- Obesity in K–8 Students: New York City, 2006–07 to 2010–11 School Years
- Looking Ahead: 2012 Food Politics
- Research Briefs Examine Obesity Epidemic Among Latino Youths
- Some Children's Cereals Packed with Sugar, Study Finds
- Teens Who See Calorie Info Buy Fewer Sugary Drinks
- Child Obesity Prevention Interventions Can Be Effective
- Overweight 7-Year-Olds Face Higher Risk of Asthma
CHILDHOOD OBESITY NEWS
- Lack of Exercise Heightens Obesity Risk Among Black Girls
- Parents May Hold Key to Healthy Weight in Hispanic Kids
- Obesity Epidemic May Have Roots in 1950s
- Few Parents Recall Doctor Saying Child Overweight
Dec. 15, 2011, The New York Times
By Anemona Hartocollis
The number of obese New York City schoolchildren fell by 5.5 percent over five years, federal and city officials said Dec. 15, offering a glimmer of optimism about one of the country's intractable health scourges.
The decline, documented by annual fitness exams given to most of the city's kindergarten through eighth-grade students, was the biggest reported by any large city. Over all, the rate of obesity dropped in New York City to 207 children per 1,000 in the 2010-11 school year, down from 219 five years earlier, meaning that 20.7 percent were still considered obese.
"This comes after decades of relentless increases," said Dr. Thomas A. Farley, the city's health commissioner. While the 5.5 percent drop may seem slight, he said, "What's impressive is the fact that it's falling at all." The results, published last month in a report by the federal Centers for Disease Control and Prevention, showed that the declines in obesity were sharply higher among middle-class children than among poor children. They were also higher among white and Asian children compared with black and Hispanic children, and among very young children — those entering kindergarten or first grade — compared with older children. Still, the drops held up to some extent across all grades, races and economic levels.
"Because of coordinated, sustained action I am happy to say our children are benefiting from our campaign against obesity, which has plagued communities here in New York and across the nation for nearly three decades," Mayor Michael R. Bloomberg said.
Mr. Bloomberg said the 5.5 percent drop translated into roughly 6,500 fewer obese children in the public schools. He said that an overwhelming majority of parents think their children are fit and at a healthy weight, but that "the facts tell a different story."
Dr. Farley attributed the progress partly to the city's aggressive advertising campaign against sugary sodas, which he said may have altered what parents were providing to their children. The city has also tried to add healthier options to school lunch menus, enacted strict rules on the calorie and sugar content of snacks and drinks in school vending machines, and even put limits on bake sales, a move that caused some grumbling.
Buoyed by the results, city officials also announced that the restrictions on school vending machines were being expanded to machines in all city buildings, and that they were forming a multiagency task force to recommend further initiatives to combat obesity. Dr. Farley also noted that salad bars were now in cafeterias at many schools, including Public School 218, near Yankee Stadium, where the mayor and the commissioner announced the results at a news conference.
Across the country, recent studies have shown childhood obesity rates remaining flat or slightly increasing. Los Angeles County, which has also conducted a campaign against sugary drinks, had a decline of 2.5 percent during the same period, according to a study by the UCLA Center for Health Policy Research and the California Center for Public Health Advocacy.
The study was cautious in its language, warning, "A causal relationship cannot be inferred between the fitness interventions implemented by New York City in schools and the decrease in prevalence of child obesity described in this report.” But it said the decreases in obesity “might” indicate that changes in the school or home environment were important.
Obesity experts said that given the stubbornness of the problem, even a small reduction in obesity was an affirmation of public health initiatives.
"We've seen nothing but bad news for the last 10 years," said Marlene Schwartz, deputy director of the Rudd Center for Food Policy and Obesity at Yale University. "I feel like that's finally starting to turn around." Dr. Schwartz said younger children, who respond better to adult direction, and children in more affluent families, which have the resources to change, were the easiest to reach, so it was not surprising that they improved the most.
Dr. Farley said the fact that obesity had declined more among younger children was not surprising because it is easier to prevent weight gain than to lose weight. The city has trained 4,000 elementary school teachers to provide in-class physical activity breaks, the study said, and has tried to limit video and TV time in child care programs.
The decline in obesity was documented by the city in FitnessGrams, annual physical education tests that are now completed by most of the city's kindergarten through eighth-grade students.
Adult men and women are considered obese if their body mass index is 30 or higher, but children are calculated differently because of their constant physical changes. A 7-year-old boy, for example, who is 3-foot-9 would be considered obese with a body mass index of 19.4, or a weight of 56 pounds. A 12-year-old girl who is 5-foot-2 is considered obese with an index of 25.2, a weight of 138 pounds.
