Child obesity plan
A service of the national library of medicine, national institutes of ute of medicine (us) committee on prevention of obesity in children and youth; koplan jp, liverman ct, kraak vi, editors. Preventing childhood obesity: health in the detailsinstitute of medicine (us) committee on prevention of obesity in youth; koplan jp, liverman ct, kraak vi, gton (dc): national academies press (us); tshardcopy version at national academies presssearch term < prevnext >. An action planthe committee was charged with developing an action plan focused on preventing obesity in children and youth in the united states. The aim of the plan was to identify the most promising approaches for prevention, including policies and interventions for immediate action and in the longer term. The critical elements of the action plan's development, described in this and subsequent chapters, were as follows:clarifying definitions related to key conceptsdeveloping a framework to guide the type and scope of data gatheredarticulating obesity prevention goals for children and youthidentifying criteria for conducting an in-depth review of the available evidencetranslating the findings from the best available evidence into specific recommendations that comprise an integrated action tions and terminologychildhood and adolescent obesitybody mass index (bmi) is an indirect measure of obesity based on the readily determined measures of height and weight. This report uses the term “obese” to refer to children and youth with bmis equal to or greater than the 95th percentile of the age- and gender-specific bmi charts developed by the centers for disease control and prevention (cdc) (kuczmarski et al. In most children, values at this level are known to indicate excess body fat, which itself is difficult to measure accurately in either clinical or population-based constitutes “excess” is an amount of body fat (often expressed as a percentage of body mass) that is sufficient to cause adverse health consequences. The exact percentage of body fat at which adverse consequences occur can vary widely across individuals and the consequences themselves— ranging from low self-esteem or mild glucose intolerance to major depression or nephropathy—show considerable variation as —calculated as weight in kilograms divided by the square of height measured in meters (kg/m2)—is the recommended indicator of obesity-related risks in both children and adults. Kg/m2 and obesity is defined as a bmi equal to or greater than 30 kg/m2 (nhlbi, 1998). Children's development varies with age, and because boys and girls develop at different rates, the use of bmi to assess body weight in children requires growth and gender considerations. Thus, bmi values for children and youth are specific to both age and gender (barlow and dietz, 1998; dietz and robinson, 1998). Committee recognizes that it has been customary to use the term “overweight” instead of “obese” to refer to children with bmis above the age- and gender-specific 95th percentiles (himes and dietz, 1994; barlow and dietz, 1998; dhhs, 2001a; kuczmarski et al. There have also been concerns about misclassification, as bmi is only a surrogate measure of body fatness in children as in adults. Furthermore, children may experience functional impairment (physical or emotional) at different levels of body r, the term “obese” more effectively conveys the seriousness, urgency, and medical nature of this concern than does the term “overweight,” thereby reinforcing the importance of taking immediate action. Further, bmi in children correlates reasonably well to direct measures of body fatness (mei et al. 2002), and high bmis in children have been associated with many co-morbidities such as elevated blood pressure, insulin resistance, and increased lipids (freedman et al. These are the same co-morbidities that often worsen in adult life and contribute to premature death from committee recognizes, however, that the term obese is probably not well suited for children younger than 2 years of age because the relationships among bmi, body fat, and morbidity are less clear at these ages. Additionally, a high bmi in children younger than 2 years of age is less likely to persist than a high bmi in older children (guo et al. Weight-for-length greater than the 95th percentile is used by cdc and the special supplemental nutrition program for women, infants, and children to define overweight for children in this age is important that government agencies, researchers, health-care providers, insurers, and others agree on the same definition of childhood obesity. Although varying definitions have arisen from many uses of the term in public health, clinical medicine, insurance coverage, government programs and other settings, to the extent possible, there should be concurrence on definitions and this report, the term “obese” refers to children and youth between the ages of 2 and 18 years who have bmis equal to or greater than the 95th percentile of the age- and gender-specific bmi charts developed by cdc. Childhood obesity) in which the progression is a continuum and the condition is both a risk factor for other chronic diseases and a health outcome in itself. The committee concluded that the well-established concept of primary prevention was most amenable to its assigned task of developing a broad-based action plan that addresses the social, cultural, and environmental factors associated with childhood obesity. Primary prevention approach emphasizes efforts that can help the majority of