Early Childhood Obesity Prevention Policies
Obesity in children is a serious health problem in the U.S. that can persist as children grow older and can affect the quality and longevity of their adult lives. Even the nation’s youngest children are at risk of becoming obese. Today, almost 10 percent of infants and toddlers carry excess weight for their length, and slightly more than 20 percent of children between the ages of two and five already are overweight or obese. A wide range of environmental factors can influence a child’s risk for obesity in the first years of life.
Because of growing evidence on the importance of assessing the beginnings of obesity and instituting preventive measures in the early years, the Institute of Medicine’s (IOM) Standing Committee on Childhood Obesity Prevention recommended that an IOM committee review factors related to overweight and obesity from birth to age five, with a focus on nutrition, physical activity, and sedentary behavior, and make policy recommendations on obesity prevention in the first five years.
Multiple stakeholders can affect the environments in which children grow and develop. Although parents usually have the greatest influence as the primary caregivers, many other adults outside of the home setting—including state and local government officials, healthcare providers, child care providers, and members of the community at large—help shape the lives of infants, toddlers, and preschool children.
The Importance of Early Assessment of Risk
Because early obesity can track to adulthood, efforts to prevent obesity should begin long before a child enters school. The committee recommends that at every routine pediatric visit—or well-child visit—healthcare professionals measure weight and length or height in a standardized way, using the most current growth charts from the World Health Organization and the Centers for Disease Control and Prevention. Additionally, healthcare professionals should consider the following when determining which young children are at highest risk of developing obesity:
- growth measurements at or above the 85th percentile curves;
- children’s rate of weight gain; and
- parents’ weight status.
Parents see pediatricians, primary care physicians, and other healthcare professionals as child care authorities. Thus, these professionals have an important opportunity to make parents aware of their child’s excess weight early on to allow time for intervention and prevention.
Creating Healthier Behaviors
Over the past 20 years, Americans have reduced their physical activity and increased the amount of time they spend in sedentary pursuits. The need to reverse this trend extends to even the youngest members of society. Evidence suggests that higher levels of physical activity are associated with a reduced risk of excessive weight gain over time in younger children. Therefore, the committee recommends that child care providers and early childhood educators afford infants, toddlers, and preschool children with opportunities to be physically active throughout the day. Child care providers and early childhood educators also should reduce the amount of time they spend sitting or standing. Healthcare providers should counsel parents on how to increase their children’s physical activity and reduce the time they are sedentary at home as well.
In addition to promoting physical activity among young children, caretakers also should pay careful attention to how they feed children. Children’s food preferences can develop as early as infancy. While research suggests that breastfeeding is associated with a reduced obesity risk for children, many hospitals and healthcare professionals do not provide sufficient information about or support for breastfeeding. Without the benefit of outside advice or resources, mothers are less likely to start breastfeeding or may stop earlier than is recommended. Because of the health benefits conveyed through breastfeeding, the committee recommends that adults who work with infants and their families promote and support breastfeeding exclusively for six months and continued in conjunction with solid foods for one year or more.
Children who consume a diet rich in nutrient- dense fruits, vegetables, low-fat or nonfat (for children over two years of age) milk and dairy products, and whole grains, and low in energydense, nutrient-poor foods, are less likely to be overweight and obese. The committee recommends that child care facilities provide meals that are consistent with the meal patterns in the federal Child and Adult Care Food Program to ensure that children have access to healthy foods and age-appropriate portions. It also is important for government agencies to do what they can to promote access to affordable healthy foods through maximizing participation in the federal nutrition assistance programs and helping communities enhance access to affordable nutritious foods where families live.
Currently, the national governmental dietary recommendations—known as the Dietary Guidelines for Americans— do not include recommendations for children under the age of two. Such guidelines are necessary for setting nutrition recommendations for public and federal programs, and therefore, the committee recommends that the Departments of Agriculture and Health and Human Services (HHS) establish dietary guidelines for children from birth to age two.