A resource for health professionals, parents, teachers, counselors & kids on the childhood obesity epidemic.

When the Institute of Medicine issued the report, “Early Childhood Obesity Prevention Policies,” Dr. Wendy Slusser of the UCLA Mattel Children’s Hospital said something interesting. As trusted adults who share responsibility for noticing a child’s risk level at an early age, along with doctors, she named day care providers.

At the website ObesityHelp.com, a writer known as “tammy” discussed a Canadian study from Sainte-Justine University Hospital and the Université de Montréal which contains bad news indeed. The scientists looked at data from 1,649 families, who were followed for six years, showing that:

[...] children between the ages of 1.5 to 4 years who attend day care versus those who do not, are 50 percent more likely to be overweight when they reach the ages of 4-10…

Yikes! That’s a lot! And nobody knows why! But what we do know, according to this information and interpretation, is that being a day care kid correlates with childhood obesity. Tammy goes on to say:

Researchers do not have a clear explanation for the higher risks but suggest that parents make sure their children are physically active and eating healthy meals whether in day care or not. According to lead researcher, Dr. Marie-Claude Geoffroy, the answers are not explained by known risk factors such as breastfeeding, BMI of the mother, or socioeconomic status of the parent.

For instance, a Canadian guide on the necessity for developing physical literacy insists on the necessity of programs in any setting that involves caring for a group of children, including day care centers.

Brenda Goodman reported for WebMD on a Duke University Medical Center meta-study led by Sara Benjamin Neelon, Ph.D., who with her colleagues reviewed 42 studies of “obesity prevention related practices in day care.” One thing they learned is that, because parents must work, about 82% of American kids younger than 6 spend a lot of time in child care settings away from home. And if they have a 50% higher chance of being overweight or obese, that adds up a lot of risk.

Also, full-time day care means that children consume about 2/3 of their daily calories away from home, so nutrition is now looked at very closely. And a lot of kids who are in day care don’t get the recommended minimum of 60 minutes of physical activity every day. Sometime it’s because of the “time out” penalty, one of the few options that such facilities have for keeping order. The paradox is, one of the reasons children misbehave might be from pure restlessness caused by not being allowed enough activity.

In Utah, some day care centers took the bold step of eliminating TV entirely, and worked to develop more indoor physical activity options like dancing and yoga. Kirsten Stewart reported:

Unhealthy habits derive from a knot of cultural and economic influences. But teachers and caregivers can be a ‘powerful force for change,’ said Jessica Haymond, Healthy Child Care Coordinator at the Utah Department of Health… They’re on the front lines and touch a lot of lives from infancy on up, making it possible for them to intervene before poor choices harden into hard-to-break habits, Haymond said. ‘We also hope they’ll educate the parents.’

Someone needs to, and it would certainly be a mistake to pin too many hopes on the power of children to cause positive change in their parents. As Childhood Obesity News mentioned before, there are strong indications that education has the best effect in parents-only programs. If day care providers can organize sessions to enlighten parents, so much the better. In such an important struggle, every little bit helps. Problem is, of what does the education consist? Good nutrition, plenty of exercise, sure, those can’t hurt. But they are not the whole answer, not by a long shot.

Please enjoy Dr. Pretlow’s webinar, “The Epidemic of Childhood Obesity: What’s our Plan?”

Your responses and feedback are welcome!

Source: “Focus on early childhood to prevent weight gain, IOM report says,” LATimes 06/23/11
Source: “Childhood Obesity: Is Day Care A Contributing Factor?,” ObesityHelp.com, 12/18/12
Source: “Study: Obesity Prevention Should Focus on Day Care,” WebMD, 08/26/11
Source: “Davis County child care centers take away TV to fight obesity,” SLTrib.com, 11/30/11
Image by USAG – Humphreys.

Over the past couple of years, many health care professionals studying childhood obesity have arrived at “early intervention” as their takeaway. According to the statistics, each year farther back toward birth that treatment begins, the odds improve.

In other words, a child whose treatment begins at 5 has a better chance than one who starts at age 6, and 4 is better than 5. In fact, 3 is said to not be too young. The younger the child is, the more likely she or he is to be successful in achieving and maintaining a healthy weight and body size.

Early intervention in childhood obesity is so important, and Nancy Walsh, staff writer for MedPage Today, explains all the details of why it’s important not to wait until a child is distressingly overweight in middle school, and then wonder what to do. No, early childhood is the “pivotal time.”