By age group, the decline was highest among 5- and 6-year-olds, at 9.9 percent. By race, the drop was highest among white children, at 12.5 percent, and Asian children, at 7.6 percent, and lower for Hispanic children, at 3.4 percent, and black children, at 1.9 percent.
Obesity in K–8 Students: New York City, 2006–07 to 2010–11 School Years
Dec. 16, 2011, Morbidity and Mortality Weekly Report
Overweight and obese children are more likely to develop risk factors that can lead to respiratory, metabolic, and cardiovascular illness. The increase in prevalence of childhood overweight and obesity in the United States since the 1960s has been well documented. In New York City, in 1996, an estimated 19.7 percent of third grade children and 21.2 percent of sixth grade children in public and private schools were found to be overweight; in 2003, an estimated 43 percent of the city's public elementary school students were found to be overweight, and 24 percent of these students were obese.
To update city data on childhood obesity and evaluate public health interventions, the New York City Department of Health and Mental Hygiene analyzed body mass index (BMI) data for public schoolchildren in kindergarten through eighth grade (K–8), using data from the 2006–07 to 2010–11 school years. This report summarizes the results of that analysis, which found that, overall, the prevalence of obesity in grades K–8 decreased 5.5 percent, from 21.9 percent in 2006–07 to 20.7 percent in 2010–11.
Obesity decreased significantly among children in all age groups and in all socioeconomic and racial/ethnic populations; however, the decrease was smaller among black (1.9 percent) and Hispanic (3.4 percent) children than among Asian/Pacific Islander (7.6 percent) and white (12.5 percent) children. Despite the decreases in obesity, continued public health interventions are needed to further reduce the prevalence of obesity and to eliminate disparities among schoolchildren in New York City.
Looking Ahead: 2012 Food Politics
Jan 4 2012, The Atlantic
By, Marion Nestle
Q: What's on the food politics agenda for 2012? Can we expect anything good to happen?
A: By "good," I assume you mean actions that make our food system safer and healthier for consumers, farmers, farm workers, and the planet.
Ordinarily, I am optimistic about such things. This year? Not so much. The crystal ball is cloudy, but seems to suggest:
Political leaders will avoid or postpone taking action on food issues that threaten corporate interests. Sometimes Congress acts in favor of public health, but 2012 is an election year. Expect calls for corporate freedom to take precedence over those for responsible regulations. Maybe next year.
Something will happen on the farm bill, but what? Last fall's secret draft bill included at least some support for producing and marketing fruits and vegetables, and only minimal cuts to SNAP (food stamps). Once that process failed, Congress must now adopt that draft, start over from scratch, or postpone the whole mess until after the election.
SNAP participation will increase, but so will pressure to cut benefits. With the economy depressed, wages low, and unemployment high, demands on SNAP keep rising. In 2011, SNAP benefits cost $72 billion, by far the largest farm bill expenditure and a tempting target for budget cutters. While some advocates will be struggling to keep the program's benefits intact, others will try to transform SNAP so it promotes purchases of more healthful foods. Both groups should expect strong opposition.
Childhood obesity will be the flash point for fights about limits on food marketing. The Lancet recently summarized [in articles and commentaries by COMNet (Collaborative Obesity Modeling Network) members] the state of the science on successful obesity interventions: taxes on unhealthy foods and beverages, restrictions on marketing such items, traffic-light front-of-package food labels, and programs to discourage consumption of sugar-sweetened drinks and television viewing. Expect the food industry to continue to get Congress to block such measures, as it did with U.S. Department of Agriculture school nutrition standards (hence: pizza counts as a vegetable).
The Federal Trade Commission will postpone release of nutrition standards for marketing to children. Although Congress asked for such standards in the first place -- and the standards are entirely voluntary -- it just inserted a section in the appropriations bill requiring a cost-benefit analysis before the FTC can release them. Why does the food industry care about voluntary restrictions? Because they might work (see previous prediction).
The Food and Drug Administration will delay issuing front-of-package labeling guidelines as long as it can. The FDA asked the Institute of Medicine for advice about such labels. The institute recommended labels listing only calories, saturated and trans fat, sodium, and sugars -- all nutrients to avoid. Although the institute did not mention traffic-light labels, it did recommend check marks or stars, which come close. The food industry much prefers its own method, Facts Up Front, which emphasizes "good-for-you" nutrients. It is already using this system. Will the FDA try to turn the institute recommendations into regulations? Maybe later.
The FDA will (still) be playing catch-up on food safety. The FDA got through the 2011 appropriations process with an increase of about $50 million for its inspection needs. This is better than nothing but nowhere near what it needs to carry out its food safety mandates. The FDA currently inspects less than two percent of imported food shipments and five percent of domestic production facilities. The overwhelming nature of the task requires FDA to set priorities. Small producers think these priorities are misplaced. Is the FDA going after them because they are easier targets than industrial producers whose products have been responsible for some of the more deadly outbreaks? Time will tell.
