Obesity Prevention in Children: Physical Activity and Nutrition
Melinda S. Sothern, PhD From the Department of Pediatrics, Louisiana State University, Pennington Biomedical Research Center, Baton Rouge, and the Louisiana State University Health Sciences Center, New Orleans, Louisiana
The current environmental experience of young children includes few opportunities for physicalactivity and an overabundance of high calorie foods. Sedentary lifestyles and poor nutrition challenge children who are predisposed to metabolic disorders. Obesity is a logical response to this challenge. To prevent clinically signiﬁcant obesity and later metabolic disease in predisposed youth, all sectors of society must work together to support strategies to change public opinion and behavioracross the life span. Parental education in all medical settings is strongly recommended, especially if the parent(s) are obese, beginning with the ﬁrst pregnancy visit to the physician. Schools should be primary targets for efforts to educate parents concerning the reduction of TV, computer games, and unhealthy snacks. Schools should be encouraged to adopt vending machine policies that promotehealthy drinks and food in appropriate portion sizes and discouraged from providing unhealthy food as rewards for positive behavior or academic accomplishment. Schools should provide daily physical education and frequent periods of unstructured play in young children. Clinical treatment should be both encouraged and ﬁnancially supported in children who are already overweight. Community wide effortsto increase awareness and promote environments that encourage physical activity and healthy nutrition are needed. Nutrition 2004;20:704 –708. ©Elsevier Inc. 2004 KEY WORDS: children, overweight, obesity, metabolic disease, physical activity, nutrition, diabetes
The number of overweight children in the United States has reached epidemic proportions and children are becomingoverweight at younger ages.1,2 Recent studies show a consistent rise in the prevalence of obesity among preschool children from lowincome families.3 These children often have low levels of cognitive stimulation, which is associated with a signiﬁcant increase in the risk for early onset obesity.4 It is well accepted that the environment of the family plays a key role in the development of obesity inchildren.4 –7 Children with two obese parents have an 80% chance of developing obesity during their lifetime.8,9 If only one parent is obese, this risk factor declines to 40%. Remarkably, only 7% of children born to lean parents will likely develop childhood obesity.8,9 Also, studies show that parental inactivity strongly predicts child inactivity.5,10 A recent study examined self-reported physicalactivity and dietary intake patterns of parents and changes in weight status over 2 y in offspring.11 Girls of parents with high dietary intake and low physical activity (obesogenic) had signiﬁcantly greater increases in weight status. However, there are strong arguments for the effect of the genetic proﬁle and the early nutritional environment on the risk for developing obesity during childhood.12–17Jackson et al.14 provided a strong argument for nutritionally-induced changes in the hypothalamic-pituitary-adrenal axis in the mother and the fetus. It is suggested that the local availability of nutrients during pregnancy, especially in relation to protein intake, may negatively affect future metabolic health. Adjustments may occur to protect brain tissue preferentially over visceral andsomatic growth, re-
sulting in an altered metabolic proﬁle.14 Thus, nutrition during pregnancy may have strong implications for future obesity and related chronic disease. Infancy is also considered a critical period for obesity development. An excessive protein intake at the age of 2 y was shown to increase fatness at age 8 y, suggesting that a high-protein diet early in life may increase the risk...