Addressing childhood obesity
Childhood obesity where children live, learn, and the past 30 years, the prevalence of childhood obesity has more than doubled among children ages 2-5 and has almost tripled among children ages 6-11 and adolescents ages 12-19. And although obesity rates are stabilizing, hispanic, african-american, and american indian youth are disproportionately ’s overweight children are more likely to become tomorrow’s chronically ill adults. Obesity in childhood is associated with serious health conditions including type 2 diabetes, sleep disorders, fatty liver disease, and increased risk of heart disease. In addition, mental health issues such as stigmatization, discrimination, depression, and emotional trauma frequently accompany childhood factors influence the diet and physical activity patterns of children and teenagers that lead to obesity. Past research has shown that for prevention and treatment strategies to be effective, they must address multiple izing this fact, the national institutes of health launched the childhood obesity prevention and treatment research (coptr) consortium to examine the many influences on childhood and adolescent obesity and to intervene at multiple levels of influence, including the home, school, neighborhood, and pediatric primary care settings. Everyone is part of the team in preventing childhood obesity: parents, pediatricians, teachers, friends, and community members. To effectively prevent and treat obesity we must reach children where they live, learn, and play,” said charlotte pratt, ph. Coptr consortium, launched in august 2010, is testing multi-level, multi-component interventions, in real world settings to prevent obesity in preschoolers and to treat overweight or obese children ages 7-13. Two of the sites will focus on preventing obesity and overweight in preschoolers and two will focus on treating obesity in 7 to 13 year ting obesity and overweight in sing the high prevalence of obese and overweight preschoolers remains a public health priority, particularly in minority populations. Although it is promising that rates of obesity among children ages 2-5 decreased from 14 percent to 8 percent between 2003 and 2012, the percentage of obese and overweight hispanic and african-american preschoolers is markedly higher. In 2012, approximately 30 percent of hispanic preschoolers and 22 percent of african-american preschoolers were overweight or of the coptr trials – at vanderbilt university and university of minnesota – are working hard to prevent childhood obesity in preschoolers with a focus on minority grow trial at vanderbilt university school of medicine.
This drive comes from serving patients as a pediatrician and seeing how obesity can have a domino effect on children’s lives: poorer health, increased depression, and more days of missed school – and, later in life, work – if they continue with a poor trajectory of body mass index. With this incredible grant opportunity from nhlbi and nichd, we have a chance to test interventions that may help prevent obesity among preschool-aged children in the context of the real world. Lower income and minority children are at even greater risk for obesity, for reasons that include lack of neighborhood spaces to be physically active and limited food access due to food costs and availability of retail stores that sell affordable healthful foods. The university of minnesota net-works (now everybody together for amazing and healthful kids) community preschooler obesity prevention trial, 534 economically challenged and racially diverse preschoolers ages 2-4 and their parents were randomized to participate in a three-year intervention program or to receive standard standard care group receives annual well-child visits – during which doctors assess height, weight, skin-fold, and waist circumference and collect information on activity levels and diet – and three postcards per year with parenting contrast, the intervention group receives annual well-child visits, monthly parenting classes and home visits from “family connectors” who teach parents about positive parenting behaviors that support healthy family actions such as exercising, healthy eating, and limiting tv and screen time, along with annual well-child family connectors help the families set goals based on the positive parenting behaviors, such as eating five fruits and vegetables daily, eating out once per week or less, and aiming for 60 minutes per day of physical activity and active play. Integrating obesity prevention messages and strategies and creating linkages among these settings where families spend much of their time offers potential for a sustainable approach that promotes healthy eating and physical activity as key factors in overall healthy child development,” explained dr. Part 2 will highlight the coptr trials based at stanford university and case western reserve articles about the coptr trials:Forging a future of better cardiovascular health: addressing childhood obesity (journal of the american college of cardiology, 2014). Obesity prevention and treatment research (coptr): interventions addressing multiple influences in childhood and adolescent obesity (contemporary clinical trials, 2013). Right onto wellness (grow): a family-centered, community-based obesity prevention randomized controlled trial for preschool child-parent pairs (contemporary clinical trials, 2013). Works: linking families, communities and primary care to prevent obesity in preschool-age children (contemporary clinical trials, 2013). Working group report on future research directions in childhood obesity prevention and updated: may 1, directly to directly to a to z directly to directly to page directly to site receive email updates about this page, enter your email address:Combatting childhood end on scientific studies are beginning to show progress against the childhood obesity epidemic, but the numbers of young people affected by obesity remain at high levels. Learn what you can do to combat childhood ood obesity touches approximately 1 of 6 young 18% of all children and teens in the united states are obese, and since 1980, the number has almost tripled.
