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Fighting Childhood Obesity

Chubby Boy Eating Hamburgers

Amanda Ford of Lexington, Kentucky, has the usual anxieties of any new mom. But since weight problems run in her family, Ford has an additional worry -- childhood obesity. Already her daughters Sarah, 4 months, and Bella, 17 months, are chubbier than most babies their age. "But I don't think there's anything I can do right now because they're so young," says Ford.

That's where she's wrong. Parents can do a lot to get baby on a healthy track -- and it's more important than ever because the rate of childhood obesity in the U.S. is at an all-time high. The number of children who are too heavy has tripled in the past 25 years, raising kids' risk for a range of health problems.

Type 2 diabetes, once a weight-related disease seen only in adults, is now appearing with alarming frequency in children as young as 4. Elevated cholesterol and blood pressure are also showing up earlier. "Today's children may be the first generation in modern American history to live shorter lives than their parents," says Colleen Thompson, a dietitian and coauthor of Overcoming Childhood Obesity (Bull, 2003).

Why are so many kids packing on pounds? For the same reasons adults are: too many calories and too little exercise. "Adults are passing on their unhealthy habits to the next generation," says Thompson. "Childhood obesity is really a family issue. To fix things, the whole family has to change."

Indeed, a recent study of 3,000 kids ages 4 to 24 months found that many of the negative eating patterns plaguing adults are affecting children as early as infancy. Not only was fruit and vegetable consumption low, but french fries were the most popular choice of toddlers. Moreover, 40 percent of 7-month-olds and 60 percent of 1-year-olds had candy or dessert at least once a day.

What's reassuring is that heading off childhood obesity is easier than you may think. While genes play a part in the tendency to put on pounds, diet and lifestyle make a huge difference. The earlier you take preventive steps, the better.

Want your child to scarf down healthy fare rather than junk food? During pregnancy, eat nutritious foods yourself. Scientists believe that flavors from the diet of moms-to-be are transferred to the amniotic fluid, thus influencing the taste buds of unborn babies. In one study, the infants of mothers who consumed carrot juice often during pregnancy ate three times more carrot-flavored cereal than infants whose moms drank no carrot juice while expecting.

Also, sticking to a sensible diet during these crucial nine months can help ensure that your baby is born at a healthy weight. Some studies show that babies born too big (over 9 pounds) or too small (under 5 pounds) have an increased risk of being overweight later on, perhaps because overnourishment or undernourishment in the womb causes babies to store fat more readily.

A weight gain of 25 to 35 pounds is recommended for women who start their pregnancy at a normal weight. But women who are already overweight should put on only 15 to 25 pounds, says Siobhan Dolan, MD, a professor of obstetrics and gynecology at Albert Einstein College of Medicine in the Bronx, New York. Too much weight gain can also cause gestational diabetes, among other complications, which increases the likelihood of having an oversized baby.

Once baby's here, start things off right with these recommendations:

Breastfeed. Breast milk is the healthiest food you can give your child and here's one more reason why: It reduces the risk of childhood obesity. In one 2004 study, infants breastfed for at least three months were significantly less overweight by age 4 than those who were never breastfed or who did so for less than a month.

Experts aren't sure why breastfeeding protects against obesity. One reason may be that nursed babies are more apt to stop feeding when they're full. "If you're giving a baby a bottle, there is a tendency to want her to finish it," says Amy DeFelice, MD, director of nutrition support at Babies & Children's Hospital of New York. "But babies are born with a wonderful mechanism for knowing how much food they need."

Delay solids. Babies are often ready to experiment with solid food by 4 months of age, but many obesity experts recommend waiting until 6 months. One study published in the British Journal of Medicine found that babies who started on solids before 6 months were more prone to weight problems by age 4.

The authors theorized that beginning solids too early added surplus calories that young infants don't need or can't burn off with physical activity. Plus, some research shows that babies who start solids before 6 months tend to wean prematurely. "Breast milk or formula gives babies all the nutrition and calories needed for the first half-year," says Dr. DeFelice.

Be mindful of mealtime signals. Back off from feeding if your baby purses his lips, turns away, or appears to lose interest in the spoonful of cereal or strained veggies. Helping a baby learn to listen to his hunger and satiety cues is an important obesity-prevention measure. Likewise, never force your baby to finish a bottle.

