SAN ANTONIO – Early childhood presents one of the most promising opportunities for addressing the problem of obesity, according to Dr. Elsie Taveras.
Not only is interaction with the health care system at its highest from the prenatal period through the second year of life, but early childhood also is a time when healthy choices can be made on behalf of children, she explained at the annual meeting of the Obesity Society.
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National Health and Nutrition Examination Survey (NHANES) data show that 17% of children aged 2-19 years in the United States are obese, with a disproportionate numbers among racial and ethnic minorities.
"This is a time when children are not making autonomous choices in eating and physical activity. ... This is a time when we can get children and families – but especially children – on a healthy weight trajectory," said Dr. Taveras, a pediatrician who is codirector of the obesity prevention program in the department of population medicine at Harvard Medical School, Boston.
Since monitoring at this stage is fairly continuous, healthy practices can be established and risks can be identified early, she added, noting that prevention is much easier than management.
The importance of prevention is underscored by 2007-2008 National Health and Nutrition Examination Survey (NHANES) data showing that 17% of children aged 2-19 years in the United States are obese, with a disproportionate effect on racial and ethnic minorities. As of 2010, obesity affected 14% of non-Hispanic white children, 24% of black children, and 22% of Hispanic children.
"The other thing that’s starting to gain more attention in the national discourse is that the obesity epidemic has not spared even the youngest of the nation’s children. Almost 10% of infants and toddlers have high weight for length, slightly more than 20% of those aged 2-5 years are overweight or obese, and approximately one to five are carrying extra weight when they enter kindergarten," she said.
Fortunately, quality data exist to help guide efforts to address obesity in these early childhood years, she said.
An Institute of Medicine report released in June 2011 draws on that data to outline important steps that can be taken in early childhood. The "evidence-informed" report specifically addresses the importance of growth monitoring, physical activity, healthy eating, limited screen time (and thus limited exposure to "toxic" food and beverage marketing), and appropriate sleep duration, said Dr. Taveras, who served on the IOM committee on obesity prevention policies for young children, which developed the recommendations in the report.
One thing that stands out based on the data included in the IOM report, as well as from other recent research, is the importance of identifying children at high risk for obesity based on accelerated weight gain during the first 6 months of life, Dr. Taveras said.
Data – including findings from her own recent research – consistently show that accelerated weight-for-length gain in the first 6 months of life is associated with increased obesity risk at age 4 years, she said.
Plot weight and length on a Centers for Disease Control growth chart, and consider it a red flag if the plot crosses two or more growth percentiles very quickly, she advised.
Good evidence also is emerging about the importance of responsiveness to infant satiety and hunger cues, she said, noting that allowing for self-regulation in several areas, including dietary and sleep patterns, appears to have long-term benefits with respect to weight and health in children.
Regarding sleep, CDC data show that insufficient sleep among adults is reported more often in areas where obesity rates are highest, and other data have also suggested a link between sleep deprivation and obesity. Most of the available data are from studies in adults, so additional study to increase understanding of the relationship between obesity and sleep in children is needed, Dr. Taveras said.
The data that are available in children, however, suggest that the worst combination is too little sleep and too much television time. Not only do children who spend a lot of time in front of the television or computer have reduced physical activity levels, but they also have increased exposures to unhealthy food and beverage marketing. Such exposures have been shown to influence food preferences, food requests, and short-term food consumption in children aged 2-12 years, and to be associated with increased body fat percentages in this age group.
Companies are getting very creative when it comes to targeting children, and a particularly disturbing trend, considering the existing disparities in racial and ethnic minorities with respect to obesity, is an increase in marketing to Hispanic youth, Dr. Taveras noted.