children who are at a healthy weight to maintain that status and not become obese. However, the committee acknowledges that obesity prevention will need to combine population-based efforts with targeted approaches for high-risk individuals and subgroups. Consequently, the report also contains specific actions aimed at high-risk populations affected by obesity, such as children and adolescents in particular ethnic groups with higher than average obesity-prevalence rates and communities in which there are recognizable social and economic disparities. Subpopulations of children warranting special consideration also include children with disabilities or special health-care needs. The complex medical, psychological, physical, and psychosocial difficulties that these children encounter may well put them at elevated risk for low physical activity levels and unhealthful dietary committee acknowledges that although population-based prevention approaches may be theoretically or conceptually the most useful approaches for addressing a society-wide problem, the practical challenge is in determining how best to implement these interventions to achieve broad outreach and maximal coverage. Committee was not charged with, nor did it develop, recommendations directed specifically at obesity treatment or reducing excess weight in children and youth. However, it is likely that many of the suggested actions will also benefit children and youth who are already obese, even if the interventions are insufficient to produce enough short-term weight loss for achieving normal weight status. For example, obese children can benefit from healthful choices in the school tion of obesity, particularly among those at high risk, may seem very similar to treatment in that screening is involved and individualized intervention is often delivered in clinical settings.
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Motivations to maintain a healthful rate of weight gain for growing children may differ in nature and intensity from motivations to lose weight. Although treatment approaches may include relatively extreme behavioral changes over the short term, preventive strategies usually necessitate long-term committee's approach to obesity prevention is similar to the range of prevention efforts that have been used to address many other public health problems. This framework, which emphasizes the need for obesity prevention efforts to leverage the interests and actions of a number of stakeholders working within and across multiple settings and sectors, guided the review of evidence and the development of recommendations in this 3-2framework for understanding obesity in children and youth. Note: in this diagram energy intake is depicted as excessive when compared to energy expenditure, leading to a positive energy balance (or energy imbalance) resulting in obesity. Obesity prevention goalsclear specification of obesity prevention goals is essential in shaping an action plan and evaluating its success. Pertinent issues for setting obesity prevention goals for populations include concepts of optimum population bmi and healthy weight levels, potential effects on food intake and patterns of physical activity and inactivity (the primary modifiable determinants of obesity), as well as attitudes and social norms related to food and eating, physical activity and inactivity, body size, and dietary restrictions (who, 2000; kumanyika et al. For children and youth, these considerations must be framed not only within the context of healthy physical, psychological, and cognitive development but in recognition that the increased prevalence of childhood obesity has broadened the emphasis of dietary guidance to address the overconsumption of energy-dense foods and beverages and physical activity patterns (ada, 2003, 2004). Individual children and youth, obesity prevention goals focus on maintaining energy balance (calories consumed versus calories expended). It is currently recommended that children and adolescents accumulate a minimum of 60 minutes of moderate to vigorous physical activity each day (see section on physical activity). Will be noted throughout this report, changing the social, physical, and economic environments that contribute to the incidence and prevalence of childhood obesity—especially in populations in which the problem is longstanding and highly prevalent—may take many years to achieve. Therefore, the committee acknowledges that numerous intermediate goals, involving step-by-step improvements in diet patterns and physical activity levels of children and youth, are necessary for assessing progress. The ultimate aim of obesity prevention in children and youth, however, is to create, through directed social change, an environmental-behavioral synergy that promotes positive outcomes both at the population and individual levels. Box 3-1 summarizes these long-term and intermediate goals, which will be discussed in greater detail throughout the 3-1goals of obesity prevention in children and youth. The goal of obesity prevention in children and youth is to create—through directed social change—an environmental-behavioral synergy that promotes for the population of children and youth (more... Population weight goals for obesity prevention in adults can also be stated in terms of decreasing the proportion that exceed the threshold of 30 kg/m2, although this goal includes both preventing new cases of obesity and reducing weight among those already over the same principles are appropriate for assessing the