Childhood Obesity Prevention Should be Started at an Early Age, Says Research

According to the researchers of the Harvard Pilgrim Health Care Institute, children obesity prevention programs should be set in motion at infancy or even earlier.

The researchers observed 1,826 women since their pregnancy to their children’s first five years and came across the fact that African American and Latino children in particular have a greater risk of being overweight. The pregnant women of Hispanic and African American origin had been more overweight and their children are also born small, put on excess mass over time, not sleep well, and begin eating solid food earlier.

“We should be starting earlier especially if we want to prevent disparities in childhood obesity”, said Taveras, who directs the One Step Ahead Program at Harvard-affiliate Children’s Hospital Boston.

The research is going on to examine link between pregnancy risk factors, and the health of the infant. The Legislature and Department of Agriculture in Texas have taken considerable steps for the promotion of access to healthy meals for our young children. The problem of obesity was first emphasized by Michelle Obama in the United States.

Prevention of Childhood Obesity

Obesity is easier to prevent than to treat, and prevention focuses in large measure on parent education. In infancy, parent education should center on promotion of breastfeeding, recognition of signals of satiety, and delayed introduction of solid foods. In early childhood, education should include proper nutrition, selection of low-fat snacks, good exercise/activity habits, and monitoring of television viewing. In cases where preventive measures cannot totally overcome the influence of hereditary factors, parent education should focus on building self-esteem and address psychological issues.

Childhood Overweight PrevalenceIn the past 30 years, the occurrence of overweight in children has doubled and it is now estimated that one in five children in the US is overweight. Increases in the prevalence of overweight are also being seen in younger children, including preschoolers. Prevalence of overweight is especially higher among certain populations such as Hispanic, African American and Native Americans where some studies indicate prevalence of >85th percentile of 35-40%. Also, while more children are becoming overweight, the heaviest children are getting even heavier. As a result, childhood overweight is regarded as the most common prevalent nutritional disorder of US children and adolescents, and one of the most common problems seen by pediatricians.

Consequences of Childhood Overweight
Both the short term and long term effects of overweight on health are of concern because of the negative psychological and health consequences in childhood.

Potential Negative Psychological Outcomes:

  * Depressive symptoms
  * Poor Body Image
  * Low Self-Concept
  * Risk for Eating Disorders

Negative Health Consequences:

  * Insulin Resistance
  * Type 2 Diabetes
  * Hypertension
  * High Total and LDL Cholesterol and triglyceride levels in the blood
  * Low HDL Cholesterol levels in the blood
  * Sleep Apnea
  * Early puberty
  * Orthopedic problems such as Blount’s disease and slipped capital femoral epiphysis
  * Non-alcoholic steatohepatitis (fatty infiltration and inflammation of the liver)

Further, obese children are more likely to be obese as adults, hence they are at increased risk for a number of diseases including: stroke, cardiovascular disease, hypertension, diabetes, and some cancers.

Treatment of Childhood Obesity

Obesity treatment programs for children and adolescents rarely have weight loss as a goal. Rather, the aim is to slow or halt weight gain so the child will grow into his or her body weight over a period of months to years. Dietz (1983) estimates that for every 20 percent excess of ideal body weight, the child will need one and one-half years of weight maintenance to attain ideal body weight.

Early and appropriate intervention is particularly valuable. There is considerable evidence that childhood eating and exercise habits are more easily modified than adult habits (Wolf, Cohen, Rosenfeld, 1985). Three forms of intervention include:

  1. Physical Activity

    Adopting a formal exercise program, or simply becoming more active, is valuable to burn fat, increase energy expenditure, and maintain lost weight. Most studies of children have not shown exercise to be a successful strategy for weight loss unless coupled with another intervention, such as nutrition education or behavior modification (Wolf et al., 1985). However, exercise has additional health benefits. Even when children’s body weight and fatness did not change following 50 minutes of aerobic exercise three times per week, blood lipid profiles and blood pressure did improve (Becque, Katch, Rocchini, Marks, & Moorehead, 1988).

  2. Diet Management

    Fasting or extreme caloric restriction is not advisable for children. Not only is this approach psychologically stressful, but it may adversely affect growth and the child’s perception of “normal” eating. Balanced diets with moderate caloric restriction, especially reduced dietary fat, have been used successfully in treating obesity (Dietz, 1983). Nutrition education may be necessary. Diet management coupled with exercise is an effective treatment for childhood obesity (Wolf et al., 1985).

  3. Behavior Modification

    Many behavioral strategies used with adults have been successfully applied to children and adolescents: self-monitoring and recording food intake and physical activity, slowing the rate of eating, limiting the time and place of eating, and using rewards and incentives for desirable behaviors. Particularly effective are behaviorally based treatments that include parents (Epstein et al., 1987). Graves, Meyers, and Clark (1988) used problem-solving exercises in a parent-child behavioral program and found children in the problem-solving group, but not those in the behavioral treatment-only group, significantly reduced percent overweight and maintained reduced weight for six months. Problem-solving training involved identifying possible weight-control problems and, as a group, discussing solutions.

Primary Prevention of Childhood Obesity

The results of the literature search and review were used to inform the background of this document and
the methodology for guideline development. After careful review, the panel found that the published
guidelines that focused on primary prevention of childhood obesity were limited. They decided to examine
existing systematic reviews of the literature on primary prevention intervention strategies for childhood
obesity. The panel members searched for high quality systematic reviews* on the prevention of childhood
obesity and the promotion of healthy eating and physical activity. Panel members evaluated the reviews
using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for systematic reviews
(Appendix C) with direction from one of the panel members who had extensive experience in undertaking
systematic literature reviews. Reviews that were judged as moderate or high quality were utilized to develop
initial recommendations and supporting discussion of evidence. The list of systematic reviews initially
critiqued are found in Appendix D. Panel members developed recommendations based on available
evidence and came to a consensus* on a draft guideline.

This initial draft was critiqued by two independent reviewers prior to publication using the AGREE
instrument (AGREE Collaboration, 2001). No revisions resulted from this review. The initial draft was shared
with a group of external stakeholders. An acknowledgement of these reviewers is provided at the front
of this document. External stakeholders were provided with specific questions for comments, as well as
the opportunity to give overall feedback and general impressions. The results were compiled and
reviewed by the development panel. Discussion and consensus resulted in revision to the draft document
prior to publication.

Obesity in childhood and adolescence may also have adverse effects on social, academic, and economic outcomes in childhood and adulthood (Gortmaker, Must, Perrin, Sobol, & Dietz, 1993; IOM, 2004; Must et al., 1992).

Obese and overweight children and youth are at risk of developing serious social and emotional health consequences related to their weight status. Today’s society often stigmatizes people with obesity. This stigmatization, in turn, can lead to shame, self-blame, and low self-esteem that may negatively affect academic and social functioning now and into adulthood (IOM, 2004, Lobstein et al., 2004).

Moreover, costs associated with the treatment of obesity and related morbidity place an increasing burden on our health care system. A meta-analysis by Katzmarzyk and Janssen (2004) used a prevalence-based approach to estimate the economic costs of physical inactivity and obesity in Canada. These authors found the economic burden of obesity in 2001 to be $4.3 billion of which $1.6 billion was attributed to direct costs and $2.7 billion to indirect expenditures. The consequences of physical inactivity alone accounted for $5.3 billion or 2.6% of total health care costs in Canada in 2001.

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This publication was prepared with funding from the Office of Educational Research and Improvement, U.S. Department of Education, under contract no. RI 88062015. The opinions expressed in this report do not necessarily reflect the positions or policies of OERI or the Department.

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