Kids are very sensitive to environmental influences, Walsh notes, and their characters and personalities tend to change rapidly. Just one way of trying to help them isn’t enough, there should be various avenues. The consensus is that children need their society to offer care and protection. The journalist talks about a study performed in Sweden by Dr. Pernilla Danielsson and colleagues, saying:

44% of those ages 6 to 9 years who were moderately obese at baseline experienced a clinically meaningful 0.5-unit decrease in body mass index (BMI) z-score with behavioral treatment, compared with only 8% of those ages 14 to 16…

To put it another way, with participation in behavioral treatment, nearly half of the 6-to-9-year-olds showed clinically noteworthy improvement, while only less than one-tenth of the older kids showed improvement. In other words, as Janis Joplin famously sang, “Get it while you can.” Catch them when they’re young, or kids will become way more resistant to behavioral change.

In the Netherlands, at the University of Groningen, Dr. Gianni Bocca headed a team that worked with very young children and showed that intervention leads to “multiple significant benefits” in reducing abdominal fat. This is important because visceral fat cells produce adipokines, which action is followed by “oxidative stress, inflammation, insulin resistance, and ultimately diabetes and the metabolic syndrome.”

Walsh says:

In the Dutch study, Bocca and colleagues enrolled 75 children ages 3 to 5 who were overweight or obese, randomizing them to a 16-week comprehensive program of daily physical activity, dietary instruction, and psychological counseling for parents… The usual-care group was provided with advice on diet and activity.

‘An important result of our study is the positive effect on the reduction of abdominal fat mass in the intervention group, shown by decreases in [waist circumference]-z and [visceral fat],’ Bocca and colleagues observed.

They found that their four-month intervention program resulted in “significantly greater decreases in BMI, waist circumference z-score, hip circumference, hip circumference z-score, upper arm circumference, percentage of body fat, and subcutaneous fat,” and what is more, the children’s positive changes were sustained over a year.

Sustainability is of course the gold standard, for this type of program. Nobody has time or use for short-term changes where kids revert back to having their original problems or worse. Learn more about current thought in the field from Dr. Pretlow’s new webinar, “The Epidemic of Childhood Obesity: What’s Our Plan?”

Your responses and feedback are welcome!

Source: “Target Obesity Early to Succeed in Kids,” MedPage Today, 10/29/12
Image by Seattle Municipal Archives.

Early intervention to avoid childhood obesity is a hot topic. The reason is obvious, and expressed by the old proverb, “A stitch in time saves nine.” In other words, if the edge of your pocket is starting to tear, sew it up, because once that little tear has been made it’s so much easier for it to catch on something and rip the whole pocket right off. Which would require a lot more than nine stitches, actually, to fix. Once again, folk wisdom points the way.

One reason why early intervention is to be desired, as Childhood Obesity News has discussed, is that habits start early and are exceedingly hard to break once they have taken hold. Of course there are many others.

Childhood is not the only time when obesity presents a danger, obviously, and now it appears the situation is even worse than previously suspected. For a while, it was accepted that people could sort of “age out” of obesity risk. This was supported by such half-baked notions as a theory that the fat padding protects obese seniors from breaking bones when they fall.

Anyway, it’s incorrect. The Mailman School of Public Health at Columbia University says:

… [A] slew of prominent research has reported an ‘obesity paradox’ that says, at age 65 and older, having an elevated BMI won’t shorten your lifespan, and may even extend it. A new study takes another look at the numbers, finding the earlier research flawed. The paradox was a mirage: As obese Americans grow older, in fact, their heightened risk of death climbs…

How do we know this? Columbia and the University of Texas put together the research team of Ryan Masters, Ph.D.; Bruce Link, Ph.D.; and Daniel Powers, Ph.D., to take a second look at that assumption. Columbia’s website quotes Dr. Masters, who is also a Robert Wood Johnson Foundation Health & Society Scholar:

Obesity wreaks so much havoc on one’s long-term survival capacity that obese adults either don’t live long enough to be included in the survey or they are institutionalized and therefore also excluded. In that sense, the survey data doesn’t capture the population we’re most interested in.

Dr. Masters does not entirely blame earlier studies for getting it wrong, however, for an interesting and rather ominous reason:

The recent obesity epidemic hit all age groups at the same time, meaning many of the elderly obese only gained their excess weight in the last 10 years or so.

Here is another recent obesity-related discovery to be concerned about: When an obese mother has a child, even if that child somehow escapes becoming obese herself or himself, there will still be a greater risk of heart disease for that child. Why? Because the aorta is thickened, and, according to this report:

Thickening of this main artery is an indication of early atherosclerosis, the disease that leads to the majority of heart attacks and strokes, and is characterized by the development of plaques in the walls of the arteries.

P.S.  Have you looked over on the right-hand side of the page lately? Don’t miss Dr. Pretlow’s new webinar, “The Epidemic of Childhood Obesity: What Is Our Plan?”

Your responses and feedback are welcome!

Source: “Old Age Offers No Protection from Obesity’s Death Grip,” Columbia.edu, 02/05/13
Source: “Heart disease signs in newborns of overweight and obese,” News-Medical.net, 03/04/13
Image by Puuikibeach (davidd).