population of children in the united states in pursuit of the committee's primary objective: to stop, and eventually reverse, current trends toward higher bmi levels. Also, as discussed in chapter 2, there are particular concerns about the population of obese children becoming heavier. Achieving this objective would have the effects of reducing the mean bmi as well as decreasing the proportion of children and youth in the population that exceeds the threshold definition of ble research does not currently allow the committee to define an optimum bmi for children and youth. To the current practice for adults, the committee recommends the use of bmi for assessing individual and population changes in children and youth over time and in response to interventions. Population weight goals for childhood obesity prevention should be stated in terms of changes in the mean bmi and in the shape of the entire bmi distribution. Alternatively, goals can be stated in terms of decreasing the proportion of children or youth who exceed particular thresholds—e. Current cdc guidelines for healthy weight in children and youth are in the range of the 5th to 85th percentiles of the age- and gender-specific bmi charts. Therefore, a child whose weight tracks in that range—that is, he or she does not cross to lower than the 5th or higher than the 85th percentiles—would be considered to be in the healthy weight range according to these cdc bmi charts are mathematically smoothed curves of the pooled growth parameters of children and adolescents sampled in cross-sectional national health surveys conducted from 1963 to 1994. But because the sample sizes at each age level get much smaller at the extremes of the distributions, the growth curves may be more prone to errors at the upper and lower e of the increases in body weight that occurred in the 1980s and 1990s—after the second national health and nutrition examination survey (nhanes ii) conducted in 1976-1980—a decision was made not to include the nhanes iii (1988-1994) body-weight data in the revised 2000 bmi charts for children aged 6 years or older. However, the fact that the cdc bmi charts were developed from data for a prior time period in which children were leaner, on average, leads to an occasionally confusing situation—for example, where more than 5 percent of the population is above the 95th percentile—but this is readily clarified in the context of the charts' historical cdc bmi charts are derived from cross-sectional samples of children (data for different age groups are based on different children). That is, they do not directly represent the longitudinal growth trajectory for the same set of children who have been measured as they age. Therefore, it is not known whether an individual child's height, weight, or bmi should be expected to follow along the same percentile curve over time in order to maintain health or whether there are health implications of variations throughout childhood (e. Mei and colleagues (2004) found that shifts in growth rates were common during birth to 6 months and less common in children aged 2 to 5 years. Population of children and youth, they are the best available tools for assessing growth in clinical and public health settings. Although there are many unknowns about how to apply this information to individual children, and clinicians face difficulties in making generalizations regarding normal growth trajectories, experience suggests that children who demonstrate rapid changes—that is, frequently crossing up or down percentiles—may require special health-care attention. Health-and medical-care professionals should be consulted regarding growth-related questions for individual children as they can assess a child's own growth trajectory in context (see chapter 6).
Balanceobesity prevention involves maintaining energy balance at a healthy weight while protecting overall health, growth and development, and nutritional status. Strictly speaking, growing children, even those at a healthy body weight, must be in a slightly positive energy balance to satisfy the additional energy needs of tissue deposition for normal growth. However, for the purpose of simplicity in this report, the committee uses the term “energy balance” in children to indicate an equality between energy intake and energy expenditure that supports normal growth without promoting excess weight children, energy expenditure constitutes the calories used for basal metabolism, processing of food, maintenance and repair of the body, and daily physical activity—in addition to the calories required for normal growth and development. Children require a dietary pattern consisting of a variety of foods that provide all the necessary nutrients to support normal growth and development, as well as regular physical activity. Are several concepts regarding energy balance and weight gain in children and youth that the committee determined were important to clarify:genetics is a factor in excess weight but it is not the explanation for the recent epidemic of obesity (koplan and dietz, 1999). Although inherited tendencies toward weight gain may be a partial explanation for excess weight in children, as discussed below, there have been no measurable changes in the genetic composition of the population during the recent decades that could explain the significant increases in spurts do occur at several points throughout childhood and adolescence, but it cannot be assumed that a child will lose his or her excess weight at those times. Many experienced