Posts Tagged ‘ Childhood Obesity ’

Toddlers Aren’t Playing At Child Care – And Here Are Some Reasons Why

Wednesday, January 11th, 2012

A stunning new paper (published online in the journal Pediatrics) focuses on a troubling trend –  many toddlers in child care (preschool, nursery school, other organized child care) devote very little time to physical activity – and provides some surprising reasons why this may be the case. Bear in mind that this study is especially relevant to the vast majority of parents of preschool aged kids, as 75% of 3-5 year-olds in the US are in some form of child care. Here’s an overview of the paper, focusing on: some startling statistics; public health concerns; research questions asked; findings; and take-home messages.

Some startling statistics:

The study provides a persuasive literature review that suggests the following:

  • Even after accounting for naps and meal times, somewhere between 70-83% of the daily activities for kids in child care are sedentary
  • On average, only 2-3% of daily time in child care is devoted to vigorous activities

Public Health Concerns:

The lack of physical activity – meaning good old-fashioned running around and playing – is troubling for the following reasons:

Research Questions:

Given these concerns, the researchers conducted focus group interviews with 49 child care providers (the study took place in Ohio) drawn from a variety of child care centers (both urban and suburban). They designed these focus groups to ask open-ended (qualitative) questions to get at the child care providers’ perceptions of the reasons why toddlers aren’t playing in child care these days. Note they acknowledge that there can be big differences across different child care centers (some may indeed have lots of playtime built into the typical day) – but their focus was to find out what might be the barriers preventing playtime from the perspective of the child care providers.


The researchers extracted 3 big reasons that physical activity is discouraged in child care settings. They are:

  • Concerns about safety. Parents express concerns to the child care providers about the possibility that their kids may get hurt and some directly ask that their kids not be permitted on playground equipment. The child care providers suggest that the state has provided overly strict standards that has resulted in boring, unchallenging playground equipment that toddlers don’t want to use. As a result, kids end up seeking out equipment  that is designed for older kids – and in fact poses dangers to them.
  • Economic issues. Lack of funding does not permit spaces devoted to physical activity – especially dedicated indoor areas that can be used year-round. In part, this reflects a lack of appreciation for the importance of physical activity in the preschool years.
  • Emphasis on academics. Child care providers suggest that many parents ask that kids’ spend the bulk of their time doing pre-academic work (such as learning shapes, colors, and pre-reading skills) and “not just running around” – parents also want physical activity to be overtly tied to academic lessons and learning.

Take-home Messages:

As the authors of this paper suggest, many toddlers spend full days in child care during the preschool years – meaning that this is the primary daily opportunity for physical activity for lots of kids. Yet there is, on average, a ridiculously small amount of time devoted to physical activity. So I see two especially important take-home messages for parents.

  • Parents should be encouraged to partner with their kids’ child care center to make sure that the playgrounds are age-appropriate – neither too babyish nor too challenging. They should also be reassured that their kids should be doing lots of physical activity that involves age-appropriate risk. Look, nobody wants to think about their kids getting hurt, and it’s tough if you are not there to supervise them. But …. kids need to play and to take some appropriate physical risks. That’s true throughout development. This issue is complicated, and also touches on the realities of budgets these days in child care centers – but clearly a change in thinking needs to happen to get back to appreciating and promoting the importance of devoted space for physical activity (both indoors and outdoors).
  • Parents also need to be told explicitly that the preschool years are a critical developmental period for learning all kinds of things – but that much of this learning happens experientially during play. This is where cognitive, emotional, and social development all come together. I would suspect that nearly anyone who studies development would agree that preschoolers need a whole lot of balance between physical activity, play, and “academics.” And despite all the pressures on parents to want their kids to be precocious academically, it is imperative to understand that your child’s brain will develop best via this balance – this has been shown to be the case over decades of research.

There’s a real bottom line here. If you want to promote the optimal development and health of your toddler, make sure they have plenty of time for free play and physical activity. Convince yourself that this will be as important – if not more so – than the “academics” they are learning during the preschool years. And do what you can to make sure they get it.

Image of happy child on playground via








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“Being Fat Takes The Fun Out Of Being A Kid”: Public Service Announcement Or Stereotyping?

Wednesday, January 4th, 2012

I was contacted by a journalist yesterday to comment on a series of television and print ads in Georgia featuring overweight children. These adds are part of an ongoing campaign by the non-profit organization Strong4Life and you can click here to view some. A number of kids are shown discussing their weight in stark terms – for example, one boy asks his mom “Why am I fat?” Other campaign slogans used by this group include “Warning: It’s Hard To Be A Little Girl If You’re Not”. Overall, the ad campaign focuses on the problems experienced by overweight and obese kids, which include risk for diabetes as well as being targets of bullying. 

The purpose of these ads is straightforward – the idea is to make people in Georgia aware of the childhood obesity epidemic (as the organization states that nearly 40% of kids in Georgia are considered to be overweight or obese). And a little bit of shock value certainly does get people’s attention. But the issue being debated is whether these ads achieve anything useful – and in fact if they actually do harm by promoting stereotypes of overweight kids.

