Obesity begins early

Prevention is best, but change is always possible

Obesity, it appears, has something in common with smoking: once the pattern is established, it’s difficult to change. A new study shows that children who have overweight or obesity as 5 year olds are more likely to have obesity as adolescents. Other studies have shown that adolescents with obesity tend to become adults with obesity. Thus, it appears that, if a child has obesity at age 5, chances are high that child will have obesity as an adult.

However, the new study of obesity does offers reason for hope. If a child doesn't have obesity by at age 5, he or she has a good chance to avoid a lifetime of having obesity and all of the health problems associated with it.

The study was conducted by Solveig Cunningham and her colleagues at Emory University in Atlanta. With financial support from the NICHD, the Emory researchers analyzed data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999, a data set compiled by the U.S. Department of Education (with support from a number of federal partners, including NICHD). The researchers analyzed data on height and weight collected from more than 7700 children throughout the United States, as the children progressed from kindergarten through eighth grade.

The researchers found that 12 percent who had obesity when they entered kindergarten, and another 15 percent had overweight. By the eighth grade, almost 21 percent had obesity and another 17 percent had overweight. Not all children with obesity or overweight retained their extra weight and not all children with typical weight remained that way. However, the trends were clear. Five-year-olds with overweight were four times more likely than 5-year-olds with typical weight to have obesity by eighth grade (incidence of 32%% vs. 8%).

No one can say just why one person has obesity and another does not. The overwhelming consensus among researchers is that obesity results from a combination of genetic and environmental factors. Some people may simply have more of a tendency to have overweight than do others. However, environment also plays a role. For example, children in certain neighborhoods may not have as many opportunities for getting out and moving around as children from other areas. Similarly, some families, for reasons of tradition, cultural heritage, economics, or even lack of knowledge about good nutrition, may select more caloric foods, and be in the habit of serving larger portion sizes.

According to the U.S. Centers for Disease Control and Prevention (CDC), 12 percent of preschoolers have obesity. Even in childhood, obesity carries the risk for such physical and mental health problems as high cholesterol, high blood sugar, and asthma. More than one-third of adults have obesity. For adults, obesity is one of the leading causes of preventable death, such as heart disease, stroke, type 2 diabetes, and many kinds of cancer.

Fortunately, we’ve learned a few things about how to prevent obesity and to help those who may already have gained weight. The American Academy of Pediatrics (AAP) has reviewed the research supported by NICHD and others to formulate recommendations for preventing and treating children with overweight and obesity. I’ve cited them here, along with additional information on nutrition and maintaining a healthy weight.

• Limiting sugar sweetened beverages. The CDC reminds us that with drinks containing sugar or other added sweeteners, calories can really add up.
• Consuming recommended amounts of fruits and vegetables. ChooseMyPlate.gov/ provides information about not only about recommendations for fruits and vegetables, but for other food groups as well.
• Limiting television and other screen time. Children who are sitting and watching television aren’t likely to be exercising and burning calories. The AAP recommends that children under age 2 don’t watch any television. After age two, children should have no more than 2 hours of television time each day. For older children, AAP recommends no more than 2 hours of total screen time a day—this means limiting TV viewing, as well as computers and electronic games. Similarly, AAP cautions against keeping television or other screens in children’s rooms.
• Eating breakfast daily. Skipping meals may make you feel hungrier and lead you to eat more than you normally would at your next meal. In particular, studies show a link between skipping breakfast and obesity. People who skip breakfast tend to have overweight than people who eat a healthy breakfast, according to NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.
• Limiting eating out at restaurants—particularly fast food restaurants. Restaurants tend to serve large portions and offer energy dense foods.
• Encouraging family meals in which parents and children eat together. Families who eat together often have healthier diets and lower obesity rates.
• Limiting portion size. Restaurant portion sizes have grown in the last 20 years. Many restaurant dishes may contain enough food for two or three people. The NIH’s National Heart Lung and Blood Institute’s (NHLBI) Portion Distortion pages show how portions have increased and compares them to appropriately sized servings. Of course, parents should avoid being overly restrictive, either in limiting what children eat, or forcing them to eat more than they’d care to. The goal is to teach children self-control, so that they can consistently make their own healthy choices.

I encourage all parents and caregivers to take advantage of the federal government’s information resources to help their children maintain a healthy weight. First Lady Michelle Obama’s Let’s Move! Initiative is dedicated to solving the challenge of childhood obesity within a generation. The Let’s Move! Website provides helpful information on diet and exercise for parents, school systems, and community leaders. Here at NIH, NHLBI’s We Can! (Ways to Enhance Children's Activity & Nutrition) national education program provides parents and caregivers with tools and activities, so they can encourage their children to eat healthy, increase physical activity, and reduce screen time.

And finally, NICHD’s “Media Smart Youth” (PDF - 30.0 MB) program is an interactive after-school program that teaches young people how media influence their health, nutrition, and physical activity. The program helps students build skills to make informed decisions about being physically active and eating nutritious food in daily life. The goal is to establish healthy habits that will last into adulthood.

Especially with the data from this recent study, it appears best to start when children are young and establish healthy habits before weight becomes a problem. And, although it may be difficult to change things for families in which unhealthy habits have taken hold, nothing is set in stone, and change is still possible. What may be most important is to start now. 

Originally posted: February 26, 2014