clinicians assess an individual child's relative weight status by examining the consistency of that child's weight or bmi percentiles over time. Thus, for example, after the age of about 4 years, normally growing children who are in the 20th or 50th or 65th percentile for weight would be expected to remain around these same percentiles for weight, during the remainder of their childhood. However, what can be considered normal variation to that pattern is not yet known, and is an important research logical reasons for a child's excess weight should be carefully explored by health-care professionals. However, the identifiable medical conditions that cause childhood obesity are rare and are not the principal underlying causes of the current obesity epidemic in the perceptions of what healthy children should “look like” differ among generations, cultures, and individuals. However, it is important that obesity not become the norm in society for children and youth as it poses serious health risks during childhood that can continue throughout adult the simplest terms, energy balance represents calories consumed versus calories expended, although as noted above, many individual variables can affect that balance. Furthermore, greater understanding is needed regarding the relative contribution of energy intake and energy expenditure to the energy imbalance that is driving the obesity epidemic. The increasing prevalence of obesity among children and youth in the united states could be the result of an upward shift in energy intake, a downward shift in energy expenditure, or the occurrence of both trends concurrently (hill and peters, 1998; harnack et al. Has been hypothesized that obesity can result from very small excesses in energy intake relative to expenditure and that the average weight gain in u. However, estimates in a population of hispanic children have shown greater potential energy gaps, ranging from approximately 200 to 500 calories per day (butte and ellis, 2003). This is an area requiring further following sections provide a brief overview of the context for energy balance and the complexities that researchers and policy makers face in these c variation and biological considerationsobesity has long been recognized to occur in families, and having overweight or obese parents increases a child's risk of being obese. After age 3, parental obesity is a stronger predictor of a child's future obesity as an adult than is the child's current weight (whitaker et al. With any precision the specific contributions of each of these factors to the development of obesity has been difficult, despite a variety of studies in nuclear families, in families with identical twins reared together or reared apart, and in families with adopted children. More than 400 genes, markers, and chromosomal regions have been linked to obesity phenotypes, 208 quantitative trait loci for human obesity have been identified, and 41 mendelian disorders manifesting obesity have been genomically mapped (snyder et al. However, only six single-gene defects resulting in obesity have been found, and in fewer than 150 individuals (snyder et al. Thus, even though these monogenetic disorders have provided significant insight into the pathophysiology of obesity (cummings and schwartz, 2003; o'rahilly et al. Nonetheless, genome-wide scans in widely varying populations have identified several genomic regions containing common quantitative trait loci for obesity phenotypes, suggesting that there may be shared genetic factors predisposing individuals of different ethnic origins to excessive storage of body fat (bouchard et al. What is clear, however, is that the genetic characteristics of human populations have not changed in the last three decades, while the prevalence of obesity has approximately doubled. Thus, the recent population rise in body weight reflects the interaction of genotypes that predispose individuals to obesity with detrimental behavioral and environmental animals, the evidence is strong for such gene-environment interactions affecting body weight and energy balance (barsh et al. Furthermore, although the system has now been characterized extensively in rodents and in adult humans, little is known about its development during the fetal period, infancy, or childhood (box 3-3). Children and adults alike consume food and beverages in part because they are hungry but also because eating and drinking are pleasurable and are an integral part of family life, celebrations, recreational events, and other social occasions. Nevertheless, the frequency of consuming certain types of foods is an indicator of the likelihood that the overall quantity and quality of foods will be appropriate, particularly in growing children for whom the nutrient density of diets (i. Adequacy of vitamins and minerals per unit of energy intake) is on current scientific evidence, the dietary guidelines for americans provide nutritional advice to the american public on how to attain a balanced diet (defined in this report as an overall dietary pattern that provides all the essential nutrients in the appropriate amounts to meet nutritional needs and support life processes such as growth in children without promoting excess weight gain7) (boxes 3-4 and 3-5; also see chapter 5 and appendix b). A low hei score suggests a poor diet and is also associated with overweight and obesity (guo et al. Are some indications of a small but significant increase in the average number of calories consumed daily by children over the last 15 to 20 years.
