Childhood obesity: trends and potential causes

The increase in childhood obesity over the past several decades, together with the associated health problems and costs, is raising grave concern among health care professionals, policy experts, children's advocates, and parents. Patricia Anderson and Kristin Butcher document trends in children's obesity and examine the possible underlying causes of the obesity epidemic. They begin by reviewing research on energy intake, energy expenditure, and "energy balance," noting that children who eat more "empty calories" and expend fewer calories through physical activity are more likely to be obese than other children. Next they ask what has changed in children's environment over the past three decades to upset this energy balance equation. In particular, they examine changes in the food market, in the built environment, in schools and child care settings, and in the role of parents-paying attention to the timing of these changes. Among the changes that affect children's energy intake are the increasing availability of energy-dense, high-calorie foods and drinks through schools. Changes in the family, particularly an increase in dual-career or single-parent working families, may also have increased demand for food away from home or pre-prepared foods. A host of factors have also contributed to reductions in energy expenditure. In particular, children today seem less likely to walk to school and to be traveling more in cars than they were during the early 1970s, perhaps because of changes in the built environment. Finally, children spend more time viewing television and using computers. Anderson and Butcher find no one factor that has led to increases in children's obesity. Rather, many complementary changes have simultaneously increased children's energy intake and decreased their energy expenditure. The challenge in formulating policies to address children's obesity is to learn how best to change the environment that affects children's energy balance.     

Targeting interventions for ethnic minority and low-income populations

Although rates of childhood obesity among the general population are alarmingly high, they are higher still in ethnic minority and low-income communities. The disparities pose a major challenge for policymakers and practitioners planning strategies for obesity prevention. In this article Shiriki Kumanyika and Sonya Grier summarize differences in childhood obesity prevalence by race and ethnicity and by socioeconomic status. They show how various environmental factors can have larger effects on disadvantaged and minority children than on their advantaged white peers-and thus contribute to disparities in obesity rates. The authors show, for example, that low-income and minority children watch more television than white, non-poor children and are potentially exposed to more commercials advertising high-calorie, low-nutrient food during an average hour of TV programming. They note that neighborhoods where low-income and minority children live typically have more fast-food restaurants and fewer vendors of healthful foods than do wealthier or predominantly white neighborhoods. They cite such obstacles to physical activity as unsafe streets, dilapidated parks, and lack of facilities. In the schools that low-income and minority children attend, however, they see opportunities to lead the way to effective obesity prevention. Finally, the authors examine several aspects of the home environment-breast-feeding, television viewing, and parental behaviors-that may contribute to childhood obesity but be amenable to change through targeted intervention. Kumanyika and Grier point out that policymakers aiming to prevent obesity can use many existing policy levers to reach ethnic minority and low-income children and families: Medicaid, the State Child Health Insurance Program, and federal nutrition "safety net" programs. Ultimately, winning the fight against childhood obesity in minority and low-income communities will depend on the nation's will to change the social and physical environments in which these communities exist.     

The role of schools in obesity prevention

Mary Story, Karen Kaphingst, and Simone French argue that U.S. schools offer many opportunities for developing obesity-prevention strategies by providing more nutritious food, offering greater opportunities for physical activity, and providing obesity-related health services. Meals at school are available both through the U.S. Department of Agriculture's school breakfast and lunch programs and through "competitive foods" sold a la carte in cafeterias, vending machines, and snack bars. School breakfasts and school lunches must meet federal nutrition standards, but competitive foods are exempt from such requirements. And budget pressures force schools to sell the popular but nutritionally poor foods a la carte. Public discomfort with the school food environment is growing. But can schools provide more healthful food options without losing money? Limited evidence shows that they can. Although federal nutrition regulations are inadequate, they permit state and local authorities to impose additional restrictions. And many are doing so. Some states limit sales of nonnutritious foods, and many large school districts restrict competitive foods. Several interventions have changed school food environments, for example, by reducing fat content of food in vending machines and making more fruits and vegetables available. Interventions are just beginning to target the availability of competitive foods. Other pressures can also compromise schools' efforts to encourage physical activity. As states use standardized tests to hold schools and students academically accountable, physical education and recess have become a lower priority. But some states are now mandating and promoting more physical activity in schools. School health services can also help address obesity by providing screening, health information, and referrals to students, especially low-income students, who are at high risk of obesity, tend to be underinsured, and may not receive health services elsewhere.     