Having watched the videos, I don’t see much information value in them. Childhood obesity is a public health problem with multiple causes. Yes, parents have the ultimate responsibility to raise their kids to be healthy. But given that a third of the adults in the US are obese – as determined by the Centers for Disease Control and Prevention (CDC) –  don’t we have a broader issue that goes beyond finger pointing and rhetoric? Don’t we owe parents and kids more information and real advice to lead healthier lives? Shouldn’t we also think beyond parenting and take on the very real issue of the contributing factor of school lunches in many communities? And shouldn’t we also acknowledge the very real role that genetics plays in this equation? (By the way, I’m planning a blog post on that topic in the very near future).

It’s very important that parents – and all of us concerned with public health – understand the very real physical and social risks experienced by overweight and obese kids. But, c’mon, simple scare tactics and dramatizations might grab someone’s attention for just a few seconds, and worse, serve as a platform for continuing stereotypes. How about presenting the grim statistics and realities of the obesity epidemic – those are scary enough on their own – along with a hopeful message that there are ways to combat this? After all, isn’t the broader goal to motivate parents to make changes in their lifestyle and hook them up with real resources to help them do this?

Image of the word diabetes courtesy of

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Obese Third Grader Placed In Foster Care: The Debate Continues

Monday, November 28th, 2011

Today there is a reported case of an obese third grader being placed in foster care. The rationale for this is that when a parent(s) ignores or doesn’t properly follow medical recommendations – and their child continues to suffer from extreme obesity – then the appropriate agency can petition a court and cite “medical neglect” as a rationale for temporary placement in foster care. 

I discussed this issue this summer in response to a thoughtful and provocative editorial published in the Journal of the American Medical Association. But now that we have a current news story in front of us, it seems appropriate to continue the debate.

To start, let’s be clear about one thing – a third grade boy who weighs over 200 pounds and is suffering from sleep apnea requires immediate intervention (we’re not talking about a kid who is a little heavy for his age). The health risks – both immediate and longer-term – are too great to be ignored. Let’s add to this that fundamental changes in the child’s caretaking are necessary (we’re not talking about occasionally eating too much junk food and not getting quite enough exercise) – especially since they have not happened despite medical advice.  And even if there is a medical basis (including rare but powerful genetic conditions) underlying the obesity, major lifestyle alterations will need to be made with respect to diet and activity. So the issue is how best to deliver an intervention that will be successful.

I continue to understand the frustrations of practitioners who are trying to (quite literally) save a child’s life, and watch as their suggestions are not followed. But I still disagree with the idea of taking the child away from the mother, especially since the goal is to return the child at a later time. Simply put, I think administering in-home intervention that will help teach the mom and her son how to break the extreme habits that have been formed would serve as the best platform for long-term change. As someone who is currently conducting research on family-centered interventions, I know first-hand that this is easier said than done. But to me there is much more potential for improving this family’s life – and this boy’s health – by keeping them together and devoting all the potential resources to deliver in-home care to get this family to make the changes they need to make. Sometimes families need help, and by bringing medical intervention to them in their home environment, perhaps we can make more progress in the fight against childhood obesity.

Image: Healthy Diet Via Shutterstock

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Sleep Loss And Fat Gain: The Link Between Two Childhood Epidemics

Thursday, June 30th, 2011

In my last post, I referenced new evidence confirming that children today suffer from a severe sleep loss compared to previous generations. One reason for concern is that new studies are showing how lack of adequate sleep in childhood leads to increases in body fat — which is a first step toward risk for type 2 diabetes (another related epidemic) as well as heart disease.

What’s especially troubling is that this process starts early in life. Two new studies have used longitudinal designs to show that short sleep (less than the minimum recommended amount of sleep for a given age) in toddlers leads to increases in body fat at age 7. In one report, consistently short sleepers at age 2 were shown to have a higher fat mass index (FMI) at age 7. Another paper showed similar findings linking short sleep at age 2 to increased Body Mass Index (BMI) at age 7 — the authors concluded that extending sleep by an additional hour per night would lead to a significant decrease in BMI reflecting a reduction in fat deposits. Importantly, both of these studies accounted for a number of confounding factors that could have skewed the results, suggesting direct links between sleep loss and fat gain.

Why is this information so important for parents? A third study has taken the research a step further by demonstrating that short sleep is linked with direct changes in body functioning, such as altered insulin levels, that signal early risk for type 2 diabetes. This report also suggested that inconsistent amounts of sleep from night to night was also bad for kids’ metabolism on top of the effects of short sleep. And there was one more important take-home message for parents:  a little catch-up sleep on the weekend was a good thing for kids and helped protect their bodies from the effects of short sleep.

As a parent, I know first-hand that regulating a child’s sleep is not easy (and sometimes becomes very hard). But putting as much effort into this as possible — especially in terms of making sure minimum sleep requirements are met consistently — can have an important positive effect on your child’s health and well-being.

In my next post, I will take on the issue of sleep methods, and provide a surprising perspective on how to determine the best sleep method for your child.

boysleepingImage by photostock via

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