The continuing survey of food intakes by individuals, which examined changes between two time periods—1989-1991 and 1994-1996— in nationally representative samples of school-aged children, found an increase from 88 to 94 percent of the recommended energy allowance (gleason and suitor, 2001). Subsequent analyses of trends in energy intakes of children and youth have produced mixed findings (enns et al. 2002; sturm, 2005), and much remains to be learned about the dietary factors that contribute to the obesity epidemic in these challenges remain in conducting research on children's dietary intake. They include difficulties in children accurately recalling and quantifying foods consumed, the accuracy of third-party reports (usually parents or caregivers), and varying estimations of portion size. Furthermore, the energy requirements for children vary, depending on the timing of growth and developmental spurts, and may be highly al activityphysical activity, which has been defined as “any bodily movement produced by skeletal muscles that results in energy expenditure” (caspersen et al. One of the joys and benefits of childhood is that being physically active is often a natural and fun part of playing and interacting with family and friends and does not generally involve a conscious decision to exercise. This play time is also developmentally important for children's cognitive, motor-skill, and social development (nrc and iom, 2000). Physical activity—not only in free play time, but in school, organized sports, and other activities—is an integral part of many children's daily routines. However, as children grow, they generally become less physically active in adolescence and adulthood (caspersen et al. Additionally, children's patterns of physical activity often differ from those of older adolescents and adults. Children often engage in intermittent activity mixed with brief periods of rest rather than in prolonged exercise (goran et al. Recommendations are for children and adolescents to accumulate a minimum of 60 minutes of moderate to vigorous physical activity each day (biddle et al. The national association for sport and physical education recommends that children aged 5 through 12 years be involved in age-appropriate physical activity (including moderate to vigorous physical activity, most of it intermittent) that adds up to at least 60 minutes—and as much as several hours—per day on most days of the week (naspe, 2004). One of the strongest correlates of physical activity in children is time spent outside (klesges et al. Health and quality-of-life benefits associated with regular moderate physical activity extend beyond the prevention of obesity (cdc, 1997) (box 3-6). One of the major research challenges in this area is how to accurately measure physical activity, particularly in young children. Questionnaires of parents and children are often confounded by recall problems and varying assessments of the type, intensity, and duration of the activity (saris, 1986; goran, 1998; sirard and pate, 2001). Pedometers and accelerometers) have come into wide use as research tools in recent years, but additional work is needed to ensure the validity of these methods in diverse groups of children and youth and in diverse settings. Additionally, research is needed to establish better methods of measurement of energy expenditure in children going through their normal daily activities in their home and school 3-6benefits associated with physical activity for children and adolescents. Improves plasma lipid/lipoprotein profile, including reduction of low-density lipoproteins (ldls) and increase of high-density lipoproteins (hdls) in children and youth with at-risk (more... This matrix of environmental levels and types can also be developed to facilitate consideration of influences on obesity-related variables such as the availability of education and counseling and broader health promotion about weight gain prevention (physical environment), cost of preventive services (economic), and coverage of preventive services by third-party payers (policy environment). As discussed in the following sections, in the sociocultural domain, attitudes about body size and obesity are also critical contextual considerations when designing obesity prevention erations regarding stigmatizationone of the concerns that arises in discussions regarding the prevention of childhood obesity is how to effectively focus on the behaviors that contribute to obesity without stigmatizing obese children and youth. As noted in chapter 2, there is a body of research indicating that obese children and youth are stigmatized and experience negative stereotyping and discrimination by their peers, with adverse social and emotional consequences (schwartz and puhl, 2003). That the stigmatization of obese children appears to have increased over a 40-year period from 1961 to 2001, there is a need to focus on the sensitivities regarding this issue and to explicitly reduce negative attitudes and behaviors such as teasing and discrimination directed toward obese children and youth (latner and stunkard, 2003; schwartz and puhl, 2003). Furthermore, our society often accommodates obesity as the social norm, for example, by resizing clothing, expanding the width of seating in public areas, and retrofitting ambulances to accommodate larger girth (newman, 2004). Just as there are social and emotional consequences of stigmatization, there are also social and health consequences for obesity becoming the accepted social norm. This tension between stigmatization and normalization can be addressed, as it has been for other public health concerns, by focusing on the behaviors that can be changed to promote health rather than on the individual and his or her is important to note that the lessons learned from tobacco prevention and control efforts are not entirely applicable to obesity prevention. Bans against smoking in public buildings, on airplanes, and at other locations have encouraged some people to quit smoking due to the added inconvenience and public disapproval of this behavior. However, foods and beverages are necessary for sustenance and the issue is not “whether or not” to eat but rather what to eat, how much, and how of further research on this issue include how to encourage children to accept peers of all sizes and shapes and how to assist and support parents, teachers, children, and youth in addressing and coping with social imagea community's norms, values, and expectations also affect the way that children in the normal or overweight (but not obese) range view their bodies. There is also concern that obesity prevention efforts will lead to inappropriate weight concern, dieting preoccupation, or unhealthful weight control practices among children and youth.