The role of built environments in physical activity, eating, and obesity in childhood

Over the past forty years various changes in the U.S. "built environment" have promoted sedentary lifestyles and less healthful diets. James Sallis and Karen Glanz investigate whether these changes have had a direct effect on childhood obesity and whether improvements to encourage more physical activity and more healthful diets are likely to lower rates of childhood obesity. Researchers, say Sallis and Glanz, have found many links between the built environment and children's physical activity, but they have yet to find conclusive evidence that aspects of the built environment promote obesity. For example, certain development patterns, such as a lack of sidewalks, long distances to schools, and the need to cross busy streets, discourage walking and biking to school. Eliminating such barriers can increase rates of active commuting. But researchers cannot yet prove that more active commuting would reduce rates of obesity. Sallis and Glanz note that recent changes in the nutrition environment, including greater reliance on convenience foods and fast foods, a lack of access to fruits and vegetables, and expanding portion sizes, are also widely believed to contribute to the epidemic of childhood obesity. But again, conclusive evidence that changes in the nutrition environment will reduce rates of obesity does not yet exist. Research into the link between the built environment and childhood obesity is still in its infancy. Analysts do not know whether changes in the built environment have increased rates of obesity or whether improvements to the built environment will decrease them. Nevertheless, say Sallis and Glanz, the policy implications are clear. People who have access to safe places to be active, neighborhoods that are walkable, and local markets that offer healthful food are likely to be more active and to eat more healthful food-two types of behavior that can lead to good health and may help avoid obesity.     

Childhood obesity and the media

This article assesses the role played by media in contributing to the current epidemic of childhood obesity. Electronic media use, often referred to as screen time, is significantly correlated with child adiposity. Although the causal mechanism that accounts for this relationship is unclear, it is well established that reducing screen time improves weight status. Media advertising for unhealthy foods contributes to obesity by influencing children's food preferences, requests, and diet. Industry efforts have failed to improve the nutritional quality of foods marketed on television to children, leading public health advocates to recommend government restrictions on child-targeted advertisements for unhealthy foods.     

The role of parents in preventing childhood obesity

As researchers continue to analyze the role of parenting both in the development of childhood overweight and in obesity prevention, studies of child nutrition and growth are detailing the ways in which parents affect their children's development of food- and activity-related behaviors. Ana Lindsay, Katarina Sussner, Juhee Kim, and Steven Gortmaker argue that interventions aimed at preventing childhood overweight and obesity should involve parents as important forces for change in their children's behaviors. The authors begin by reviewing evidence on how parents can help their children develop and maintain healthful eating and physical activity habits, thereby ultimately helping prevent childhood overweight and obesity. They show how important it is for parents to understand how their roles in preventing obesity change as their children move through critical developmental periods, from before birth and through adolescence. They point out that researchers, policymakers, and practitioners should also make use of such information to develop more effective interventions and educational programs that address childhood obesity right where it starts-at home. The authors review research evaluating school-based obesity-prevention interventions that include components targeted at parents. Although much research has been done on how parents shape their children's eating and physical activity habits, surprisingly few high-quality data exist on the effectiveness of such programs. The authors call for more programs and cost-effectiveness studies aimed at improving parents' ability to shape healthful eating and physical activity behaviors in their children. The authors conclude that preventing and controlling childhood obesity will require multifaceted and community-wide programs and policies, with parents having a critical role to play. Successful intervention efforts, they argue, must involve and work directly with parents from the earliest stages of child development to support healthful practices both in and outside of the home.     

Associations between Introduction of Age-Inappropriate Foods and Early Eating Environments in Low-Socioeconomic Hispanic Infants

Purpose

To examine the associations between feeding practices and eating environments of low-socioeconomic Hispanic infants.