Research shows that fewer physical activity programs in schools, and drinking too many sugar-sweetened beverages, likes sodas and juices, are just some of the reasons childhood obesity is growing in the united states. The good news is there are a number of actions communities, states, schools, and parents can use to combat the childhood obesity is childhood obesity? Childhood obesity is defined as a bmi at or above 25 or at or above the 95th percentile. To cdc’s august 2013 vital signs report, after decades of rising obesity rates among low-income preschoolers aged 2–4 years, many states are now showing small declines in childhood obesity rates. Among older children, a recent cdc survey shows that school districts nationwide are making school meals more healthy and requiring physical ements in childhood obesity rates have also been noted at the local level. For example, a study conducted in philadelphia, pennsylvania, and published in cdc’s preventing chronic disease (pcd) reported that childhood obesity has declined in philadelphia. Although we are finding better ways to help children be a healthy weight, researchers note that much work remains before childhood obesity rates begin to show a dramatic sure your child gets physical activity each needs to be done? Learn how much physical activity children information and research about childhood obesity is available in the following preventing chronic disease articles and via these cdc ing children’s menus in community restaurants: best food for families, infants, and toddlers (best food fits) intervention, south central texas, 2010–’s childhood overweight and signs—progress on childhood physical activity guidelines for receive email updates about this page, enter your email address:File formats help:how do i view different file formats (pdf, doc, ppt, mpeg) on this site? Winston-salem, nc 27157 tel: (336) 713-2348 fax: (336) 716-9699 ekaw@notleksjauthor information ► article notes ► copyright and license information ►keywords: etiology, prevention, obesity, risk factors, pediatric, genetics, overweightcopyright notice and disclaimerpublisher's disclaimerthe publisher's final edited version of this article is available at pediatr clin north amsee other articles in pmc that cite the published uctionthe prevalence of obesity in the united states remains dangerously high, at nearly 10% among infants and toddlers, 17% of children and teens, and more than 30% of adults1,2. While the prevalence has stabilized somewhat over the past few years1, rates of severe obesity have continued to climb, particularly in high-risk populations3. Intervening during childhood is important due to the persistence of obesity into adulthood with associated increased morbidity and mortality4–7.
The personal and emotional face of childhood obesity is also serious: daily quality of life can be significantly worsened by obesity13. The psychosocial complications of obesity include depression, body dissatisfaction, unhealthy weight control behaviors, stigmatization, and poor have advocated for the prevention of obesity for some time, yet efforts to advance preventative interventions may have been limited by the difficulties and expense of long-term studies of a complex problem and increasing focus on treatments. Repetition of concepts can aid in approaching an issue as complex as childhood obesity; the ecological model of childhood obesity (figure 1) provides a broad framework for understanding the mediators and moderators of childhood obesity. This overview highlights evidence-based factors on which clinicians can focus efforts to effectively prevent the development of childhood obesity. In this chapter, we will review both general and age-specific risk factors for pediatric obesity and discuss specific strategies for intervention at the level of the pediatrician, school, government, and 1ecological model of childhood obesityrisk factorsgenetic risk factorsobesity is commonly known to “run in families. Obesity in children correlates with obesity in their parents, and the level of obesity in children increases when both parents are obese, as well as with increasing levels of obesity in the parents15. Indeed, it has been shown that parental overweight is the most significant risk factor for childhood overweight 16. Children's food choices and eating behaviors are learned from parents at very young ages and influence eating behaviors as children get older 17,gh the vast majority of cases of childhood obesity are exogenous, a small proportion may have endogenous causes. The following genetic disorders, both syndromic as well as monogenic in origin, predispose children to obesity:Syndromes: trisomy 21, prader-willi syndrome, albright's hereditary osteodystrophy, cohen syndrome, bardet-biedl syndromes, alstrom syndrome, and wagr (wilms' tumor, aniridia, genitourinary anomalies, and retardation) 19,nic disorders: leptin deficiency, leptin receptor mutations, proopiomelanocortin deficiency, preproconvertase deficiency, and melanocortin 4 receptor al disorders: hypothyroidism, growth hormone deficiency, cushing's syndrome, hypothalamic obesity, polycystic ovary syndrome, and nmental/societal risk factors the child's living environment, both in the home as well as in the community, can contribute to a higher risk of development of obesity:23,32,77,84–y care providers should advocate for their patients and families; to build community-wide efforts to prevent obesity, clinicians can look to successful models in other areas to support their efforts. The chronic care model has been successfully implemented by health-related organizations such as kaiser