Review articleObesity prevention in children: physical activity and nutrition
Introduction
The number of overweight children in the United States has reached epidemic proportions and children are becoming overweight at younger ages.1, 2 Recent studies show a consistent rise in the prevalence of obesity among preschool children from low-income 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 in children.4, 5, 6, 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 physical activity 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, 13, 14, 15, 16, 17 Jackson 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 and somatic growth, resulting 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 of obesity later in childhood.18 Moreover, research supports findings that breast-fed children have a lower risk of obesity than formula-fed children.19, 20, 21, 22 In addition, those infants who were breast fed for longer durations showed an even lower risk of childhood obesity.23 Therefore, birth weight and breast-feeding history should be considered factors in obesity development in young children. Moreover, children with such risk factors may be predisposed genetically and behaviorally to the early manifestation of subtle, non-symptomatic metabolic abnormalities working synergistically to create a childhood obesity phenotype for obesity and related chronic disease.24, 25, 26, 27, 28, 29, 30 Therefore, strategies that positively alter nutritional and physical activity behaviors and environment of the family may reduce the risk of obesity in young children, especially in those with one or more risk factors. A recent publication by the American Academy of Pediatrics offers pediatric obesity-prevention guidelines for medical professionals, which include increased monitoring of at-risk children and parent education.31
Section snippets
Nutrition and obesity prevention in children
Parental influences are early determinants of food attitudes and practices in young children.32 The social affective context in which foods are presented to young children greatly affects their food preferences.33, 34, 35 For example, Birch33 found in a study of 64 preschool-age children that foods presented as rewards enhance preference for that food. Further, in a follow-up study, providing rewards for consuming nutritious foods initially enhanced the preference for that food but later
Physical activity and obesity prevention in children
Evidence continues to support reduced physical activity and sedentary behaviors, such as television viewing, as primary factors of the current worldwide obesity epidemic.53, 54, 55 A recent media study found that youths ages 2 to 18 y spend an average of 5 h 29 min per day using various types of media.56 Television viewing is consistently associated with increased weight status in cross-sectional studies of children.57, 58, 59, 60, 61 However, in one study, this relation was insignificant after
Summary
Jackson80 suggested that genetic makeup determines the limits of metabolic function, but the environmental experience ultimately manifests obesity and metabolic disease. The current environmental experience of young children includes few opportunities for physical activity1 and an overabundance of high-calorie foods. Sedentary lifestyles and poor nutrition challenge children who are genetically predisposed to metabolic disorders. Obesity is a logical response to this challenge. Therefore, in
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