Energy expenditure, physical activity, and obesity in children

Although there are physiologic and genetic influences on the various components of energy metabolism and body weight regulation, and a major portion of individual differences in body weight can be explained by genetic differences, it seems unlikely that the increased global prevalence of obesity has been driven by a dramatic change in the gene pool. It is more likely and more reasonable that acute changes in behavior and environment have contributed to the rapid increase in obesity and that genetic factors may be important in the deferring individual susceptibilities to these changes. The most striking behavioral changes that have occurred have been an increased reliance on high-fat and energy-dense "fast foods," with larger portion sizes, coupled with an ever-increasing sedentary lifestyle. The more sedentary lifestyle is caused by an increased reliance on technology and labor-saving devices, which has reduced the need for physical exertion for everyday activities. Examples of energy-saving devices that have resulted in a secular decline in physical activity include: Increased use of automated transport rather than walking or biking Central heating and use of automated equipment, such as washing machines, in the household. Reduction in physical activity in the workplace because of computers, automated equipment, and electronic mail. Increased use of television and computers for entertainment and leisure activities. Use of elevators and escalators rather than stairs. Increased concern for crime, which has reduced the likelihood of outdoor playing. Poor urban planning that does not provide adequate biking paths or even sidewalks in some communities. Thus, the increasing prevalence, numerous health risks, and astounding economic costs of obesity clearly justify widespread efforts toward prevention efforts. These prevention efforts should begin in childhood because the behaviors are learned and continue through the lifetime.     

Policies to support obesity prevention for children: a focus on of early childhood policies

Policies at many levels may help to shape environments that promote healthy weight and prevent obesity. We present policies to support obesity prevention for young children. We highlight policy Sand environmental systems change examples in the areas of promoting breastfeeding and providing healthy affordable food and information about food in community and child care settings and promoting physical activity in child care and the community. We address the role of the health care system and health care professionals to shape and advocate for policy and environmental systems change and provide resources for pediatric health care professionals to engage in community-based advocacy.     

News media framing of childhood obesity in the United States from 2000 to 2009

The American public holds mixed views about the desirability of government action to combat childhood obesity. The framing of coverage by news media may affect citizens' views about the causes of childhood obesity and the most appropriate strategies for addressing the problem. We analyzed the content of a 20% random sample of news stories on childhood obesity published in 18 national and regional news sources in the United States over a 10-year period (2000-2009). News media coverage patterns indicated that by 2003, childhood obesity was firmly on the news media's agenda and remained so until 2007, after which coverage decreased. We identified changes in news media framing over time and significant differences according to news source. News coverage of causes of childhood obesity that were linked to the food and beverage industry increased in the early years of the study but then decreased markedly in later years. Similarly, mention of solutions to the problem of childhood obesity that involved restrictions on the food and beverage industry followed a reverse U-shaped pattern over the 10-year study period. News stories consistently mentioned individual behavioral changes most often as a solution to the problem of childhood obesity. Television news was more likely than other news sources to focus on behavior change as a solution, whereas newspapers were more likely to identify system-level solutions such as changes that would affect neighborhoods, schools, and the food and beverage industry.     

Obesity: A crisis of growing proportions

Childhood obesity is a condition characterized by an imbalance between energy consumed and energy expended. A variety of factors that are unique to our modern day western society lead to the increasing prevalence of childhood obesity. The ease and volume of food supply, high calorie density, convenience foods, convenience transportation, sedentary lifestyle, school system issues, and perceptions of unsafe neighbourhoods all contribute to this increase in obesity. Consequences of childhood obesity are now known to carry health risks for childhood, as well as greater health risks in adulthood. A societal approach to solving this problem is necessary. The paediatrician’s role as an advocate in society is vital. On an individual basis, paediatricians can help to identify these patterns early and prevent them by providing basic nutritional advice to the child and parents at an early stage.     

The policy challenge of coexisting undernutrition and nutrition-related chronic diseases

The original focus on energy and protein needs for combating malnutrition gave way to UNICEF promoted concerns for maternal care and complementary feeding in association with longer-term breast feeding. Nevertheless the World Food Summit's drive to halve malnutrition rates by 2015 was not accelerating the fall in malnutrition prevalences. The UN's Standing Committee on Nutrition's commission highlighted the crucial role of maternal nutrition and low birthweights, the need for a life cycle approach to prevention and the current global effects of maternal/fetal and childhood malnutrition in amplifying the impact of the new epidemic of obesity and chronic diseases. The emphasis on poverty reduction and free market solutions is too crude and national interventions geared to protecting the vulnerable, promoting equity with major community involvement in integrated multifaceted programmes are needed. The same principles apply to overnutrition and specifically to the avoidance of the current pandemic of the metabolic syndrome. An intergenerational amplification of diabesity is now emerging as overweight but poorly fed micronutrient deficient girls enter pregnancy and produce ever more susceptible children. So new strategies are now needed as recognized by economists but not by doctors and nutritionists! Economy, agriculture, food processing and marketing policy changes are crucial in determining patterns of food consumption because the costs of foods and their availability, rather than policies centred on individual responsibility for consumer choice, are the keys to making coherent public health advances.     

