools for assessing population-level nutritional exposure have been proposed, paving the way for epigenetic epidemiology (Waterland). In the domain of potentially malleable mechanisms, we have learned that RNA damage in sperm might be reversible (Krawetz), that metastable epialleles are sensitive to periconceptional maternal diet (Waterland), and that novel molecules affecting metabolicAuthor Manuscript Author Manuscript Author Manuscript Au.Uscript Author Manuscript Author ManuscriptAnn N Y Acad Sci. Author manuscript; available in PMC 2016 July 01.Wahlqvist et al.Pagesimply lived in an environment that provided fewer calories and included more physical activity for all.”100 The huge business of dangling tempting palatable choices before the eyes of children participating in parental food shopping exerts real pressure on the parent in industrialized nations. Although this specifically refers to affluent overnutrition, there are substantial similarities with underresourced populations everywhere. Physical activity–In a recent systematic review, Hall et al. created a mathematical model of childhood growth at ages 5?8, predicting the energy equivalents of healthy and obese children of both sexes and proposing the magnitude and timing of treatment that might inform policy: “At the population level, the excess weight of US children in 2003?6 was associated with a mean increase in energy intake of roughly 200 kcal per day per child compared with similar children in 1976?0.”101 Clearly, there is a need for reasonably simple methods to increase daily expenditure by 200 kcal/day in school children. Just as there are few studies of mechanisms maintaining leanness, remarkably little attention is paid to maintaining wellness or fitness. Prevention and quality-of-life aspects of medical care and patient satisfaction have only recently emerged as significant goals of the medical?industrial complex, yet are the ultimate determinants of sustainability of proposed remedies. Conflict between econometric public health models and care of individual patients (i.e., between policy and medical practice) is based on the dilemma of choosing between investing in prevention versus paying to reduce extant suffering. Effective global policies, if achievable, cannot mitigate the differential distribution of natural resources and impoverishing, unpredictable catastrophes, thus arguing for local policies except to address truly global threats (e.g., anthropogenic climate change, pollution, and depletion of unrenewable resources). The goal of reversing maladaptive behavior requires durable adherence to health-sustaining behaviors (habits) that can realistically be sustained on the individual level. Such habits are easiest to establish during the period of greatest neuroplasticity starting in the womb and continuing through pubarche, where the intrauterine environment is the most sensitive and responsive.102 Solutions? The magnitude and scope of the problems are well-known and authoritatively documented with impressive supporting information (Wahlqvist). New knowledge about contributions to the problem have surfaced: remote patrilineal inheritance of famine-induced genomic changes (Rizzo), outcomes of unintended pregnancies (Finer), RNA damage in sperm (Krawetz), effects of urbanization on the microbiome (Dominguez-Bello), food choices during gestation (Menella), and disturbances of satiety responsiveness in children engendering behavioral susceptibility (Wardle). New tools for assessing population-level nutritional exposure have been proposed, paving the way for epigenetic epidemiology (Waterland). In the domain of potentially malleable mechanisms, we have learned that RNA damage in sperm might be reversible (Krawetz), that metastable epialleles are sensitive to periconceptional maternal diet (Waterland), and that novel molecules affecting metabolicAuthor Manuscript Author Manuscript Author Manuscript Au.