Childhood obesity declines in 18 states

Obesity in preschoolers had doubled in recent years, but the numbers are stagnating or improving in many states. Health officials are not yet declaring victory.

By — Posted Aug. 19, 2013

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The message to get preschool children to eat healthier and exercise more may be getting through to parents and other caregivers, a new study on obesity prevalence in these children shows.

Although the news is encouraging to experts, they say it doesn't mean that physicians, schools and parents can ease up on stressing the importance of healthy eating and exercise.

“We are moving from awareness to action and now are starting to see some promising examples of positive impact,” said Texas pediatrician Stephen J. Pont, MD, MPH, chair of the American Academy of Pediatrics Section on Obesity. “However … even if obesity rates plateau, we still face extremely high rates of both adult and childhood obesity. If we don't continue to build upon our success, our progress will be lost.”

Data gathered primarily from children who participate in the Special Supplemental Nutrition Program for Women, Infants and Children between 2008 and 2011 showed significant downward trends in obesity prevalence among low-income preschoolers in 18 states, according to a report published Aug. 6 in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. Florida, Georgia, Missouri, New Jersey and South Dakota saw the most improvement, with decreases over the four-year period at more than one percentage point.

“Although obesity remains epidemic, the tide has begun to turn for some kids in some states,” CDC Director Tom Frieden, MD, MPH, said in a statement. “While the changes are small, for the first time in a generation, they are going in the right direction.”

The CDC was quick to point out that there is still a long way to go to create a nation of healthy children. For example, while California saw a statistically significant reduction in obesity prevalence, its rate is still 16.8%. The state with the lowest obesity prevalence rate, Hawaii, stands at 9.2%.

“One in eight preschoolers are obese. That is far too many,” Dr. Frieden said. “Obese children are much more likely to be obese as adults and have lifelong physical and mental health problems.”

Physicians in states that saw the biggest strides against preschoolers' obesity were happy to see some progress but acknowledged that this is only one study and that there are still a significant number of obese children.

“The good thing was this was the youngest children, and hopefully that will be sustained,” said Mary F. Campagnolo, MD, past president of the Medical Society of New Jersey and a family physician. New Jersey saw obesity prevalence drop to 16.6% in 2011, down from 17.9% in 2008.

Family physician Daniel J. Heinemann, MD, president of the South Dakota State Medical Assn., said the numbers in his state are encouraging. South Dakota's obesity prevalence was 15.2% in 2011, down from 16.2% in 2008. But physicians and others cannot afford to let their guard down, he added.

“This is a long-term issue, and a lot of work needs to be done,” Dr. Heinemann said.

Making a difference

1 in 8 U.S. preschoolers is obese.

The MMWR report and physicians noted that there isn't any one thing helping reduce obesity rates. Instead, there have been a number of campaigns against childhood obesity in recent years. For example, first lady Michelle Obama's Let's Move campaign encourages exercise, and the WIC program no longer pays for sugary beverages and has encouraged healthier eating habits.

Locally, some communities have worked to promote healthier lifestyles by making it easier for families to buy healthy foods, improving parks and recreation centers, increasing breastfeeding rates and providing free safe drinking water at parks and recreational facilities.

“It feels like it is a war and everyone is working together to help everyone else find a strategy that is a way forward,” said Rebecca Jaffe, MD, MPH, a member of American Academy of Family Physician's board of directors and a family physician in Wilmington, Del. “When we find a strategy that makes a difference, such as WIC not paying for sugary drinks, we need to make sure legislators continue those policies.”

A study posted online in Pediatrics on Aug. 5 further confirmed that sugary drinks contribute to obesity. The study found that 4- and 5-year-olds who drank one or more sugar-sweetened beverages a day were more likely to be overweight or obese. Although the study didn't find that link for 2-year-olds who consumed the sugary beverages, it discovered that those children had greater changes in their body mass index scores in the next two years than children who didn't regularly drink sugary beverages when they were 2.

Physicians said preventing children from gaining weight will be a continuation of keeping sugary drinks out of children's hands, making sure physical education programs are maintained in schools to get students moving, educating parents about what food they are putting in front of them and making sure parents limit their children's screen time.

