Child­hood obe­sity: Early years a crit­i­cal win­dow

USA TODAY International Edition - - NEWS - Kim Pain­ter

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 flavored 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 first 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 first 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 office 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 find it difficult to fol­low the guide­lines laid down by pe­di­a­tri­cians, di­eti­tians and fitness groups.

“Par­ents want their chil­dren to be healthy, but there are some­times sig­nificant ob­sta­cles they can’t over­come,” says John Auer­bach, pres­i­dent and CEO of Trust for Amer­ica’s Health, a non­profit 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 offer­ing 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 profile they gained dur­ing for­mer first 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 find Tor­res’ child care cen­ter for her 3-year-old daugh­ter, Clare.

Other places she con­sid­ered were still “serv­ing chicken fingers 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 confident 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.

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