Nutritive Einflussfaktoren auf die Entwicklung von kindlicher Adipositas und mögliche Präventionsansätze

Tremendous increases in the prevalence rates of overweight and obesity in children and adolescents require a search for possible causes and potential prevention strategies. Intrauterine and early infant nutrition are recognized as modifying factors for the development of obesity in adolescence and adulthood. Several recent investigations found that breastfeeding prevents obesity and overweight in later childhood and adolescence. However, so far no causal and definitive factors for the preventive effect could be found.Excessive fat intake during infancy and childhood is thought to play a major role in development of obesity. Typical food preferences for fatty and sweet foods paired with permanent availability and increasing inactivity predispose our society to weight gain and obesity. Preventive measures will have to take into account all possible causative factors in order to fight the disastrous consequences for the whole society.     

The Nutrition Committee of the Austrian Society of Pediatrics and Adolescent Medicine. Comment on nutrition with solid foods in infancy and early childhood]

The Nutrition Committee of the Austrian Pediatric Society recommends that weaning foods should be introduced between 4 and 6 months of age, which agrees with the recommendations in the EC and the U.S. Opinion against early introduction of solid foods have focused on concerns about renal solute load, obesity, coeliac disease, and food allergy. On the other hand, when weaning was postponed after 6 months of age, growth faltering in some breastfed infants and iron-deficiency anemia in infants fed non-fortified formulas or cow's milk were observed. Two broad categories--"baby foods" and "cereal-based weaning foods"--are on the market in Austria. "Baby foods" include complete meals sold in jars, soups, desserts and puddings, fruit juices, nectars, and vegetable juices. "Cereal-based weaning foods" are composed of one or more cereals either alone, or with the addition of vegetables, fruits, milk and milk products, egg, or other ingredients. Weaning food labelling should include information if sugars, salt, iron, vitamins minerals and trace elements have been added and if the product is free from gluten, cow's milk and egg protein, and lactose.     

Piloting a food photo sorting activity in Samoa to assess maternal beliefs and their role in child diet

Eating habits begin forming early in life when parental beliefs and behaviours often play a major role in shaping dietary intake. We aimed to assess maternal beliefs about the cost, social status, and nutritional value of foods in Samoa—a setting with an alarming burden of childhood obesity—and to determine how those beliefs may be related to child dietary intake. Samoan mothers (n = 44) sorted photographs of 26 foods commonly consumed in children in Samoa by cost, social status, and nutritional value (healthfulness). Responses were then assessed for their association with child dietary intake (reported using a food frequency questionnaire) using Pearson correlations. Mothers indicated that traditional Samoan foods were healthier, of higher social status, and lower cost compared with non‐traditional/imported food items. Compared with nutritional experts and a market survey of food prices, mothers demonstrated strong nutritional (r = .87, 95% CI [0.68, 0.95], p < .001) and consumer (r = .84, 95% CI [0.68, 0.93], p < .001) knowledge. The perceived cost of food was more strongly associated (r = ?.37, 95% CI [?0.66, 0.02], p = .06) with child dietary intake than either healthfulness or social status, with decreasing consumption reported with increasing food cost. Our findings contradicted the notion that the high social status of imported foods may be contributing to increased intake and rising prevalence of childhood obesity in this developing country setting. Despite their nutritional knowledge, Samoan mothers may need additional support in applying their knowledge/beliefs to provide a healthy child diet, including support for access to reasonably priced healthy foods.     

Food Marketing to Children in India: Comparative Review of Regulatory Strategies Across the World

Food marketing directed to children is an issue of concern in the present day society. Revolution in food industry, increasing globalization and boom in information technology has introduced various types of food products and the way they are placed in front of likely consumers. This has resulted in rising trend of obesity and switch from communicable to non-communicable diseases, which is not cost effective for nation as a whole. Multinational companies have targeted children as a naïve audience to boost their sales. In-ethical practice of misleading claims in the advertisements is instrumental in many cases. Food marketing to children has been assumed a public health threat since times of yore. World Health Organization has resolutions and recommendations on this subject. Member countries, including India are a signatory to this declaration. However, much needs to be done to counter these multinational food giants. Regulations and policies need to be enforced at national and institutional levels. Parents must be educated; schools and social organizations to be made proactive on this aspect.     