On the bright side, the food movement will gather even more momentum. While the food industry digs in to fight public health regulations, the food movement will continue to attract support from those willing to promote a healthier and more sustainable food system. Watch for more young people going into farming (see Chronicle staff writer Amanda Gold's Dec. 25 article) and more farmers' markets, farm-to-school programs, school meal initiatives, and grassroots community efforts to implement food programs and legislate local reforms. There is plenty of hope for the future in local efforts to improve school meals, reduce childhood obesity, and make healthier food more available and affordable for all.
Research Briefs Examine Obesity Epidemic Among Latino Youths
Salud America!, a national program of the Robert Wood Johnson Foundation (RWJF), has released a comprehensive collection of research briefs examining the obesity epidemic among Latino children and teens.
Three of the new national briefs review current evidence and provide policy recommendations with respect to Latino youth in three major areas: the availability of healthy, affordable foods; opportunities for physical activity; and the impact of food marketing on diets and obesity rates.
In addition, 20 pilot grantees funded by RWJF through Salud America! have produced briefs highlighting their own, new research. These briefs analyze a wide range of issues, from the impact of menu labeling in small restaurants in south Los Angeles, to how after-school programs can help Latino youths to become more active, to how community gardens can help lower-income Latino families eat more fruits and vegetables.
Read the research briefs below:
- Influence of Media on Overweight and Obesity Among Latino Youth
- Addressing Nutrition, Overweight and Obesity Among Latino Youth
- Physical Activity, Overweight and Obesity Among Latino Youth
Some Children's Cereals Packed with Sugar, Study Finds
Dec. 6, 2011, The Washington Post
By Dina ElBoghdady
At least three popular children's cereals are packed with more sugar in a one-cup serving than a Hostess Twinkie, and an additional 44 are loaded with more sugar in a cup than three Chips Ahoy cookies, according to a study released last month by the Environmental Working Group.
Kellogg's Honey Smacks, Post Golden Crisp and General Mills Wheaties Fuel rank as the worst offenders based on the Twinkie measure, said the study, which analyzed 84 cereals. Other brands — including Honey Nut Cheerios, Apple Jacks and Cap'n Crunch — are among the 44 cereals that have more sugar in a cup than three Chips Ahoy cookies.
In nearly three-dozen brands, sugar makes up more than a third of the cereal by weight, the study said. Those include the original and "marshmallow" versions of Kellogg's Froot Loops, as well as the original and "all berries" version of Quaker Oats Cap'n Crunch.
"Most parents would never serve dessert for breakfast, but many children's cereals have just as much sugar or more," said Jane Houlihan, senior vice president of research for the group, a nonprofit that researches everything from the safety of sunscreens to pesticides in foods. "I wasn't surprised that so many of these cereals contained sugar. I was surprised at the very high amounts."
The report comes at a time when the federal government is considering voluntary guidelines for foods marketed to children. With obesity rates at epidemic levels, a federal inter-agency group wants the industry to limit the sodium, fats and added sugars in the foods and drinks advertised to kids ages 2 to 17.
But the industry has lobbied against the proposal, which would take effect in 2016. Food companies say the guidelines are back-door regulations that would effectively ban food advertising to youth because they are so severe.
The guidelines allow for 13 grams of added sugar per 50 grams of cereal, so that a cereal can be about one-quarter sugar by weight. Two-thirds of the children's cereals analyzed exceed that threshold, the Environmental Working Group said.
The industry prefers its own standard, unveiled in July, that calls for no more than 10 grams of sugar per listed serving size, starting in 2013. Most of the cereals analyzed now meet that threshold, but a quarter do not, the study said.
Many cereal makers say the study is misleading on several fronts.
For starters, only two cereals on the group's "10 worst" list are marketed to kids, industry advocates said. Those two are Kellogg's Apple Jacks and Froot Loops Original. Food firms stopped advertising products with more than 12 grams of sugar to children under age 12 starting in 2006, when the industry adopted its own marketing standards.
Honey Smacks is not marketed to children and seldom eaten by them, said Lisa Sutherland, vice president of nutrition at Kellogg North America. Neither is Wheaties Fuel, said Kirstie Foster, a General Mills spokesman. Its target audience is active male adults, Foster said.
Industry advocates also dismissed the comparisons between cereals and dessert, such as Twinkies with 17.5 grams of sugar and three Chips Ahoy cookies with 11 grams of sugar.
Even the sugary cereals, they said, are of nutritional value because they contain vitamins and minerals. Research shows that 40 percent of U.S. children consume their milk via cereal, said Sutherland of Kellogg. General Mills cites data from the Journal of the American Dietetic Association that says people who frequently eat cereal; including kids who eat sweetened ones, tend to have healthier body weights than those that don't.