Attitudes about acceptable body size and shape also change over time and may apply differently to people of different potential importance of this issue is underscored by reports of weight concerns in young children and in adolescents, in numerous ethnic groups, and in both low and high socioeconomic strata (see chapter 2). Studies of children as young as the first grade have reported that a substantial proportion of children (about 50 percent of girls and 30 to 40 percent of boys), when given a choice of silhouettes will choose a thinner body size than their own as the “ideal” body size (thompson et al. These findings in children and adolescents are generally parallel to the numerous studies in adults indicating a relatively lower level of weight concern and higher level of body satisfaction in black women compared to white women; even considering the higher weight levels of the black women (flynn and fitzgibbon, 1998). Statussocioeconomic status has generally been inversely associated with obesity prevalence (see chapter 2) and children with obese mothers and low family income were found to have significantly elevated risks of becoming obese, independent of other demographic and socioeconomic factors (strauss and knight, 1999). When compared with food-insufficient households of higher income, low-income food-insufficient households had more obese children; however, food insufficiency by itself was not associated with self-reported measures of childhood obesity (casey et al. Other studies have not been able to show a clear relationship between childhood obesity and food insufficiency or food insecurity8 after adjusting for other confounding variables (alaimo et al. 2004) and with negative academic and psychosocial outcomes including depression in older children (alaimo et al. Of the variables in tables 3-1 and 3-2 may be potential mediators of the relationship between socioeconomic inequities and childhood obesity. Some types of leisure-time physical activity are theoretically available at low or no cost, but these options may be less available to children in low-income neighborhoods because of neighborhood safety concerns, lack of adult supervision, or limited community recreational or other resources. Addressing childhood obesity in these contexts will require attention to root causes, and attempts to mitigate the underlying social and environmental adversity will be needed (travers, 1997). And ethnic disparitiesthe substantially higher prevalence of obesity in adults, children, and youth in some african-american, hispanic, american-indian, and pacific islander populations (see chapter 2) generates considerations across the entire ecologic framework (see figure 3-2). A relatively high obesity prevalence in some hispanic and american-indian groups was noted prior to the obesity epidemic (kumanyika, 1993); the pattern of excess weight gain and accelerated rates of obesity prevalence in african-american children and youth is a more recent development. However, the different historical and geographical trajectories of these social and politically defined groups are associated with some differences in gene frequencies that may be linked with obesity development. Regardless, as discussed earlier in this chapter, the predominant factors responsible for the expression of obesity as a general population phenomenon are the linked behavioral and environmental factors outlined in the framework in figure factors that potentially mediate racial and ethnic differences and predispose minority children and youth to high obesity risks can be postulated across physical, economic, sociocultural, and policy/political environments (tables 3-1 and 3-2). Variables that need to be considered when approaching obesity prevention to reduce racial and ethnic disparities include traditional cuisines and any aspect of the attitudes, beliefs, and values (referred to in tables 3-1 and table 3-2 as the ethos or climate) that may facilitate or inhibit the promotion of healthful eating, physical activity, and weight control patterns in children and youth in these communities (kumanyika and morssink, 1997; kumanyika, 2002, 2004). The normative presence of the problem) as well as high levels of obesity-related health problems. In addition, to the extent that a history of discrimination or marginalization based on race or ethnicity becomes intertwined with other sociocultural factors, a certain level of skepticism or distrust relative to mainstream information and initiatives, including health information, may influence the receptivity to obesity prevention messages—particularly when these messages seem to conflict with pre-existing attitudes and of the evidencethe committee identified a primary prevention, population-based approach to be the most viable long-term strategy for reducing obesity and its chronic disease burdens. An evidence-based medicine approach has been adopted by federal and scientific institutions to guide obesity treatment in adults (nhlbi, 1998). But given the complex environment in which multiple social, economic, cultural, and political elements interact to produce change in population-wide problems such as obesity, causality may not always be established for the relationships among the various interventions (mcqueen, 2002; tang et al. Developing recommendations based on an integrated approach to the evidencethe committee faced a significant challenge in deciding what types of evidence to use in formulating recommendations for obesity prevention in children and youth. A review of randomized controlled interventions for obesity prevention and treatment among children and adolescents identified only 35 such studies (campbell et al. Due to the limited number of rcts in obesity prevention efforts