Dietitians and exercise professionals in a childhood obesity treatment team

There has been a remarkable increase in the prevalence of childhood obesity in most countries in recent years, which indicates that modern lifestyle is the triggering factor for genetic susceptibility. This report focuses on the two main environmental factors, nutrition and physical activity, that could influence paediatric obesity development, and how health professionals can address these aspects in the management of childhood obesity in a multidisciplinary treatment team. First, the role of a nutrition expert in the multidisciplinary obesity team is discussed and then the importance of physical activity in the treatment of paediatric obesity. The part on nutrition highlights some interesting areas in this field, namely glycaemic index, high-protein diet, fast foods, portion sizes and soft-drink consumption. Dietary treatment in childhood obesity should be combined with changes in physical activity to promote long-term weight loss. Research on the physical activity of children and adolescents indicates some significant changes over the last decades, which are also reviewed. Factors such as sports club participation and television viewing are discussed. The appropriate physical activity level and effective physical activity programmes are also presented. Physical activity can be promoted in childhood obesity treatment in many ways. Practical advice regarding physical activity programme and the role of exercise professionals in childhood obesity treatment team is given.
Conclusion: For successful obesity management, the child should be assessed and treated by a multidisciplinary team, including a physician, dietitian, exercise expert, nurse and behavioural therapist.     

Dietitians and exercise professionals in a childhood obesity treatment team

There has been a remarkable increase in the prevalence of childhood obesity in most countries in recent years, which indicates that modern lifestyle is the triggering factor for genetic susceptibility. This report focuses on the two main environmental factors, nutrition and physical activity, that could influence paediatric obesity development, and how health professionals can address these aspects in the management of childhood obesity in a multidisciplinary treatment team. First, the role of a nutrition expert in the multidisciplinary obesity team is discussed and then the importance of physical activity in the treatment of paediatric obesity. The part on nutrition highlights some interesting areas in this field, namely glycaemic index, high-protein diet, fast foods, portion sizes and soft-drink consumption. Dietary treatment in childhood obesity should be combined with changes in physical activity to promote long-term weight loss. Research on the physical activity of children and adolescents indicates some significant changes over the last decades, which are also reviewed. Factors such as sports club participation and television viewing are discussed. The appropriate physical activity level and effective physical activity programmes are also presented. Physical activity can be promoted in childhood obesity treatment in many ways. Practical advice regarding physical activity programme and the role of exercise professionals in childhood obesity treatment team is given. Conclusion: For successful obesity management, the child should be assessed and treated by a multidisciplinary team, including a physician, dietitian, exercise expert, nurse and behavioural therapist.     

Is body composition important for paediatricians?

Body composition is increasingly demonstrated to be an important adult health outcome but receives little attention in paediatric clinical practice. There are several reasons why greater interest is merited. First, while obesity and eating disorders are currently defined by anthropometric criteria (weight relative to height, body mass index), these variables have poor sensitivity for monitoring response to treatment, and so body composition measurement could improve management. Second, body fat and its distribution merit monitoring more generally in patients in relation to the aetiology of cardiovascular disease, hypertension and type 2 diabetes, diseases now considered to have an "incubation period" during childhood and adolescence. Third, body composition is increasingly associated with clinical progress and outcome, including survival in some disease states. Finally, measurements of lean mass may improve the capacity to tailor nutrition, treatment and management to metabolic criteria.     

Childhood obesity--a sign of commercial success, but a market failure.

'Obesogenic' products, such as energy dense foods, passive entertainment products, cars, and labour-saving devices, are widely available and heavily promoted. Because they are highly consumed and very profitable, obesity becomes the inevitable consequence of their commercial successes. Contemporary market forces heavily favour behaviours for short-term preferences (i.e. over-consumption and underactivity) over long-term preferences (i.e. healthy weight) and this is especially true for children. Hence, if the market, as the main mechanism for determining choices, results in outcomes, which make our children worse off, as is occurring with childhood obesity, then the market has failed to sustain and promote social and individual goals. This is a serious market failure. In the current obesogenic environment, expecting adults, let alone children, to make food and activity choices in their own best long-term interests is, therefore, demonstrably flawed. We argue that significant government intervention is needed to correct this market failure, as has been done for other major health problems.