How physicians can help children avoid obesity

Pediatricians who monitor infants' weight at well-child visits and educate new parents on implementing healthy habits at home could help prevent obesity later in children's lives.

That's what the Institute of Medicine recommends in a report issued June 23 on early childhood obesity prevention for newborns to 5-year-olds. The report urges health professionals, caregivers and policymakers to be mindful that obesity takes time to develop and that even the youngest children are at risk.

To identify at-risk children, the IOM recommends that pediatricians measure infants' weight and length and calculate toddlers' body mass index at each well-child visit. In instances where patients are too heavy for their length, physicians should talk to parents about problems associated with excess weight in young children. Doctors also should recommend steps parents can take to prevent the problem from escalating.

These steps include ensuring that young children get a sufficient amount of sleep, encouraging them to be physically active, and limiting their use of computers, televisions and other technology.

"Contrary to the common perception that chubby babies are healthy babies and will naturally outgrow their baby fat, excess weight tends to persist," said Leann Birch, PhD, chair of the IOM's Committee on Obesity Prevention Policies for Young Children, which wrote the report.

"This is a national concern, because weight-related conditions such as diabetes and high blood pressure once occurred almost exclusively in adults, but are now occurring at rising rates among teens and young adults," said Birch, director of Pennsylvania State University's Center for Childhood Obesity Research.

About 10% of the nation's infants and toddlers are too heavy for their length, the report said. Among children 2 to 5, slightly more than 20% are overweight or obese. Since the 1980s, the prevalence of overweight and obese children in this age group has doubled, the report said.

Tackling obesity in young children

The IOM's 15-member committee formed in 2010 to create an action plan to address obesity in young children. The committee included experts in child development, nutrition, obesity prevention and pediatrics. In making its recommendations, the group reviewed related literature and examined reports from organizations that work with young children.

Committee member Ronald E. Kleinman, MD, said the high number of overweight or obese children is worrisome.

"What this obesity issue alerts us to is that primary care physicians should be providing parents with a message [about leading a] healthy lifestyle at each visit. It's part of preventive care, and the obesity [information] highlights the need to reinforce this message," said Dr. Kleinman, physician in chief at MassGeneral Hospital for Childrenin Boston.

The committee recommends that health professionals educate new parents about the importance of exclusively breastfeeding babies for their first six months. Breastfeeding should continue in conjunction with solid foods until the child is at least a year old, the report said. For women who bottle-feed, pediatricians should discuss age-appropriate volumes of breast milk or formula and cues that the baby is full to prevent over-feeding the child.

Increasing physical activity among young children, even in infants, also is key to preventing obesity later in life, according to the report. The committee recommends limiting the use of seats and cribs for infants and allowing them to move freely under adult supervision. Toddlers and preschool-age children should have opportunities for physical activity for at least 15 minutes every hour while in day care or school.

Pediatricians are urged to discuss with parents the appropriate amount of sleep for their child and encourage them to keep computers, televisions and other digital media devices out of the child's bedroom. Additionally, children 2 to 5 should have less than two hours of screen time each day. Screen time includes watching television and using a cellphone or computer.

Obesity "has gotten to be such a pervasive issue among young children that it's important primary care physicians get the message out that there's some reason to be concerned if your child is overweight and obese at these young ages," Dr. Kleinman said.