and methodological issues, including small sample sizes and high attrition rates of study participants, there is a paucity of rct data from which to generalize results to broader populations (nhs centre for reviews and dissemination, 2002). Committee, therefore, developed guidelines for an integrated use of the available evidence to inform population-based obesity prevention interventions and on which to base its recommendations. Childhood obesity is a serious public health problem calling for immediate reductions in obesity prevalence and in its health and social consequences, the committee strongly believed that actions should be based on the best available evidence—as opposed to waiting for the best possible different types of evidence that the committee used in developing the report's recommendations are illustrated in table 3-5, and the following principles guided the committee's process:table 3-5proposed components of evidence-based obesity prevention. Evidence is needed to inform and guide policy and programmatic decisions, justify a course of action, and evaluate the effectiveness of interventions that support obesity gh the strength of the evidence is a basis for policy development, other considerations—including the fiscal and sociopolitical climate within which governments, institutions, and communities operate—must also be taken into account (tang et al. Of experimental evidence does not indicate a lack of causation or the ineffectiveness of an obesity prevention intervention. This has been exemplified by programs that reduce television viewing time and decrease bmi in children (robinson, 1999). The significant shortage at present of experimental evidence to guide programs and policies, and the fact that many societal variables of interest have not been well addressed in controlled experimental studies as moderating or mediating factors, obesity prevention will require an evidence-based public health approach that continues to draw on rcts, quasi-experiments, and observational studies as important sources of information (victora et al. That obesity is a serious health risk, preventive actions should be taken even if there is as-yet-incomplete scientific evidence on the interventions to address specific causes and correlates of obesity. In examining the literature, the committee focused on studies that examined weight and body composition outcomes, but it also broadened its scope to include studies that looked at changes in physical activity (or sedentary behavior) levels and in dietary intake examining the evidence on obesity-related prevention interventions, the committee considered the methodologies used by individual studies.
Report uses the term “obese” to refer to children and youth between the ages of 2 and 18 years who have bmis equal to or greater than the 95th percentile of the age- and gender-specific bmi charts developed by cdc. For individuals, obesity prevention involves maintaining energy balance at a healthy weight while protecting overall health, growth and development, and nutritional status. Energy balance (calories consumed versus calories expended) is an extraordinarily complex concept when considering the multitude of genetic, biological, psychological, sociocultural, and environmental factors that affect both sides of the energy balance equation and the interrelationships among these specification of obesity prevention goals is essential in shaping an action plan and evaluating its success. Relevant issues for setting obesity prevention goals for populations include concepts of optimum population bmi and healthy weight levels, potential effects on food intake and patterns of physical activity and inactivity, as well as attitudes and social norms related to food and eating, physical activity, inactivity, body size, and dietary restrictions. This chapter discusses a variety of influences on children's diets and physical activity patterns including genetic variation and biological considerations, and sociocultural and other environmental an ecological systems theory model and a primary prevention evidence-based public health approach, this report focuses on how changes in the individual child's behaviors are affected not only by individual factors but also through interactions with the larger social, cultural, and environmental contexts in which he or she lives (e. Low family income and food insufficiency in relation to overweight in us children: is there a paradox? The maternal and child health bureau, health resources and services administration and the department of health and human services. Overweight concerns and body dissatisfaction among third-grade children: the impacts of ethnicity and socioeconomic status. The health benefits of physical activity in children and adolescents and implications for chronic disease prevention. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. International references such as the international obesity task force or cole bmi values allow for cross-cultural comparisons. Viewcite this pageinstitute of medicine (us) committee on prevention of obesity in children and youth; koplan jp, liverman ct, kraak vi, editors. 