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Addressing the external influences on the rise of childhood obesity: Breastfeeding, Home Environment and Toddler Nutrition

The steady rise of obesity rates in America’s children should be a wakeup call for everyone, especially parents. Yet, it seems that those who should take the strongest course of action consistently ignore this growing epidemic. In a time when external factors make it more and more difficult to raise healthy children, it is important to recognize the environmental and nutritional aspects associated with childhood obesity. The common claim that, “he’s just big-boned” can only rationalize a child’s unhealthy weight so much. At some point parents need to look beyond genetics.

This year’s American Heart Association Annual Update reported that more than 10 percent of U.S. toddlers and preschoolers between the ages of two and five are overweight. It also found that nearly 4 million children ages 6 to 11 and 5.3 million young people ages 12 to 19 were overweight or obese. These shocking statistics account for the Centers for Disease Control and Prevention report that child obesity rates have doubled since the early 1970s, with approximately 15 percent of children and adolescents now overweight.

This national epidemic is rapidly turning into a global pandemic, the obesity rates in other countries are, equally shocking. The International Obesity Task Force reports that the number of overweight European children is rising 400,000 per year. Recent clinical testing done on 367 children in Aruba found that 36.3 percent suffered from excess body weight, 10.2 percent were overweight, and 26.1 percent were obese. Nearly one fourth showed pathological lipid profiles. The number of children with pathological lipid profiles tended to increase with age. Further testing of 2,950 school-aged children (ages 6 to 11) classified 26 percent as obese.

Childhood obesity comes with various undesirable health effects, such as reduced lung and alveolar capacity, poor metabolism leading to growth and developmental disorders, reduced physical activity that can lead to reduced bone mass and joint problems, type II diabetes, hypertension, and cancer. These health issues will not only impact our children, but also the state of public health as a whole. It is estimated that the rapid increases in childhood obesity will shorten the future American lifespan by two to five years. This will make our children’s generation the first group to die younger than their parents.

With mounting studies finding that children are reaching unhealthy weights earlier and earlier in life, it is imperative that we examine some of the external factors that influence the development and growth of infants, toddlers and preschoolers. Three important factors that affect children’s early development are: breastfeeding practices, home environment and activities, and toddler nutrition. By weighing current research, practical guidelines, and realistic goals, parents can take early steps to raise healthy and fit children.

Nursing an infant is the most effective way a mother can provide nourishment, and the most complete form of infant nutrition. So why are only 35 percent of infants being breastfed for the first six months of life and a mere 16 percent receiving breast milk for a full year? Some would argue that the low rate is due to the influx of working mothers, the increasing scrutiny of public breastfeeding, the perceived lack of adequate milk supply, or poor breastfeeding education of mothers-to-be. Whatever the primary reason may be, it is imperative to the health of future generations that the rates of breastfed infants increase. The American Academy of Pediatrics (AAP) and the U.S. Public Health Service support a 2010 goal that at least 50 percent of infants will be breastfed for six months postpartum.

Breast milk has the right amount of fat, sugar, water, and protein that infants need for proper growth and development. Recent studies have shown that the antibodies found in breast milk help to protect infants from viruses and bacteria, and, as a result, these infants are less likely to develop ear infections, diarrhea, and respiratory illnesses. It has also been shown that breastfed infants tend to gain less unnecessary weight.

Other studies have found that breastfeeding for longer than six months may result in children being less overweight later in life. Varied studies found reduced risks of being overweight and obese depending on children’s socioeconomic status, birth weight, sex, and length of time they were breastfed.

The connection breastfeeding and a reduced risk of children being overweight and obese, combined with the positive nutrition and development facts about breast milk, should be enough to encourage all parents to incorporate breastfeeding in their parenting practice.

Home Environment and Activities
The environment in which a child is raised has an enormous impact on a healthy childhood and adolescent weight. Family environments are key to the development of early childhood activity preferences, food intake patterns, and eating habits.

Parents should actively provide their children
with positive examples through their own actions.

These factors, along with parental eating behavior, will directly affect children's developing weight status. However, the strongest predictor of overweight and obese children is the mother's weight. Children of overweight mothers are three times as likely to be overweight; children of obese mothers are four times as likely to be obese.

Taking into account the myriad environmental factors that influence children's weight, it is important that parents actively provide their children with positive examples through their own actions. Children are more likely to form good dietary habits if their parents display healthy eating practices, such as eating breakfast everyday, eating small portions of food several times per day, and not consuming food that contains excessive fat or simple sugars.

