Childhood obesity: Early years a critical window
At Shining Stars Family Child Care in San Francisco, toddlers and preschoolers celebrate birthdays with quinoa cakes sweetened only with sweet potatoes. There’s no juice at snack time. Instead, the children sip water flavored with berries or cucumbers.
And they do work up a thirst, salsa dancing and running around the center’s backyard.
The children may not know they are engaged in an obesity prevention program backed by research. They just know “they love it,” Shining Stars owner Zonia Torres says.
Researchers say an early embrace of healthy habits is a key ingredient in tackling an urgent problem: excess weight gain in very young children.
Researchers have long known that heavy children often grow up to become heavy teens and adults. The latest research, a study that followed 50,000 German children, found an especially strong risk when children gain weight too rapidly from ages 2 to 6.
An early weight surge “is the most powerful predictor of subsequent obesity in adolescence,” says Michael Freemark, a professor of pediatrics at Duke University School of Medicine.
The longer a child stays heavy, the more likely the pounds are to stick, says Freemark, who wrote an editorial accompanying the study, published this month in the New England Journal of Medicine.
Many obese adults were never obese children, he says, but obese children and teens are at very high risk for becoming obese adults.
Freemark wrote in his editorial that it’s clear “we are now witness to an evolving epidemic of childhood obesity” that’s putting youngsters at risk for eventual complications ranging from type 2 diabetes to fatty liver disease.
The early years are a critical window, he says, and perhaps the best time to prevent harm.
Parents face obstacles
Alvin Eden, a pediatrician in Forest Hills, New York, and a clinical professor of pediatrics at Weill-Cornell Medical Center, has practiced for more than 40 years. He wrote his first book about obesity prevention in the mid-1970s; his most recent is “Obesity Prevention for Children: Before It’s Too Late: A Program for Toddlers & Preschoolers.”
“Many many years ago, when I first started, I went out to California and visited Disneyland,” Eden recalls. “As I walked along, I started noticing families where the mother and father were obese, and there would be three or four children behind them who were also obese.
“Then I went back and started to notice the same thing in my practice.”
The numbers of obese parents and children in his office keep increasing, he says.
He advises high-risk families to cut down on juice, add fruits and vegetables, get children outside to play, limit TV and make sleep a priority.
He also talks about health consequences.
“There’s more and more evidence showing that even a child at 4 or 5 who is obese is already developing high cholesterol, higher blood pressure,” he says. “The kid isn’t going to have a heart attack now but is getting set up for it.”
Even when parents know the risks, they can find it difficult to follow the guidelines laid down by pediatricians, dietitians and fitness groups.
“Parents want their children to be healthy, but there are sometimes significant obstacles they can’t overcome,” says John Auerbach, president and CEO of Trust for America’s Health, a nonprofit group based in Washington.
Fresh fruits and vegetables can be more expensive than junk food, he says. Many families, he says, don’t live in neighborhoods where sidewalks, playgrounds and other amenities make physical activity an easy choice.
Child care centers can help
Dianne Ward, a professor of nutrition at the University of North Carolina-Chapel Hill, helped develop some of the best known obesity prevention practices for child care centers.
The program used by Torres in San Francisco, called Healthy Apple, is administered by the city’s Children’s Council and uses materials developed at North Carolina.
The centerpiece is a set of questionnaires that providers use to assess how well they incorporate healthy practices such as offering plenty of water, vegetables and outdoor play.
Providers choose which goals they want to pursue, and can attend workshops to learn how. They can earn awards for progress.
A pilot study published in 2017 found the program slowed weight gain in children who participated.
Ward says it’s impossible to say how many child care providers have changed their practices for the better as the result of such programs and the higher profile they gained during former first lady Michelle Obama’s Let’s Move campaign.
No matter how much progress has been made, she says, “we have not done enough yet.”
San Francisco mom Lindsay Mason says she was lucky to find Torres’ child care center for her 3-year-old daughter, Clare.
Other places she considered were still “serving chicken fingers and hamburgers on a daily basis.”
Mason’s family doesn’t have a history of obesity, she says, but it does have a history of diabetes. She is happy her daughter is learning so many good habits.
“We are confident she is being fed the right foods, and we know she is not just being propped in front of a TV,” Mason says. “She is moving and learning to play and having fun doing what kids are supposed to do. … She is getting a wealth of knowledge.”
Zonia Torres, educator at Shining Stars Family Child Care in San Francisco, dances with preschoolers on Oct. 24.
Lunch options for children at Shining Stars include lentils with sweet potatoes or couscous with chicken and red peppers.