permanente, that provided education for providers in motivational interviewing, and wellpoint, that distributed parental toolkits to families in ting for children's health and healthcare is an important role for pediatricians to embrace on both a local and national level, examples of areas for advocacy include:Third-party reimbursement to ensure that children continue to have access to services necessary for obesity prevention and treatment, such as yearly bmi screening and well-visits with their primary care providerfunding for research to prevent childhood obesitypromotion of healthy foods and beverages and physical activities in schools and daycaresmaintenance of safe neighborhoods that encourage physical activityavailability of healthy food26policy and environmental interventionsusing the socio-ecologic model as a guide14 on a societal level, policy and environmental interventions have the potential to exert the farthest-reaching influence in thwarting obesity97. The over-arching goals are for policies to prevent obesity by: 1) increasing awareness of and actions to change attitudes and norms to support healthy energy balance; 2) making healthy options for physical activity and nutrition readily available and, where possible, the default choices; and 3) reducing barriers to making healthy maximal impact, policy changes should be informed by the existing science of obesity prevention and established theories of behavior change, such as social cognitive theory99, self-determination theory100, and/or the trans theoretical model of behavior change101, and subsequently evaluated by rigorous studies demonstrating both feasibility and effectiveness.
Although the body of literature assessing polices for obesity prevention is growing, there are still many areas actively under study or for which evidence is inadequate for a definitive recommendation for wide scale adoption98, examples illustrative of policies with growing support and/or evidence and ranging in scope are shown in table 2, and for specific settings in which children spend substantial time are shown in table 3table 2policy examples: ranging in scopetable 3examples of policies and programs in settings where children spend substantial timenotable recent progress in the policy arena has occurred in standards for food programs affecting children including application of the 2010 united states department of agriculture (usda) dietary guidelines for americans to schools109 and science–based nutrition standards for meals offered in daycare and after-school programs through the pending child and adult care food program (cacfp). These changes are largely a result of passage of the healthy and hunger-free child act of 2010 that was motivated in large-part to curb the obesity epidemic110. Related changes are evident in the revised food package offered to participant in the women, infants and children (wic) program since 2007 and broadening of educational messages and materials supported by the supplemental nutrition assistance education program (snap-ed) programs to include emphasis on energy balance and obesity e progress in recent decades, there remain many areas for which evidence is insufficient or policies are lacking, emerging or facing challenges97. Some barriers may be reduced as more evidence demonstrates links between academic performance and health/obesity status or health behaviors (to support policy changes in the school setting) or the economic benefits of a healthier population/workforce to factors such as defense preparedness and economic measures (to support changes in business and industry). Primary care providers and any professional or individual with an interest in obesity prevention for children can actively support efforts in policy or environmental changes through lending expertise, providing advocacy or local support, or by leading and role modeling in one's own work setting and community (box 4). Familywhile environmental pressures at the national and community level contribute greatly to a child's risk of obesity, “families are the most central and enduring influence in children's lives… the health and well-being of children are inextricably linked to their parents' physical, emotional and social health, social circumstances, and child-rearing practices” (schor 2003, page 1542)111. As mentioned previously, a child's risk of obesity is greatly influenced by parental weight status. While the genetic contribution to the child's weight is great, the environmental influence is likely greater: parental obesity can predict genetic susceptibility, but a child's environment can determine the expression and severity of that risk112. Despite any genetic predisposition to obesity, the environment is likely the greatest potentially modifiable determinant of obesity, with the family being the most proximate of that environment. As presently understood, family-related risk-factors for childhood obesity include114:Minority ethnic and cultural backgroundsingle parent householdlower maternal educationparent obesity status and family history of obesitypoverty: receipt of supplemental food assistancehigher levels of television viewing of family, particularly during meals, amounts and locations (bedrooms)restrictive parental feeding the risk factors above (out of a total of 22 studied), parental feeding practices and parent bmi were most associated with child weight status (child sleep duration was also determined to be significantly associated)114. These findings are preliminary, as the extensive, long-term studies necessary to link risk with later obesity development have not yet been performed.