The study also ignores the progress made in reducing the sugars in children's cereals, said Elaine D. Kolish, director of the Children's Food and Beverage Advertising Initiative, which developed the industry's self-regulation program. Cereal makers have cut sugar content from 10 to 25 percent since 2007, Kolish's group reported.
For them, "this is about selling products. It's not about health," said Marion Nestle, a nutrition and food studies professor at New York University. "Their goal is to sell cereals, and these sugary cereals are enormously profitable."
That's why companies spend huge amounts of money advertising them, packaging them with colorful cartoon characters that lure children and placing them at eye-level on grocery store shelves, said Nestle, author of "What to Eat."
Aside from the obesity issues tied to sugar, research also suggests that sugar is habit-forming and that children who eat high-sugar breakfasts have more problems at school because they are more easily frustrated and have a hard time working independently, according to the Environmental Working Group's study.
But it was the climbing obesity rates that led Congress in 2009 to direct four agencies — the Federal Trade Commission, the Centers for Disease Control and Prevention, the Food and Drug Administration and the Agriculture Department — to look at how to improve the nutritional standards for foods marketed to children. The report might be presented to Congress by year's end.
Obesity rates have more than doubled for children ages 2 to 11 and more than tripled for teens ages 12 to 19 in the past three decades.
Teens Who See Calorie Info Buy Fewer Sugary Drinks
Dec. 15, 2011, The Washington Post
By Jennifer LaRue Huget
In 2012 the FDA is to issue regulations requiring chain restaurants to include calorie counts on their menus. The initiative, part of the Patient Protection and Affordable Care Act of 2010, has hurtled forward, even as the science supporting it remains unsettled.
But the newest findings bolster the notion that providing information about foods' caloric content can help people make more healthful choices. Research published last month in the American Journal of Public Health shows that when teens — in this study — black teens shopping in corner convenience stores in low-income areas in Baltimore — see signs alerting them to the caloric impact of sugar-sweetened beverages (including soda, fruit juice, energy drinks and other sugary sips), some of them choose less-caloric options.
Obesity experts single out sugar-sweetened beverages because, as the study notes, people tend not to register the amount of calories they consume through drinking them and aren't likely to compensate by consuming fewer calories elsewhere during the day.
This study's innovation was to provide calorie information via three different messages, one of each was posted on a bright-colored sign in each of four stores that were within walking distance of local middle and high schools. One simply said that a bottle of soda or fruit juice has about 250 calories. Another said a bottle of soda or juice contains 10 percent of the daily recommended calories. And a third noted that a teen would have to jog for 50 minutes to burn the calories in a single bottle of soda or juice.
Overall, the presence of such signs reduced the odds that a teen would buy a sugar sweetened soda by 40 percent. In particular, kids who saw the sign about physical activity were 50 percent less likely to buy a sugary beverage than they had been observed to be before the signs were posted.
Before the signs went up, water, diet soda and other beverages that aren't sweetened with sugar made up 6.7 percent of teen customers' purchases in those stores. After the signs, that number went up to between 12 percent and 14 percent, depending on which sign was in the store.
Calories are notoriously difficult for many people to grasp; the study points to literature showing that folks asked to estimate how many calories are in a restaurant meal tend to guess wildly wrong, underestimating by an average of 600 calories. That's why I like the idea of the information's being posted in terms of a workout equivalent; that's something we can all understand, right?
The study tallied 1,600 beverage purchases by black teens (400 to establish a baseline and 400 purchases in each of three stores, each with a different sign posted). It was conducted by researchers at the Johns Hopkins Bloomberg School of Public Health and funded through the Robert Wood Johnson Foundation's Healthy Eating Research program.
Child Obesity Prevention Interventions Can Be Effective
Dec. 9, 2011, USA Today
Obesity prevention interventions in children can be effective, according to a review published online last month in the Cochrane Database of Systematic Reviews.
Elizabeth Waters, M.P.H., D.Phil., from the University of Melbourne in Australia, and colleagues reviewed available literature to update a previous Cochrane review on childhood obesity prevention research.
Studies that used a controlled design and evaluated interventions, policies, or programs in place for twelve weeks or more were included. Data on intervention implementation, cost, equity, and outcomes were extracted. Meta-analyses using available body mass index (BMI) or standardized BMI (zBMI) scores were performed, with subgroup analysis by age group.
The investigators identified 55 studies, the majority of which targeted children aged 6 to 12 years. A meta-analysis of 37 studies, including 27,946 children, confirmed that programs were effective at reducing adiposity, but individual interventions were not all effective, and the observed heterogeneity was high (I² = 82 percent). A standardized mean difference in adiposity of -0.15 kg/m² was seen overall for children in the intervention groups, with intervention effects of -0.26 kg/m² for 0- to 5-year-olds; -0.15 kg/m² for 6- to 12-year olds; and -0.09 kg/m² for 13- to 18-year-olds.
