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Early Childhood Obesity Role of Nutritional Factors

Early Childhood Obesity Role of Nutritional Factors. Barbara A. Dennison, MD New York State Department of Health School of Public Health, SUNY Albany. Chicago, IL October 1, 2010. Childhood Obesity Role of Nutritional Factors.

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Early Childhood Obesity Role of Nutritional Factors

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  1. Early Childhood Obesity Role of Nutritional Factors Barbara A. Dennison, MD New York State Department of Health School of Public Health, SUNY Albany Chicago, IL October 1, 2010

  2. Childhood ObesityRole of Nutritional Factors • Why are we seeing an obesity epidemic? Why caused the shift in the distribution of children’s weight status? • Causes and Solutions may not be the same. • Individual dietary behaviors/actions influenced by biology, psycho-social context, family, social, education, economics and nutrition environment.

  3. Why are young children getting fatter?They are eating too many calories. FITS, JADA, 2004; IOM, 2002; USDA, ERS, 2004

  4. Food Consumed in U.S -- Out of Sync with Recommended Dietary Guidelines http://www.ers.usda.gov/AmberWaves/March10/PDF/TrackingACentury.pdf

  5. Foresight’s Obesity System Map:Complicated, Multi-factorial Finegood, Merth, Rutter: Obesity 2010;18:S13-S16

  6. Foresight ‘s Reduced Obesity Map Individual psychology Social psychology Physical activity environment Individual physical activity Engine Food production Food consumption Physiology Finegood, Merth, Rutter: Obesity 2010;18:S13-S16

  7. Food Produced in U.S. vs. Recommended Dietary Intakes, 2008 Percent Food Subsidies 13% 74% http://www.ers.usda.gov/AmberWaves/March10/PDF/TrackingACentury.pdf

  8. Availability of food and calories in the US (average daily per capita) -- 1970, 1990 & 2008 Source: ERS Food Availability (Per Capita) Data System http://www.ers.usda.gov/Data/FoodConsumption/.

  9. Socio-ecologic Model: A Framework to Identify Levels of Influence

  10. Policy & Systems • Federal Agriculture - Food Policy • Subsidies & Taxes; Trade Agreements • Public Health: Child Nutrition - funding; standards • WIC; SNAP; CACFP (foods included) • Nutrition Education (WIC, SNAP) • School Meals • Social Support, Financing (Universal or low SES) • Healthcare • Childcare, After-school programs • Head Start, Early Head Start, Extended Day • Education – Early education, Pre-K

  11. Community & Nutrition Environment • Food Marketing / Advertising • Television • Fast Food • Food availability & access (F&V) • Supermarkets • Farmers Markets • Costs / Affordability • WIC; SNAP IOM: Food Marketing to Children and Youth, 2006; Khan, et al; MMWR 2009;58:1-26

  12. Organizational & Institutional:Childcare • Attending childcare associated with obesity • Healthy Eating Standards • Regulations, Quality Stars, NAPSACC • Meal pattern • Limit Juice, Ban SSBs • F&Vs: order served • Reduce energy density • Portion size Gubbels, et al: Int J Obesity 2010 May; Khan, et al; MMWR 2009;58:1-26; Rolls: Poc Nutr Soci, December 2009; Lehahy, et al: JADA 2008;108:41-48.

  13. Organizational & Institutional:Early Education and Schools • School Breakfast • Nutrition Education • Alone: Limited impact • Nutritional Stds -> Environment • Meals, competitive foods, vending • Limit SSBs & energy-dense, high-fat, high sugar, low-nutrition foods • Increase F&Vs, whole grains • Nutrition Education & Nutritional Standards - Most promising Khan, et al; MMWR 2009;58:1-26; Foster, et al: Pediatrics 2008;121:e794-e802.

  14. Interpersonal • Child Feeding Practices • Foods Provided - Exposure (familiarity) • Modeling (Parents, adults, peers) • Restricting vs. Coercing • Contingencies, Rewards • Social Environment • Family Meals • TV, Screen Time (Mindless eating) Birch, et al: Am J Clin Nutr 2003;78:215-220; Birch, Fisher: Pediatrics 1998;101:539-549; Fitzpatrick, et al, JADA 2007;107:666-671; Gillman, et al: Arch Fam Med 2000;9:235-240; ; Anderson, Whitaker: Pediatrics 2010;125:420-428.

  15. Individual Factors • Genetics • Obese parents • Decreased Sleep • Eating Behaviors • Eating in the absence of hunger • Portion Size Bell, Zimmerma:n Arch Ped Adol Med 2010;164:840-845; Anderson, Whitaker: Pediatrics 2010;125:420-428; Kral, Faith: J Pediatr Psychol 2009;34:596-605; Rolls, et al: JADA 2000;100:232-23; Fisher, et al: Am J Clin Nutr 2007;86:174-179.4.

  16. Dietary Components • Sweet liquids, Sugar-sweetened beverages, Juice Drinks, Juice • Reduced compensation for liquid vs. solid calories • Eating away-from-home (Fast Food) • High energy density; large portions • Vegetables (and fruits) Mattes RD: Physiol Behav 1996;59:179-187; Ludwig: Lancet 2001;367:505-508; Ebbrling, et al: Pediatrics 2006;117:673-680; Dennison, et al: Pediatrics 1997;99:15-22; Welsh, et al: Pediatrics 2005;115:223-229; Faith, et al: Pediatrics 2006;118:2066-2075; Bowman, et al: Pediatrics 2004;113:112-118; http://www.cdc.gov/nutrition/professionals/researchtopractice/index.html

  17. Interventions to Prevent Obesity in Preschool – Early School Age • Most Studies in Single Domain • Childcare; Home; Primary Care; School • Often multi-modality (Nutrition PLUS) • Small sample size • Short time frame • Modest Outcomes • Minimal dietary change (F, V, reduced fat) • Most no change in BMI/weight status • Hesketh, Campbell: Obesity 2010;18:S27-S35; Campbell, Hesketh: Obes Res 2007;8:327-338; Summerbell, et al, Cochran, 2007; French, Wechsler: Prev. Med 2004; Katz, et al, MMWR, October 2005

  18. Children’ Typical DaySpent in Multiple Settings * * Adopted from Debbie Chang, Nemours

  19. High Resource Low Resource Frieden TR: Am J Public Health 2010;100:590-595

  20. NYS Nutrition Initiatives to Reduce Childhood Obesity: 1995 - 2008 • Improve Counseling to parents and children • Training: WIC, Childcare Staff, Peds Providers • Nutrition (BFing, F&V, Low-fat milk, Juice) • Physical activity ( PA, Limit TV) • Increase BMI, Wt Status Screening –Peds, WIC • Change Nutrition Environment (Context) • Childcare Regs (NYC) – juice; PA, TV • NAPSACC (plus TV reduction module) • Improve foods – WIC (home), CACFP (CC) • F&V, Low-fat milk, Limit juice; Value • Increase availability & affordability of F&V • Farmers’ & Green Markets, Health Bucks

  21. Obesity Prevalence: PedNSS (WIC) NYS vs. U.S. (2 to <5 years) Prevalence (%) JADA 2006:106:113-117; JAMA. 2010;303:28-30; Public Health Reports 2010;125:218-224.

  22. Summary: Role of Nutritional Factors in Early Childhood Obesity • Foods • Context • Policy, systems, environmental factors • Limits of Evidence-base • Promising strategies & changes • Research needed to • Identify Best Practices • Evaluate implementation and impact

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