“We need to continue to help parents and children make better choices,” Dr. Heinemann said. He noted that South Dakotans in recent years have worked to promote breastfeeding and discourage children from drinking sugary beverages. Also, the SDSMA's journal put out a special issue dedicated to obesity.

In New Jersey, the WIC program's focus on health food and breastfeeding may have helped reduce obesity numbers, Dr. Campagnolo said. She also noted that there has been a focus on practices creating patient medical homes in the past four years, a model that emphasizes preventive health.

“We don't have a total answer,” she said. “We are just happy to see New Jersey make some improvement. It is going to take another generation to turn it around.”

More strides to make

In addition to continuing to do things that seem to be working, physicians called for new efforts.

For example, Dr. Pont, who also heads the Texas Center for the Prevention and Treatment of Childhood Obesity in Austin, said more policy changes are needed.

“Our government subsidizes the production and consumption of many less healthy foods. Many companies also take advantage of vague laws and use advertising to coax and manipulate our children into craving and demanding less health products,” he said. “We've seen some improvement here, but a lot more needs to be done.”

He noted that payers need to change the way they pay physicians who treat obese and overweight children.

“I can see a child for vomiting last night, even if they're visibly better by the time that I examine them,” Dr. Pont said. “However, I can't see that same child to address the fact that they are 50 to 100 or more pounds overweight until they have developed another medical condition due to their obesity. This doesn't make any sense, and it leads to massive costs to our health care system.”

The American Medical Association declared obesity a disease at its Annual Meeting in June, a classification that could influence changes in treatment, coverage, research and health policy.

Dr. Pont said: “The solution to the obesity epidemic is not in the doctor's office, but the doctor's office has to be part of the solution.”

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Where childhood obesity decreased and increased

Data gathered from nearly 12 million low-income preschoolers showed that 18 states saw significant decreases in obesity prevalence between 2008 and 2011. Five states saw decreases of one percentage point or more. The remaining states with declines saw changes of at least 0.3 percentage points. While encouraging, experts say there is still much more work to do: An estimated one in eight U.S. preschoolers is obese.

Significantly increased: Colorado, Pennsylvania, Tennessee

Significantly decreased: California, Florida, Georgia, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Mississippi, New Hampshire, New Jersey, New Mexico, New York, South Dakota, Washington

No statistically significant change: Alabama, Arizona, Arkansas, Connecticut, District of Columbia, Hawaii, Illinois, Indiana, Kentucky, Montana, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, Vermont, Wisconsin, West Virginia

States not included in the analysis: Alaska, Delaware, Louisiana, Maine, Oklahoma, South Carolina, Texas, Utah, Virginia, Wyoming

Note: Some states were not included because they changed the way they collected data.

Source: “Vital Signs: Obesity Among Low-Income, Preschool-Aged Children — United States, 2008-2011;” Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, Aug. 6 (link)

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10 steps to help children lead healthier lifestyles

American culture can make it difficult for children to make healthy choices, according to the Centers for Disease Control and Prevention. Here are 10 things agency officials say promote children eating less healthy food and getting less physical activity.

  1. School campuses often have sugary drinks and less healthy food options.
  2. Children see advertising promoting less healthy foods, with almost no ads promoting healthy food.
  3. Variations in licensure regulations among child care centers result in some states not using licensing regulations to ensure that children are eating healthy food and getting physical activity.
  4. Not all schools have daily, quality physical activity.
  5. There is no safe and appealing place to play or be active in all communities.
  6. Some communities have limited access to healthy, affordable foods.
  7. There is greater availability of high-energy-dense foods and sugary drinks than in the past.
  8. Portion sizes have become larger.
  9. There is a lack of support for breastfeeding.
  10. Children spend too much time in front of the television and other media, including computers, videos games and cell phones.

Source: Centers for Disease Control and Prevention on overweight and obesity (link)

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External links

“Sugar-Sweetened Beverages and Weight Gain in 2- to 5-Year-Old Children,” Pediatrics, posted online Aug. 5 (link)

“Vital Signs: Obesity Among Low-Income, Preschool-Aged Children — United States, 2008-1011,” Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, Aug. 6 (link)

Centers for Disease Control and Prevention on overweight and obesity (link)

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