prevention of pediatric obesity william j. cochran, md, faap department of pediatric nutrition...

PREVENTION OF PREVENTION OF PEDIATRIC OBESITYPEDIATRIC OBESITY

William J. Cochran, MD, FAAPWilliam J. Cochran, MD, FAAP

Department of Pediatric Department of Pediatric NutritionNutrition

Geisinger Clinic, Danville PAGeisinger Clinic, Danville PA

Faculty Disclosure Information

In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.

I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

WHY WORRY ABOUT WHY WORRY ABOUT PEDIDATRIC PEDIDATRIC OBESITY?OBESITY?

Prevalence of obese Prevalence of obese children and children and adolescentsadolescents

02468

101214161820

1963-70

1971-74

1976-80

1988-94

1999-02

2002-04

6-11 years12-19 years

RISK OF OBESE RISK OF OBESE CHILDREN BECOMING CHILDREN BECOMING OBESE ADULTSOBESE ADULTS

0

10

20

30

40

50

60

70

80

Preschool School-age Adolescent

IMPACT OF CHILDHOOD IMPACT OF CHILDHOOD OBESITY ON ADULT OBESITY ON ADULT HEALTHHEALTH Adverse effects of childhood Adverse effects of childhood

obesity on adult healthobesity on adult health– Increased rates of all cause mortality Increased rates of all cause mortality

in adulthoodin adulthood– Increased rates of mortality from Increased rates of mortality from

CAD in adult malesCAD in adult males– Increased morbidity from CAD in Increased morbidity from CAD in

adult males and femalesadult males and females

IMPACT OF CHILDHOOD IMPACT OF CHILDHOOD OBESITY ON ADULT OBESITY ON ADULT HEALTHHEALTH Adverse effects of childhood Adverse effects of childhood

obesity on adult healthobesity on adult health– Increased rates of colon cancer in Increased rates of colon cancer in

malesmales– Increased rates of arthritis in femalesIncreased rates of arthritis in females– Childhood obesity may be a greater Childhood obesity may be a greater

predictor of complications in predictor of complications in adulthood than obesity in adulthoodadulthood than obesity in adulthood

CHILDHOOD OBESITY IS CHILDHOOD OBESITY IS ALSO ASSOCIATED ALSO ASSOCIATED WITH PROBLEMS IN WITH PROBLEMS IN CHILDHOODCHILDHOOD

PEDIATRIC PEDIATRIC OBESITY IS NOT OBESITY IS NOT JUST A COSMETIC JUST A COSMETIC

PROBLEM!PROBLEM!

TREATMENT OF TREATMENT OF PEDIATRIC OBESITY IS PEDIATRIC OBESITY IS AVAILABLE AND CAN BE AVAILABLE AND CAN BE EFFECTIVEEFFECTIVE

PREVENTION IS PREVENTION IS PREFERABLEPREFERABLE

What is the etiology What is the etiology of pediatric obesity?of pediatric obesity?

PREVENTION: PREVENTION: PRECONCEPTIONPRECONCEPTION Prevention starts prior to conceptionPrevention starts prior to conception

– Obese adolescents have an 80% probability Obese adolescents have an 80% probability of being obese as an adultof being obese as an adult

– Today's adolescents are tomorrows parentsToday's adolescents are tomorrows parents– The risk of obesity in a child born to obese The risk of obesity in a child born to obese

parents is significantly increasedparents is significantly increased– Parents act as role models for their childrenParents act as role models for their children– Need to educate and intervene in childhood Need to educate and intervene in childhood

to help prevent obesity in subsequent to help prevent obesity in subsequent generationsgenerations

PREVENTION: POST PREVENTION: POST CONCEPTIONCONCEPTION Routine prenatal careRoutine prenatal care Advocate appropriate weight gain Advocate appropriate weight gain

during the pregnancyduring the pregnancy– LGA infants and infants of diabetic LGA infants and infants of diabetic

mothers have higher rates of mothers have higher rates of subsequent obesitysubsequent obesity

– SGA infants also at higher riskSGA infants also at higher risk Hediger ML et: Pediatrics104:e33, 1999Hediger ML et: Pediatrics104:e33, 1999

PREVENTION: POST PREVENTION: POST CONCEPTIONCONCEPTION Promote breastfeeding prior to deliveryPromote breastfeeding prior to delivery Dewey 2003: 8 out of 11 studies noted Dewey 2003: 8 out of 11 studies noted

a lower rate of obesity in children if a lower rate of obesity in children if breastfed vs. formula fed breastfed vs. formula fed

Bergmann 2003: Longitudinal study of Bergmann 2003: Longitudinal study of breastfed vs. formula fed infantsbreastfed vs. formula fed infants– BMI the same at birthBMI the same at birth– BMI at 3 & 6 months > in formula fed vs. BMI at 3 & 6 months > in formula fed vs.

breastfed infantsbreastfed infants– Rate of obesity at 6 years was 3 fold greater Rate of obesity at 6 years was 3 fold greater

in formula fed vs. breastfedin formula fed vs. breastfed

PREVENTION: INFANCYPREVENTION: INFANCY

Advocate for continued breast feedingAdvocate for continued breast feeding– The duration of breastfeeding is inversely The duration of breastfeeding is inversely

associated with the risk of overweight associated with the risk of overweight – Harder T. Am J Epidemiol. 2005;162(5):397-Harder T. Am J Epidemiol. 2005;162(5):397-