Clinicians should customize risk assessments to each family, knowing that sound anticipatory guidance can be safely provided to all families regardless of weight status and risk for later ing styles and the risk of childhood obesity have been investigated extensively, though there are many areas still in need of study. As with many aspects of complex problems, such as childhood obesity, long-term definitive studies are lacking. Authoritative parents had children with the lowest prevalence of obesity in rhee's study of 1st graders, while authoritarian, or strict disciplinarian, parents had children with the highest prevalence of obesity, more than even permissive or neglectful parents. These findings are important, as parents of children with obesity could be more likely to institute dieting or restrictive behaviors to help their children lose weight. A non-restrictive approach to early childhood feeding, while providing structure and healthy meals, is important for parents of young children to ensure healthy eating 4parenting stylesthe bulk of parenting research and prevention of childhood obesity relates to early childhood feeding, though many principles can likely be extended to older age groups. Analysis of an older study identified the importance of healthy parenting skills, even if the focus is not obesity or weight-related behaviors120. Brotman et al reviewed outcomes of children at high risk for behavioral problems and high risk for obesity120. The intervention group had significantly lower prevalence of obesity as well as healthier nutrition and activity habits than control groups, despite the intervention not having a focus on nutrition, activity, or weight. Positive interaction between members during family meals may contribute just as much to these positive outcomes as changes in nutritional e this promising research, there are no clear answers on how to become an “obesity-resistant family. Increasing focus on family dynamics and communication will be key to successfully preventing childhood obesity within the context of the family (box 5). Unfortunately, the unhealthy evolution of food and activity environments has placed children at a higher risk for obesity and associated weight problems than they ever have been before.
Although significantly more research is needed to optimize these strategies, interventions at the level of the pediatrician, school, government, and family have shown success in the prevention of childhood obesity. Overweight and obesity epidemic among children and adolescents in the united states continues to worsen, with notable racial, ethnic, and socioeconomic disparities. Risk factors for pediatric obesity include genetics; environmental and neighborhood factors; increased intake of sugar-sweetened beverages, fast-food, and processed snacks; decreased physical activity; shorter sleep duration; and increased personal, prenatal, or family stress. Pediatricians can help prevent obesity by measuring body mass index at least yearly and providing age and development-appropriate anticipatory guidance to families. Interventions focused on family habits and parenting strategies have also been successful at preventing or treating childhood pointschildhood obesity is a complex medical issue, representing the interplay of physical and environmental neuroendocrine control of weight includes multiple situations where genetic variation can influence a person's weight unhealthy evolution of food and activity environments has placed children at a higher risk for obesity and associated weight problems than they ever have been 1. Review of risk factors for pediatric obesitygenetic syndromes, monogenic disorders, or hormonal disordersliving in neighborhoods that are lower-income, predominantly non-mixed-race, perceived as dangerous, or are an increased distance from parks and foods storesincreased intake of sugar-sweetened beverages, fast food, and processed snacksdecreased physical activityshorter sleep durationincreased personal, prenatal, or family stressbox 2. Review of developmental approach to obesity preventionprenatal – appropriate gestational weight gain, no tobacco exposureinfancy – minimize rapid weight gain, later introduction of solid foods, avoid broad-spectrum antibiotics as possibletoddlers – encourage self-regulation of feeding and lots of physical activityschool-aged children – exergaming, use of technology-based interventions to improve nutrition and physical activityadolescents – include peer groups in interventionsbox 3. Review of the primary care provider's role in preventing obesitymeasure height and weight and calculate bmi at least