Factors that are not related to food, but rather to physical activity and behavior, can also be directly associated with excess weight and obesity risk. Children who use electronic games and television as primary forms of entertainment have a significantly higher risk of becoming obese. It has also been shown that children from obese and overweight families have a higher preference for sedentary activities and pastimes.

All of these familial factors—parental health, family dietary habits and pastime activities—should be examined. There are marked weight differences in children who are guided by healthy parents, practice moderate eating routines, and participate in varied activities such as sports, games, dancing, and martial arts.

Toddler Nutrition
As a whole, children today are overfed and undernourished. Children's normal and expected physical growth requires adequate nutrients, including micronutrients, vitamins and trace elements. Yet many children do not obtain adequate amounts of calcium, potassium, fiber, magnesium, and vitamins A, C and E. Larger portion sizes of less-nutritious foods are all too commonplace, thanks to the abundance of junk food that is directly marketed to kids. Up from the 7 percent figure of 1994, the 2005 finding of 10 percent of overweight 2- to 5-year-olds is projected to keep rising as unhealthy eating habits are increasingly formed at the toddler and preschool ages.

Making a smooth transition from breast milk and formula to small meals can either make or break a child's future eating patterns. Toddler-hood is especially important for laying the foundation for a healthy childhood. This age is a key development period for growth of tissue and organs, as well as psychological and intellectual. From 12 to 24 months, toddlers gain an average of 3 to 5 pounds and grow an average of 3 to 5 inches.

The USDA's Food Guide Pyramid for Young Children recommends the following food choices for 2- to 6-year olds:

  • 6 servings of breads, cereals, rice, and pasta
  • 3 servings of vegetables
  • 2 servings of fruit
  • 2 servings of dairy products
  • 2 servings of meat, fish, poultry, and legumes

However, toddlers' actual food intake shows quite a departure from the USDA's recommendations. More than 25 percent of toddlers eat French fries on a daily basis, an estimated 62 percent consume a baked dessert, 20 percent consume candy, and 44 percent drink a sweetened beverage.

Sweetened beverages, such as added sugar juice, boxed drinks, and sodas are high in sugar, high in calories and low in nutrients. Recent studies have found a link between overweight preschoolers and their consumption of such “sweet drinks” and have also determined that added-sugar beverages and, to a lesser extent, 100 percent juice, decrease the diet quality of young children. On average, American preschoolers consume about 14 to 17 teaspoons of added sugar a day, mostly from fruit-flavored drinks, high-fat desserts and cola-type soft drinks.

In an attempt to curb the direct marketing of junk food to America's children, organizations such as the Center for Science in the Public Interest (CSPI) have recommended a set of advertising guidelines for the food and beverage industries. While it is unrealistic to only have children eat fruits and vegetables, it is plausible to limit the types of food that are directly targeted at children's easily influenced taste buds. Specifically, CSPI proposed that fruit drinks marketed to kids should contain at least 50 percent fruit juice and no caloric sweeteners.

Natural food formulators are also tackling toddlers' lack of nutritional drink mediums. The recent development of an alternative to high-sugar drinks and juices, in the form of an all-natural, nutritional powdered drink mix, further addresses the increasing need for proper early childhood nutrition.

There is no easy solution or miracle drug to “cure” childhood obesity. The most effective preventative tactic is to bring information about external obesity risk factors to the top-of-mind within the home, mainstream media and school systems. Collective efforts by parents, lawmakers, teachers, industry players, health professionals, and community leaders can work to further educate themselves and others on the importance of establishing healthy eating habits for children in their earliest years. It is absolutely necessary to promote the development and application of breastfeeding, lifestyle, and nutrition education programs to effectively combat the rapidly increasing rates of childhood obesity.

For references, send a SASE to Total Health magazine.

Richard WM Visser DC, PhD

During his distinguished career, Richard W. M. Visser D.C., Ph.D. has focused on the pandemic of childhood obesity among various populations, working in consultation with other international experts. He studied the problem and implemented solutions from many perspectives: as a clinical researcher, academic and educator, activist and politician, entrepreneur, concerned citizen, and parent. His work has made vital contribution to a greater understanding of the biological, sociological, and psychological factors surrounding childhood obesity.

Having written numerous articles on the subject for professional journals, he has twice presented papers in Geneva at the congress hosted by the International Association of the Study of Obesity, and he has collaborated with the Department of Public and Occupational Health in the Netherlands on a proposal for combating the disease throughout the Caribbean.

Early in 2008, he was appointed by the Government of Aruba to head the Obesity Task Force, and a year later, he began his four-year term as Aruba's Minister of Health, and Sport.

CV: Dr. Richard Visser