There was unexplained heterogeneity seen in all age groups. Adverse effects were reported by only eight studies and there was no evidence of adverse outcomes like unhealthy dieting practices, increased prevalence of underweight, or body image sensitivities.
Overweight 7-Year-Olds Face Higher Risk of Asthma
Dec. 23, 2011, HealthDay
By Jenifer Goodwin
Children who are overweight or obese during early childhood have a greater risk of having asthma at age 8 than normal-weight kids, a new study finds.
Researchers in Sweden followed more than 2,000 children for eight years, using preschool and school health records to track their height and weight at ages 1 year, 18 months, 4 years, and 7 years. Parents completed questionnaires about their child's health, including asthma and allergy status.
Children who had persistently high BMI (body mass index) – in the 85th percentile or above –throughout early childhood, or who were normal-weight toddlers but gained weight and had a high BMI at age 7, were more likely to have asthma than kids who had a normal body weight.
However, kids who had a high BMI at an early age – at 18 months or 4 years – but slimmed down by age 7 were not at higher risk of asthma than other kids.
"If the children are only overweight during the early period before 4 years of age we do not see an increased risk of asthma during school age," said lead study author Jessica Magnusson, a Ph.D. student at the Institute of Environmental Medicine in Stockholm. "However, if they are persistently overweight, or overweight at a later age – age 7 – then there is an association with asthma at age 8."
Asthma, characterized by inflammation of the airways, may cause wheezing, coughing, chest tightness and trouble breathing.
The study is in the January issue of Pediatrics.
At age 8, about 6 percent of the kids in the study had asthma. Those overweight at age 4 and age 7 had a nearly 2.5 times greater risk of having asthma.
Researchers excluded kids who'd had early symptoms of wheezing or had been diagnosed with asthma prior to age 2.
Researchers also took into account parental history of asthma. A high BMI was associated with an increased risk of asthma only in kids without parental history of the disease, according to the study.
Researchers pointed out that their study does not show that being overweight or obese causes asthma. However, the march upward in childhood obesity rates has coincided with an increase in asthma rates, leading some to speculate that the two may be linked biologically.
One theory is that leptin, a hormone found in fat tissue, may contribute to an inflammatory immune response that could trigger asthma, which is a chronic inflammation of the airways.
A prior study found higher leptin levels in overweight children, and that even among overweight children with similar BMIs, kids with asthma tended to have higher leptin levels.
The current study also found an association between being overweight at age 7 and sensitization to airborne allergens. Sensitization, or the presence of certain antibodies in the blood, often indicates an allergy to a particular substance, but researchers did not track actual symptoms.
Getting control of a child's weight is important to prevent asthma and other conditions that are showing up more in kids, including diabetes and high cholesterol, said Nancy Copperman, director of public health initiatives in the Office of Community Health at North Shore-LIJ Health System in Great Neck, N.Y.
And obesity and asthma can feed off each another. Children experiencing asthma symptoms and having difficulty breathing may be less apt to participate in physical activity, while parents may worry about their asthmatic kids and not allow them to do certain things, such as run outside in the cold, Copperman said.
"What this study argues for is prevention," she said. "The kids who were heavier and got leaner didn't have the increased incidence of asthma, while those who were lean and got heavier or were heavy from the beginning did ... Obesity is not a cosmetic problem. It has real health consequences."
CHILDHOOD OBESITY NEWS
Lack of Exercise Heightens Obesity Risk Among Black Girls
Dec. 19, 2011, NPR
By Taunya English
The evidence of America's obesity epidemic is all around us. But the problem is particularly acute among African-American women.
About half of African-American women in the U.S. are obese, compared to 30 percent of white women. Black women not only carry more weight, but they start piling on extra pounds years before their white counterparts.
So when does it begin, this excess and unhealthful weight? Research suggests the problem starts early, and it may have a lot to do with when girls give up regular exercise.
Doctors and public health specialists want kids to exercise at least 60 minutes every day, but among all children, black girls are most likely to report they got no physical activity in the past week. A lack of access to exercise opportunities may be one big reason why, says Shiriki Kumanyika, an epidemiologist and public health professor at the University of Pennsylvania.
Research shows that opportunities for recess, sports, physical education and just going outside aren't spread evenly among children.
"If you kind of add up those situations in urban, inner-city neighborhoods — where most African-Americans live — they are not as available. That's been documented," says Kumanyika, who studies patterns of illness and health behavior.
But research suggests that even those girls who do engage in sports and other forms of regular physical activity tend to abandon it in their teen years — and that's true not just for urban girls or black girls, but all girls.