Offer a variety of baby foods. Take advantage of all the flavors out there, especially in fruits and vegetables. Research shows that lifelong food preferences are formed in the first few years. In fact, when University of Tennessee researchers surveyed more than 100 children ages 2 to 8 about their food likes and dislikes, they found that 70 percent of food preferences were established by age 2.

As your child's diet begins to include more adult foods, the challenge really begins! Here's how to keep your little diner hooked on the healthy stuff:

Make fruits and vegetables a priority. Don't let these colorful edibles fall by the wayside during the transition to table foods. Nutritionists recommend that toddlers eat five or more servings of fruits and vegetables every day, just like adults. Aim to include at least one with every meal, including snack time. Melody Osborn of Clinton, Massachusetts, prepares baked sweet-potato fries and veggies with dip as snacks for her 3-year-old. "Cassidy will eat anything she can dip," says Osborn.

Keep portion sizes small. Toddlers don't require many calories, so it's important to serve age-appropriate servings. The general rule of thumb is one tablespoon of each food for each year of age. "Portions that are too large can set up a bad pattern of overeating," says Susan Roberts, PhD, coauthor of Feeding Your Child for Lifelong Health (Bantam, 1999).

Stick to a regular meal schedule. Toddlers as young as 1 year old should eat three meals and just two snacks daily, three to four hours apart. A child who grazes throughout the day can lose the ability to sense real hunger. He may snack out of boredom or to relieve frustration -- a habit that can lead to obesity down the road.

Don't give up. If you already have a little french fry fiend on your hands, it's not too late to make changes. Begin consistently offering healthier alternatives. Research shows that children may need to be exposed to a new food as many as 15 times before accepting it. Judy Musa of Middletown, New Jersey, serves nutritious dishes to her 3-year-old son, Liam, with the persistence of a telemarketer. "He sometimes spits out unfamiliar foods," says Musa, "but he's required to take at least one bite of everything."

Monitor beverages. While obesity can't be blamed on a single food, research shows that kids' surging soda consumption is contributing to the problem. A recent Harvard study, for example, found that drinking more than one glass of sugared soda a day raises a child's risk of becoming obese by 60 percent. Although fruit juice is more nutritious than soda, some juice drinks are little more than sugar water. Stick to 100 percent fruit juice -- it has no added sugar. One 4- to 6-ounce serving per day is plenty for children under age 3.

Be a good role model. If you're constantly slurping soda and eating junk food, your child will grow up thinking that kind of diet is normal. "Kids pay more attention to what you do than to what you say," says Roberts.

Making smart food choices is only one part of the obesity-prevention picture. Getting kids into the habit of being physically active early is also important.

Encourage infant and toddler activity. According to a recent report from the National Association of Sport and Physical Activity, many infants and toddlers are confined too much in playpens, strollers, and infant seats. Allow lots of time for active play and plenty of room for baby to move around so he can practice rolling and crawling skills. Let toddlers walk instead of ride in strollers whenever possible.

Limit TV time. Kids younger than 2 are already averaging more than two hours of total screen time (including videos and computer games) daily. Restricting your child's TV watching can be an effective way to downsize weight problems. "Studies show that children who watch less than two hours of television per day are significantly less likely to be overweight than kids who sit in front of the tube for four hours or more," says Thompson.

Get them outside. Just about any outdoor activity -- playing tag, riding a tricycle, throwing a ball -- will help your youngster burn calories. Shoo kids into the yard or plan daily trips to the local park or playground. Thompson also suggests getting a pet: "I guarantee your child will want to help walk the dog or play outside with Rover."

Exercise as a family. It's no secret that kids enjoy anything more when their parents join them. Elaine Shimberg of Tampa, Florida, keeps Nerf balls in the car for impromptu park outings and says "follow the leader" has become a regular family game. "As I skip, hop, and twirl around, my kids imitate me," says the mom of 3-year-old Tyler and 4-year-old Shelby. "They think it's fun, but it's also exercise." Christine Wells of San Diego plans family vacations with fitness in mind. "I make sure our trips incorporate activities like hiking and walking along the beach," says Wells, mother to Ben, 5, Jack, 3, and Madison, 2.

Overall, the sooner you get your little one on the road to exercising and eating well, the better. "If you wait until your child is already obese, you'll have a real challenge on your hands," says Thompson. Taking obesity-prevention steps early means a healthier, happier child now and in the years to come.

Jan Sheehan is a writer in Denver, Colorado.

Originally published in American Baby magazine, September 2004.