Recently, reports appeared of a new study of childhood obesity, which is described as:

[...] the first comprehensive national profile of associations between weight status and a broad set of associated health conditions, or co-morbidities, that kids suffer from during childhood.

Lead author Dr. Neal Halfon, a professor of pediatrics and public health, is the director of UCLA’s Center for Healthier Children, Families and Communities.

The study’s novelty is in its extent, covering data extracted from the health records of more than 43,000 children between 10 and 17 years old. As always, one of the problems of thorough research is the time lag. Facts need to be collected, gathered together, set in order, appropriately stored, then analyzed, rechecked, written up, and so on. Because of this, it is not surprising that the data originated from the 2007 National Survey of Children’s Health.

The other novelty is in the widespread nature of the data the team worked with, in contrast to previous studies of the same kind that narrowly focused on a single region or a single medical condition. One writer described it this way:

They assessed associations between weight status and 21 indicators of general health, psychosocial functioning and specific health disorders, adjusting for sociodemographic factors.

Overall, the researchers found, obese children were more likely than those who were classified as not overweight to have reported poorer health; more disability; a greater tendency toward emotional and behavioral problems; higher rates of grade repetition, missed school days and other school problems; ADHD; conduct disorder; depression; learning disabilities; developmental delays; bone, joint and muscle problems; asthma; allergies; headaches; and ear infections.

The thing is, these researchers were looking not just at long-term effects of childhood obesity, but the associated conditions that happen right away. The harm is not in the future, but immediate. Overweight and obese kids are much more likely to have co-morbitities — medical, mental or developmental conditions, and often more than one of them.

An article about behavioral counseling in the areas of maternity and child health care emphasizes again the difficulty of change:

Obesity originates prenatally and in early childhood… Once a child is obese it is difficult to reverse this adverse metabolic state with interventions. This supports the rationale to find early preventive interventions… An appropriate setting for these interventions would be municipal maternity and child health clinics, making it possible to reach the target population at moderate cost…

Childhood Obesity News has talked about the EarlyBird Diabetes Study, which stressed the same point. There is ever-increasing evidence that obesity needs to be looked at right from the first, with more emphasis than ever before on early intervention.

Your responses and feedback are welcome!

Source: “Childhood obesity linked to more immediate health problems,” MachinesLikeUs.com, 01/14/13
Source: “Behavioral counseling to prevent childhood obesity – study protocol of a pragmatic trial in maternity and child health care,” BMC Pediatrics, 2012
Image by Frank Douwes.

Childhood Obesity News has mentioned various aspects of the EarlyBird Study and one of the most important is the fact that dietary habits are established very early in a child’s life. Once established, they tend to be retained. If children’s habits change at all, it’s usually for the worse.

The importance of early intervention has been highlighted again and again by numerous authorities. For instance, in the course of explaining why Michelle Obama’s Let’s Move! program is “fine, but not enough,” primary care physician Dr. Donald Kushner wrote:

It is never too soon for a family to begin working on its weight problems. The Early Bird Diabetes Study conducted in the United Kingdom found that 90 percent of excess weight in girls and 70 percent in boys is evident as early as age 5.

It would be good if parents could, among other things, get over quaint ideas about outgrowing baby fat. Dr. Kushner believes that family influence is probably the most important factor in childhood obesity. Grandparents are included, because even if the parents are normal weight, kids have a tendency to be heavy if their grandparents are setting that example. He says:

Girls born to obese mothers are 10 times more likely to become obese. Boys born to obese fathers are six times more likely to become obese.

Evidence shows obesity follows gender: Girls follow their mothers and boys their fathers. However, the opposite is not true, even though children pick up an equal number of genes from both parents. This suggests behavior is more important than genetics. In fact, it is estimated that only 20 percent of weight variance can be attributed to genes.

There are three ways to go about anti-obesity training: sessions with kids only; kids and parents together; and parents only. The article mentions an interesting study that appeared in the International Journal of Pediatric Obesity, looking into the effectiveness of each method, and guess what? The parents-only lessons had the best outcome, in terms of preventing and reducing obesity in children.

Dr. Kushner offers suggestions about how to succeed in preventing childhood obesity, and please do see his article for more detail. This is only a teaser. The main thing is, weight loss per se should not be the goal. You want to go for lifestyle change, the kind that becomes so natural to the person that it’s unconscious. Also, “the approach should provide mutual benefit for the entire family,” and it should be comprehensive and balanced. The approach must be comprehensive and balanced.

Start early, and focus on the long term — that is the message.

P.S. Something is new, over on the right-hand side of the page — Dr. Pretlow’s webinar, “The Epidemic of Childhood Obesity: What’s Our Plan?” We told you a little about it last week, and now here is the whole thing!

Your responses and feedback are welcome!

Source: “Childhood obesity: It’s a family affair,” Post-Gazette.com, 03/03/10
Image by Beverly & Pack.