A National Institutes of Health study that followed girls for 10 years, beginning at age 8 or 9, found that, over time, their leisure-time physical activity declined dramatically. That drop-off was steepest for African-American girls.
"What they found was that by the age of 17 — so that's the junior, senior year of high school — more than half of black girls, and nearly a third of white girls were reporting no leisure time physical activity at all," says Temple University researcher Clare Lenhartsays.
There are lots of reasons why teen girls drop exercise from their lives, says Lenhart: "They have found changes in enjoyment of activities, in peer support or social support for physical activity. They found a lot of competing interests — be it part-time jobs or caring for younger siblings or other family members."
Walter Stewart says he's witnessed the phenomenon first-hand. He's the longtime coach of the Anderson Monarchs, a soccer team of mostly African-American girls from inner-city Philadelphia.
"Eighth grade — that's where it gets to be difficult," he says. "They are making the transition from young kids to more teenagers, and they are more interested in boys and what boys think."
Jennifer Johnson was determined not to let that happen to her daughter, Alexandria. Johnson discovered the Monarchs when she was looking for an affordable way to keep Alexandria active.
Alexandria is now 15 and an assistant coach with the team, but her interest in soccer dipped in middle school, around age 12, says Johnson.
"In come the friends, and in come the extracurricular activities at school, and as a parent you really have to press on. I said to her, 'If it's not this, you will be involved in something,' " Johnson says.
So Alexandria stuck with soccer, and so did her mother. Johnson is on the sidelines at games and during most practices.
That's an approach that obesity researchers would approve of. Researchers say that family support — especially mom's presence — may motivate girls to keep playing.
Parents May Hold Key to Healthy Weight in Hispanic Kids
Dec. 23, 2011 HealthDay
Parents of overweight Hispanic children are willing to make food and lifestyle changes that will benefits their kids' health, a new study suggests. The findings may help improve efforts to combat the childhood obesity epidemic among Hispanic Americans, the largest and fastest-growing ethnic group in the United States, said the researchers at University of Texas Southwestern Medical Center in Dallas.
"Almost half of all Latino kids are either overweight or obese," senior study author Dr. Glenn Flores, a professor of pediatrics and clinical sciences, said in a medical center news release. "It's an important issue in terms of our future generations. If we intervene early enough, we won't have obese adults."
In the study, the researchers asked 19 Hispanic parents about their children's dietary and exercise habits and roadblocks to making healthier choices.
"Themes regarding the most important things parents can do to help overweight children lose weight included encouragement, not making the child feel left out, the whole family eating healthy and the parent setting a good example," said Flores, who is also head of general pediatrics at UT Southwestern and chief of general pediatrics at Children's Medical Center Dallas.
The parents and children also tasted Hispanic foods prepared with healthy alternatives, such as tortillas made with vegetable oil instead of lard, beans made without lard, healthy-grain enchiladas with low-fat cheese, baked fish, skinless chicken breasts and brown rice. The participants had favorable responses to all of the foods, with the exception of brown rice instead of white rice.
In addition to healthier foods, the parents said other actions that would help their children lose weight included cutting down on portion sizes and second helpings, drinking more water, being more physically active, making exercise a family activity, and limiting time in front of the television or computer.
Barriers to increased physical activity include cost, time constraints and neighborhood safety, according to the parents.
"Sometimes getting kids into organized sports in the inner city is very difficult," Flores said. "The kids usually want it, but it's not always easy to find."
Obesity Epidemic May Have Roots in 1950s
Dec. 19, 2011, Los Angeles Times
By Shari Roan
After long days discussing America's obesity problem, Melinda Sothern has had enough of windowless conference rooms.
"I need to exercise," she says, pausing to review her plans in the San Diego Convention Center lobby. She plans to rent a bicycle in Coronado and ride, fast and far.
Sothern, 55, is a woman who practices what she preaches. And one of her messages about obesity is aimed at women like herself: mothers.
Fat mothers. Thin mothers. And especially mothers-to-be.
A leading fitness and nutrition expert at Louisiana State University, she has a theory that the tide of obesity that has swept the nation in the last two decades had its roots in what young mothers did, or didn't do, in the postwar, suburban-sprouting 1950s.
If she's right — and evidence is stacking up on her side — reproductive-age women may become the central focus of efforts to reverse America's fat problem.
The obesity epidemic has multiple causes, Sothern acknowledges. Food has changed in the last five decades. Americans have become much more sedentary. But she thinks that obesity rates soared just when they did — in the 1980s — because a generation of young women decades earlier smoked, spurned breastfeeding and restricted their weight during numerous, closely spaced pregnancies.
"It was the evil '50s. A perfect recipe for obesity," she says.
Sothern calls her theory "the obesity trinity." And she thinks the key to getting Americans to slim down lies in studying those lessons from the past. Among her prescriptions for change: Women who are significantly overweight should be discouraged from having babies until they shed some pounds.