annually, observing for trends such as a rapid increase in bmioffer anticipatory guidance about nutrition and physical activity at every well child checkuse motivational interviewing to help families to make healthier choicesadvocate for children on a local and national levelbox 4. Review of policy and environmental interventions to prevent obesityimprove attitudes and norms to support healthy energy balancemake healthy options for physical activity and nutrition easy and the default choicesreduce barriers to making healthy nutrition and physical activity choicessubstantial progress has been made- policy changes are underway and are being evaluatedbox 5. Review of the family's role in preventing pediatric obesityinclude the entire family in obesity prevention and treatmentact as positive role models to children regarding healthy nutrition, physical activity, and emotional and social healthpractice authoritative, not authoritarian, parenting styleshave a non-restrictive approach to early childhood feedingprovide structurehave regular family mealsacknowledgmentssupport: supported in part by a grant from nichd/nih mentored patient-oriented research career development award k23 hd061597 (jas) and from the health recourses and service administration national research service award (nrsa) grant t32 hp14001 (clb). Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood.
Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Health and economic burden of the projected obesity trends in the usa and the uk. Availability and night time use of electronic entertainment and communication devices are associated with short sleep duration and obesity among canadian children. The home environment and childhood obesity in low-income households: indirect effects via sleep duration and screen time. Adverse childhood events are associated with obesity and disordered eating: results from a us population-based survey of young adults. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. Risk of childhood overweight after exposure to tobacco smoking in prenatal and early postnatal life. Maternal caffeine intake during pregnancy and risk of obesity in offspring: a prospective cohort study. Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity. The types of food introduced during complementary feeding and risk of childhood obesity: a systematic review.
Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Screening and interventions for childhood overweight: a summary of evidence for the us preventive services task force. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Disseminating evidence from research and practice: a model for selecting evidence to guide obesity prevention. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings. Epub 2015 jul sing childhood obesity: opportunities for cl1, halvorson ee2, cohen gm3, lazorick s4, skelton information1department of pediatrics, university of north carolina at chapel hill, 301b, s. Electronic address: jskelton@ctthe overweight and obesity epidemic among children and adolescents in the united states continues to worsen, with notable racial, ethnic, and socioeconomic disparities. Risk factors for pediatric obesity include genetics; environmental and neighborhood factors; increased intake of sugar-sweetened beverages (ssbs), fast-food, and processed snacks; decreased physical activity; shorter sleep duration; and increased personal, prenatal, or family stress. Pediatricians can help prevent obesity by measuring body mass index at least yearly and providing age- and development-appropriate anticipatory guidance to families. Interventions focused on family habits and parenting strategies have also been successful at preventing or treating childhood obesity.
Indexed for medline] free pmc articleshareimages from this all images (2)free textfigure 1ecological model of childhood obesityaddressing childhood obesity: opportunities for preventionpediatr clin north am. 62(5): 2motivational interviewing to help families make positive changes to prevent obesityaddressing childhood obesity: opportunities for preventionpediatr clin north am. Gov't, mesh termsadolescentbody weightchildhumanspediatric obesity/etiologypediatric obesity/prevention & control*risk factorsgrant supportk23 hd061597/hd/nichd nih hhs/united statest32 hp14001/phs hhs/united stateslinkout - more resourcesfull text sourceselsevier sciencew. Saundersclinicalkeyclinicalkey nursingeurope pubmed central - author manuscriptpubmed central - author manuscriptpubmed central canada - author manuscriptmedicalobesity - genetic allianceobesity in children - medlineplus health informationpubmed commons home.
