Obesity prevention for the under 5 crowd

Is there anything cuter than the chubby face of a smiling baby?  Maybe not, but in some instances that baby fat should elicit more concern than cooing, according to a report released by the Institute of Medicine (IOM).

The Early Childhood Obesity Prevention Policies report shows that even the youngest children in the United States are at risk of becoming obese. Today, almost 10 percent of infants and toddlers are heavy when compared to their length, and that number doubles for kids between the ages of 2 and 5.

A little baby fat may not be a red flag for health concerns now, but studies show that early obesity can track into adulthood. To prevent future health problems before they occur, the IOM is calling on healthcare professionals, caregivers and policymakers to step up their game when it comes to imparting on parents the importance of nutrition, physical activity and the dangers of sedentary behavior. And the sooner the better; the report stresses that kids should be on the right nutrition and physical activity path before they even enter school.

Elsie Taveras, MD, MPH

“There’s been a lot of evidence accumulating over the past couple years that indicates that the first few years of life are crucial to future health and the prevention of obesity in children,” says Elsie Taveras, MD, MPH, who served on the IOM committee that released the report and is co-director of Children’s Hospital Boston’s One Step Ahead Program. “In the past there’s been a precedent to wait until a problem exists before we intervene, but the point of this report was to stress the importance of prevention. Preventing obesity before it occurs is easier and more efficient than trying to reduce it once its been established.”

Because obesity can’t be prevented by just one single method, the IOM report made several suggestions. Here’s a breakdown of some their more important findings:

Identify at-risk kids early. Parents that don’t fully grasp the long-term consequences of excess weight in infants and young children may not be too worried about a little extra weight on their kids. If doctors, daycare providers and other professionals identify a child as being at risk for obesity, the report suggests they discuss their concerns with the child’s parents, clearly explaining the potential future problems early obesity can lead to.

“One of the main points of this report was to emphasize that everyone has a role in helping kids maintain a healthy weight, from doctors to daycare providers and so on,” Taveras says. “If you are an adult who works with children, you have a responsibility to let a family know if you are concerned about a child’s health. In situations where weight is a concern, it may not always be an easy conversation to have, but if done with sensitivity it should provide support for the family and allow them to go to their healthcare provider to learn more.”

Poor sleeping habits have been linked to early weight gain. An environment that promotes quality rest is important for young children.

Don’t just eat well, sleep well. It’s been documented that kids younger than 3 are getting less sleep than they used to. Because there have been studies that directly link poor sleep habits to obesity, the report suggests agencies that oversee childcare centers should do more to ensure that daycares offer plenty of space and time for sleep, and encourage healthier sleep habits.

It’s an important recommendation, and one that Taveras understands well. In 2008 she was the lead author on one of the first studies to explore how insufficient sleep could lead to weight gain in infants.

“In recent years studies have shown that short sleep in early childhood precedes excess weight gain and obesity in children,” she says.  “Based on that data, the report suggests that adults who work with kids offer an environment that promotes healthy sleep. When children in their care are sleeping, adults need to do more to ensure that the environment really lends itself to quality rest.”

Get active early. Children who frequently play active games at an early age are more likely to stay active through childhood, adolescence and adulthood. With this in mind, the report says agencies that regulate childcare facilities should require childcare providers and early childhood educators to create opportunities for physical activity and play throughout the day. What’s appropriate will vary greatly from child to child and center to center, but the IOM committee recommends no less than 15 minutes per cumulative hour spent in daycare be spent doing physical, active play. These games should take place outside whenever possible.

Also, the report says schools and daycare should move away from the practice of denying outside play as punishment.

“In my work at Children’s, many of my patients tell me that they lose recess time if they misbehave or break a rule,” says Taveras. “Denying kids time for physical activity is so counterproductive to health. I’ve found that a lot of kids will be physically active if we let them, so we need more policies to encourage that, not take it away.”

The report also noted that infants who are constantly confided to car seats, highchairs and bouncing apparatuses aren’t moving independently enough. The report says babies should be given more supervised crawl and movement time, allowing them to exercise their arms and legs and get in the habit of being active.

“By not allowing a child to move often enough, we’re restricting early activity,” Taveras says. “As a committee we really felt that we needed to stress the importance of letting infants crawl and move freely to increase physical activity early on.”

Is your infant spending too much time in restrictive devices?

Start good nutrition habits at birth. For infants, breast-feeding promotes balanced nutrition in many ways. But reports show that only 13 percent of mothers breast-feed exclusively for six months after birth, and only 22 percent continue breast-feeding up to a year. To increase these numbers, the IOM report suggests that health care providers and employers should do more to encourage breast-feeding among new mothers.

“Breast- feeding is good for many reasons, not just preventing obesity,” says Taveras. “Unfortunately there are still too many barriers to the practice. The stance of the IOM committee was that there needs to be more breast-feeding education from hospitals and healthcare providers, as well as an effort by work environments to support a woman’s choice to breast feed or pump breast milk, should she choose to do so.”

Once the child moves on to solid food, the report suggests that child care facilities and preschools should be required to follow the meal patterns established by the federal Child and Adult Care Food Program (CACFP). Adhering to age-appropriate amounts of sugar, salt, fat and necessary nutrients assure that children are getting healthier food options when not at home.

The Early Childhood Obesity Prevention Policies report may not have been intended for parents, but Taveras says there is still a good deal of valuable parenting information inside. She encourages anyone with children to read it and use what they learn to start conversations with the adults in their children’s lives.

“Although the report wasn’t created directly for parents, we want it to influence them as much as we want it to influence healthcare workers, educators and policy makers,” she says. “It’s a good read for parents. It can give them a better sense of what they should be talking about with pediatricians during well visits or things to talk to their childcare provider about when they want to know more about how their child spends their time away from home.”