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Find out more about ood obesity: a plan for t office, department of health, hm treasury, and prime minister's office, 10 downing reduction and wider government’s plan for action to significantly reduce childhood obesity by supporting healthier ood obesity: a plan for ood obesity: a plan for case studies on how schools and local authorities are working to reduce childhood government’s plan to reduce england’s rate of childhood obesity within the next 10 years by encouraging:Industry to cut the amount of sugar in food and y school children to eat more healthily and stay case studies describing the progress being made by schools, local councils and minister's office, 10 downing reduction and wider us improve ’t include personal or financial information like your national insurance number or credit card sion on ending childhood sion on ending childhood obesity (echo). The work of the ation global estimates of child and adolescent obesity released on world obesity day. October 2017 - the number of obese children and adolescents has increased tenfold in the last 40 years, according to a study published in the lancet ending childhood obesity implementation plan guides policy-makers on the recommended actions to prevent and treat childhood childhood obesity: securing the future for our children. May 2016 – the report of the commission on ending childhood obesity formed the basis for a side event, hosted by ghana, malaysia and mexico, along with new zealand and zambia during the sixty-ninth world health sion presents its final report, calling for high-level action to address major health challenge. January 2016 -- the commission on ending childhood obesity (echo) presented its final report to the who director-general today culminating a two-year process to address the alarming levels of childhood obesity and overweight globally. The echo report proposes a range of recommendations for governments aimed at reversing the rising trend of children aged under 5 years becoming overweight and on the final sion on ending childhood obesity seeks comments on report from around the the first meeting of the commission on ending childhood obesity in july 2014, the commissioners decided it would be important to engage with a broad range of stakeholders. In addition, the commissioners have heard from non-state actors, both through international and regional more about the report global estimates of child and adolescent obesity released on world obesity childhood obesity: securing the future for our sion presents its final report, calling for high-level action to address major health sion on ending childhood obesity seeks comments on report from around the world. Millionchildren and adolescents are obese – a tenfold increase in the last four and figures on childhood 1 in 5children and adolescents are overweight or y and on childhood monitoring framework for noncommunicable global monitoring 7: halt the rise in tor 13: overweight and obesity in tor 23: marketing of foods to who child growth reference data for 5-19 ing of foods and non-alcoholic beverages to ended levels of physical activity for tion-based approaches to childhood obesity tizing areas for action in the field of population-based prevention of childhood policy ight and sion on ending childhood of the commission on ending childhood obesity: implementation plan: executive sion on ending childhood mmes and region of the south-east asia eastern mediterranean western pacific up for who sion on ending childhood sion on ending childhood obesity (echo). The work of the ation global estimates of child and adolescent obesity released on world obesity study published today in the lancet analysed weight and height in nearly 130 million people, including 31. The number of obese children and adolescents rose from 11 million in 1975 to 124 million in 2016 – a tenfold increase. Kyalie photography, courtesy of sor majid ezzati, of imperial college, london school of public health, says “over the past four decades obesity rates in children and adolescents have soared globally and continue to do so in low- and middle-income countries”. The areas of the world with some of the largest increase in the number of obese children and adolescents were east asia and the middle east and north africa. The rise in childhood obesity rates has recently accelerated , especially in are obesity rates increasing so rapidly? S choices, diet and physical activity habits are influenced by their surroundings and rapid social and economic development has changed the environment many children are now growing up in. There is clear evidence that the marketing of unhealthy foods and drinks to children is related to childhood obesity. The low price and widespread availability of energy-dense, nutrient-poor foods is also an important conjunction with the release of the new obesity estimates, who has published a summary of the ending childhood obesity implementation plan. This plan provide guidance to countries on the effective actions to curb childhood and adolescent childhood obesity implementation plan: executive fiona bull adds “who encourages countries to implement policies to address the environments that children are growing up in today, that increase the risk of obesity.
They should promote greater physical activity through play and sport, to reduce the time children spend on sedentary, screen-based activities. Has also released guidelines calling on frontline healthcare workers to actively identify and manage children who are overweight or obese. Obese children are more likely develop type 2 diabetes and cardiovascular diseases at a younger age, which in turn are associated with a higher chance of premature death and ing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of ight children are also likely to become obese adults. Overweight and obesity are risk factors for cardiovascular disease, diabetes and some cancers in later sion on ending childhood mmes and region of the south-east asia eastern mediterranean western pacific up for who sion on ending childhood sion on ending childhood obesity (echo). Overweight and obesity are risk factors for cardiovascular disease, diabetes and some cancers in later sion on ending childhood mmes and region of the south-east asia eastern mediterranean western pacific up for who updates.