A central part of Sothern's theory — that obesity starts in the womb — is gaining currency with a growing number of doctors and researchers who say that reversing the epidemic, with its attendant cases of weight-related illnesses such as diabetes, should begin by addressing nutrition in pregnancy and early-life feeding practices.
"We don't completely understand how people become obese, when people become obese and why children become obese," says Michael L. Power, a senior research associate at the American College of Obstetricians and Gynecologists and a coauthor of the book The Evolution of Obesity.
"But children of parents in the '50s and '60s may have started this off."
Sothern points to her own family as an example of the obesity trinity in action.
Her mother was told by the obstetrician in the 1950s to gain less than 20 pounds during pregnancy. Smoking a pack of cigarettes a day was a good way to keep the weight down, the doctor said.
Breastfeeding was not in vogue, so Sothern and her two siblings were bottle-fed formula. The kids were born within a span of four years.
All three children — Sothern thinks it's no coincidence — battled with their weight as adults: Her brother is diabetic and her sister is obese.
Sothern, at a healthy-looking 5 feet 3 and 129 pounds, has spent her adult life beating down a tendency to pack on weight by sticking to a diet rich in fruit, vegetables and fish and a regimen of dancing, biking, housework, gardening, sailing and strength training.
Her story, she says, is nothing unusual.
Women in the 1950s and 1960s — think Betty Draper on the hit TV show "Mad Men" — were generally advised to restrict weight gain in pregnancy to as little as 10 pounds. Inadequate nutrition in some of these women could easily have programmed their babies to catch up on growth during infancy — and studies suggest such growth spurts increase the risk of later obesity.
Women smoked with abandon, unaware of the health risks. Smoking during pregnancy is thought to contribute to obesity risk in offspring because nicotine disrupts mechanisms in the body that control appetite, metabolic rate and fat storage.
By the mid-1970s, breastfeeding in the U.S. had hit an all-time low of 25 percent. Studies show that formula-fed babies have a higher risk for obesity than breast-fed babies, perhaps because of metabolic changes or because drinking formula from a bottle is passive and easy and generally done till a bottle is empty.
And since breastfeeding can prevent ovulation, women using formulas were more apt to experience multiple pregnancies over a shorter period of time. Babies born close together can have inferior nutrition during gestation, which can permanently program their metabolism toward becoming overweight.
Things only worsened with subsequent generations, according to Sothern's theory. Over-nourished kids grew up to be over-nourished women, producing large babies. Large babies, just like too-small babies, are at heightened risk of obesity, says Sebastien Bouret, an assistant professor of pediatrics at the USC Keck School of Medicine. They are less sensitive to hunger cues and less sensitive to insulin.
Overweight women are more likely to have diabetes — and in a study in mice published last month, Bouret found that diabetes during pregnancy triggers obesity in the offspring.
Today, about one-third of women are overweight when they enter pregnancy. And almost one-third of U.S. babies are too fat by nine months.
Statistics tell the tale.
In 1960, middle-aged men were, on average, about 27 pounds lighter than middle-aged men in 2002, and women were more than 25 pounds lighter.
In 1963, the average 10-year-old boy weighed 74 pounds and the average 10-year-old girl 77 pounds — compared with 85 pounds and 88 pounds, respectively, in 2002.
"It is stunning, looking at pictures of kids in the '50s," says Dr. Matthew Gillman, a professor in the department of nutrition at Harvard School of Public Health. "They look scrawny."
Other changes were afoot in the mid-20th century, of course: the growth of suburbs, a car culture and modern conveniences. The fast-food craze was launched with the first McDonald's in 1961.
Nonetheless, Sothern thinks there must be more to the story for the changes to have happened the way they did, at warp speed: "There had to be physiological and metabolic changes in our bodies."
Indeed, scientists are coming to realize that subtle changes in our genetic material — technically known as epigenetic changes — can alter the way that genes are turned on and off, in ways that affect the body's functioning.
Sothern thinks the obesity trinity tweaked our genetic material to make us prone to pack on pounds.
If yesterday's young women may have gotten us into the obesity epidemic, today's must be counted on to help us get out, Sothern said. She doesn't mince words when describing the necessary changes.
"Significantly overweight women should not have babies. Women should be physically active and have a healthy diet for at least a year before pregnancy," she says. "I do think we can de-program, but you have to be very aggressive."
Women should breastfeed for at least six months after childbirth or — better yet — take one year off from work and breastfeed. They should not smoke.
And after those babies become toddlers and enter preschool, they should have 60 minutes a day of recess plus a 40-minute physical education class.
Reproductive-age women are, in fact, becoming attractive targets for change.
