The CDC estimate that ∼20% of American children are already overweight or obese before they begin school. Moreover, the risk of obesity in young children is even higher in low-income, African American, and Latino children. Although much research and many public health recommendations have focused on preventing and reversing obesity trends among school-age children and adolescents, there has been less attention paid to reducing the ever-expanding collective waistlines of our youngest citizens. Addressing this issue is critically important because, contrary to popular belief, children do not “grow out of their baby fat.” Instead, early excessive weight gain leads to substantially increased risks of later obesity and chronic disease.
In response to very little published consensus on policies and public health recommendations related to very early childhood obesity, the Institute of Medicine's Committee on Obesity Prevention Policies for Young Children released its report, Early Childhood Obesity Prevention Policies in June 2011. Sponsored by The Robert Wood Johnson Foundation and chaired by Dr. Leann Birch (Pennsylvania State University), the task of this committee was to first review factors related to overweight and obesity in infants, toddlers, and preschool children with a focus on nutrition, physical activity, and sedentary behaviors. The committee members were then charged with identifying gaps in knowledge and making recommendations on early childhood obesity prevention policies.
Importantly, although the committee fully acknowledges that parents and families play the primary role in shaping a child's development and influencing his or her obesity risk through genetics and home environment, the report's audience is actually those who are involved in children's development outside the home, such as child-care providers and regulators, health-care professionals, and directors of federal and local child care and nutrition programs. The hope is that the guidance outlined in the report will be used as an important part of the coordination of care and consistent messages about child health that are critical to success in helping families raise healthy children.
Recognizing the relative dearth of published data concerning the issue of obesity-related policies in very early childhood, the committee did not rely extensively on a systematic, evidence-based approach when addressing their charge. Instead, they carefully considered both direct and indirect evidence regarding the likely impact of policies on reducing childhood obesity, as well as evidence pertaining to the potential for unintended adverse consequences. Committee members also relied on their collective expertise, reports published by organizations that work with young children, invited presentations from experts in the field, and a variety of materials that had already been developed for programs and practitioners working with very young children in this capacity.
In all, 11 goals were put forth, each one having at least one specific recommendation.
Assess, monitor, and track growth from birth to age 5 y. The committee recommends that health-care providers measure weight and length or height using the WHO growth charts (1–23 mo) or the CDC growth charts (24–59 mo) as part of every well-child visit. They are also urged to consider the following: 1) children's weight-for-length or BMI at or above the 85th percentile; 2) children's rate of weight gain; and 3) parental weight status as risk factors for assessing the risk of current and later obesity.
Increase physical activity in young children. It is recommended that all child-care regulatory agencies require child-care providers and early childhood educators to provide infants, toddlers, and preschool children with opportunities for physical activity throughout the day. Further, communities should promote appropriate and accessible physical activity opportunities for all children.
Decrease sedentary behavior in young children. Child-care regulators and providers are encouraged to implement strategies to ensure that the amount of time that toddlers and preschoolers spend sitting or standing (such as occurs in car seats and high chairs) is limited.
Help adults to increase physical activity and decrease sedentary behavior in young children. The committee recommends that all individuals working with young children be trained in ways to increase children's physical activity and decrease their sedentary behavior, as well as how to counsel parents to encourage the same.
Promote the consumption of a variety of nutritious foods and encourage and support breastfeeding during infancy. Adults who work with infants are advised to promote and support exclusive breastfeeding for 6 mo and continuation of breastfeeding for 1 y or more. It is also recommended that child-care regulatory agencies require all meals, snacks, and beverages served to be consistent with federal guidelines. In addition, the committee supports establishment of dietary guidelines for children from birth to 2 y of age beginning with the 2015 Dietary Guidelines for Americans.
Create a healthful eating environment that is responsive to children's hunger and fullness cues. State child-care agencies are urged to require child-care providers and educators to practice responsive feeding techniques.
Ensure access to affordable healthy foods for all children. Government agencies should strive to maximize participation in federal nutrition assistance programs and increase access to healthy foods at the community level.
Help adults to increase children's healthy eating. The committee encourages health and education professionals providing guidance to parents and those working with young children to be trained, educated, and provided the “right tools” to increase children's healthy eating and counsel parents about their children's diets.
Use social marketing to provide consistent information and strategies for the prevention of childhood obesity in infancy and early childhood. The Secretary of the U.S. Department of Health and Human Services, along with other state, federal, and private entities, are encouraged to establish social marketing programs aimed at providing consistent, practical information on the risk factors for childhood obesity to pregnant women and early child-care providers.
Promote age-appropriate sleep durations among children. It is recommended that child-care providers adopt practices that promote age-appropriate sleep habits, such as removing all screen media sources in sleeping areas and keeping noise and light levels low during napping.
This report provides concrete and actionable recommendations related to policies affecting obesity risk in very early childhood. Specifically, these recommendations target measures that can be taken outside the home and call on government at all levels to support healthy eating among young children through guidelines and promotion efforts. The report also highlights myriad gaps in research knowledge, but concludes that “the urgency of the issue of obesity in young children demands that action be taken now with the best available evidence.”