In 2009, the Institute of Medicine introduced limits on how much weight an obese woman should gain during pregnancy; critics felt the board should have gone further.
In January, U.S. Surgeon General Regina M. Benjamin launched a plan to increase the number of babies that are breastfed for at least six months.
A strategic plan to tackle obesity released in March by the National Institutes of Health highlights the period of before and during pregnancy as "a critical period to intervene."
"The epidemic is partially reversible if we intervene at the right time," Bouret says. "If we can convince women to have a better diet during pregnancy for the health of their babies, most women will do that."
It can take as little as two generations for our genes to be programmed in ways that tip us toward obesity. It may take more generations than that to reverse the damage done. But after all, Sothern says, we have to start somewhere.
"We can reverse it," she says. "I think the next generation knows what is good for their babies."
Few Parents Recall Doctor Saying Child Overweight
Dec. 5, 2011, The Associated Press
By Lauren Neergaard
Pediatricians are supposed to track if youngsters are putting on too many pounds — but a new study found less than a quarter of parents of overweight children recall the doctor ever saying there was a problem. Does that mean doctors aren't screening enough kids, or aren't frank enough in these tough conversations? Or is the real story parent denial? The research published last month can't tell, but makes it clear the message too often isn't getting through.
"It's tricky to say, and it's tricky to hear," says lead researcher Dr. Eliana Perrin of the University of North Carolina. She analyzed government health surveys that included nearly 5,000 parents of overweight children from 1999 to 2008.
Parents tend not to realize when a weight problem is creeping up on their children. When almost a third of U.S. children are at least overweight, and about 17 percent are obese, it's harder to notice that there's anything unusual about their own families. Plus, children change as they grow older.
The new study suggests when parents do recall a doctor noting the problem, it's been going on for a while.
About 30 percent of the parents of overweight 12- to 15-year-olds said a doctor had alerted them, compared with just 12 percent of the parents of overweight preschoolers. Even among the parents of very obese children, only 58 percent recalled a doctor discussing it, says the report published last month in the journal Archives of Pediatrics & Adolescent Medicine.
"Many pediatricians don't worry until children are very overweight, or until they're much older," says Perrin, whose team has created stoplight-colored growth charts to help doctors explain when a problem's brewing. "If we can notice a concerning trend early, we're more likely to be able to do something about it."
That means taking a family approach, says Dr. Nazrat Mirza, medical director of an obesity clinic at Children's National Medical Center in Washington. Important changes — such as switching to low-fat milk and water instead of sugary sodas and juice, or cutting back on fast food — should be viewed as making the whole family healthier, not depriving everyone because Johnny needs to lose weight.
"You do not want to single out one individual in the family. That's enough to cause a lot of friction," says Mirza, who wasn't involved with the new study.
Doctors have long tracked children's height and weight during yearly checkups, but more recent guidelines urge them to calculate a youngster's body mass index, or BMI, to screen for developing obesity. Unlike with adults, one measurement alone doesn't necessarily mean children are overweight — they might be about to shoot up an inch.
The next step is plotting that BMI on a growth chart. Youngsters are considered overweight if their BMIs track in the 85th to 95th percentile for children their same age and gender, a range that just a few years ago was termed merely "at risk." Above the 95th percentile is considered obese.
To tackle lack of awareness, Children's National has begun calculating BMIs for every child age 2 or older who is admitted for any reason. Mirza calls it "a teachable moment."
Perrin's analysis shows more parents of overweight kids are starting to get the message. Overall, 22 percent of parents reported a health professional telling them their child was overweight. But that rose to 29 percent in 2008, the latest year of the survey data and about the time guidelines changed. So what should parents, and overweight children themselves, be told?
Perrin focuses on health, not fat. She tells them the child is at an unhealthy weight that puts them at risk for later problems — and that she can help families learn to eat better and get more active. That's where her color-coded BMI charts (www.eatsmartmovemorenc.com) come in. Parents can tell at a glance if their child is in the overweight yellow zone or the obese red zone, and over time if they're moving closer to the green zone. Perrin calls the charts especially useful between ages 3 and 8, when children are growing so fast it's particularly hard to tell if they're a healthy size.
Portion size is key, too. Nutritionists define the right size as about 1 tablespoon of each food type for every year of age. Perrin's easier measure is that a serving is about the size of a child's palm, which will grow as the child gets older.
Pre-teens and teens are more independent and have to be on board, adds Mirza. Teens, for example, start to stay up late, eating more at night and skipping breakfast, not a healthy pattern. The kid who never exercises will tune out all weight advice if told to hit the gym but might agree to walk around the block. The athlete might be sabotaging physical activity with 600-calorie snacks.
The good news: As kids grow older and taller, "they can grow into a healthier weight," Perrin says. And "we know that parents with an accurate assessment of their child's weight are more likely to make weight-related changes."