403403 Avoid over feeding formula feed infantsAvoid over feeding formula feed infants Monitor growth curve including weight Monitor growth curve including weight

for length curvefor length curve– Excessive weight gain associated obesityExcessive weight gain associated obesity– Taveras EM et al. Weight status in the first 6 Taveras EM et al. Weight status in the first 6

months of life and obesity at 3 years of age. months of life and obesity at 3 years of age. Pediatrics 2009;123:1177-1183Pediatrics 2009;123:1177-1183


Educate parents about beveragesEducate parents about beverages– No nutritional need for juice for at least No nutritional need for juice for at least

the first 6 months of agethe first 6 months of age– 1-6 year olds limit juice to 4-6 oz per 1-6 year olds limit juice to 4-6 oz per

dayday– Provision of sweet beverages promotes Provision of sweet beverages promotes

desire to consume sweet beveragesdesire to consume sweet beverages– The use and misuse of fruit juice in The use and misuse of fruit juice in

pediatrics. Pediatrics 107:1210-1213, pediatrics. Pediatrics 107:1210-1213, 2001. 2001.


Introduction of solidsIntroduction of solids– Do not introduce solids until 4-6 months of Do not introduce solids until 4-6 months of

ageage– Introduce vegetables firstIntroduce vegetables first

Infants born with preference for sweetInfants born with preference for sweet

– Continue to provided the food even if Continue to provided the food even if initially rejectedinitially rejected

– Breast fed babies are more willing to Breast fed babies are more willing to accept other new foods compared to accept other new foods compared to formula fed infantsformula fed infants

PREVENTION: INFANCY PREVENTION: INFANCY

Promote parental interaction with Promote parental interaction with infantinfant

Discuss TV Discuss TV – Do not use TV as a “Baby sitter”Do not use TV as a “Baby sitter”– AAP recommends no TV for the first AAP recommends no TV for the first

2 years of life2 years of life– AAP recommends no TV in bedroomAAP recommends no TV in bedroom

Children, adolescents and television. Children, adolescents and television. Pediatrics 107:423-426, 2001Pediatrics 107:423-426, 2001


TV in bedroomTV in bedroom– 40% of 1-5 year olds have TV in 40% of 1-5 year olds have TV in

bedroombedroom– Children with TV in bedroomChildren with TV in bedroom

Watch more TVWatch more TV Have higher rates of obesityHave higher rates of obesity Associated with increased sedentary timeAssociated with increased sedentary time Promotes more social isolationPromotes more social isolation

– Dennison, BA et al. Pediatrics Dennison, BA et al. Pediatrics 109:1028-1035, 2002.109:1028-1035, 2002.


Identify those at riskIdentify those at risk– Family historyFamily history

Risk of obesity 9% if both parents are leanRisk of obesity 9% if both parents are lean Risk of obesity 60-80% if both parents are obeseRisk of obesity 60-80% if both parents are obese Sibling over weight (genetics vs. obesigenic Sibling over weight (genetics vs. obesigenic

environment)environment)

– Ethnicity: African-American, HispanicEthnicity: African-American, Hispanic– Large for gestational ageLarge for gestational age– Small for gestational ageSmall for gestational age


Identify those at riskIdentify those at risk– Lower socioeconomic statusLower socioeconomic status– Rural settingRural setting– Both parents workBoth parents work– Single parent familySingle parent family– Little cognitive stimulationLittle cognitive stimulation– Lack of safe play areasLack of safe play areas– Family stressFamily stress

Strauss, RS et al. Pediatrics 1999;103 (6) e-pagesStrauss, RS et al. Pediatrics 1999;103 (6) e-pages

PREVENTION: PREVENTION: TODDLERTODDLER Discuss beveragesDiscuss beverages

– 20% of obese children are obese due to 20% of obese children are obese due to excessive caloric consumption from excessive caloric consumption from beveragesbeverages

– Soda has 150 calories per 12 ozSoda has 150 calories per 12 oz– Juice on average has 120 calories per 8 ozJuice on average has 120 calories per 8 oz– For every 100 calories consumed per day in For every 100 calories consumed per day in

excess will result in 10 pound weight gain excess will result in 10 pound weight gain per yearper year

– Promote consumption of water when thirstyPromote consumption of water when thirsty

PREVENTION: PREVENTION: TODDLERTODDLER Do not use the “clean the plate rule”Do not use the “clean the plate rule” ““Parents provide, children decide what Parents provide, children decide what

to eat”to eat” Parents should provide a healthy array Parents should provide a healthy array

of food and appropriate portions of food and appropriate portions Child’s intake varies from day to day Child’s intake varies from day to day Do not use food as a rewardDo not use food as a reward

PREVENTION: PREVENTION: TODDLERTODDLER No TV for children less than 2No TV for children less than 2 Promote physical activityPromote physical activity

– Free playFree play– Play with parents as well as friendsPlay with parents as well as friends

PREVENTION: PREVENTION: PRESCHOOLERPRESCHOOLER Measure and plot BMIMeasure and plot BMI

– Monitor BMIMonitor BMI– If increasing BMI % even if “normal” this is a If increasing BMI % even if “normal” this is a

red flagred flag– Review BMI curve with parent and childReview BMI curve with parent and child– Provide positive reinforcement for being Provide positive reinforcement for being

normalnormal– Being over weight at one time between ages Being over weight at one time between ages

of 24 and 54 months was associated with a of 24 and 54 months was associated with a 5 fold increased risk of obesity at 12 years 5 fold increased risk of obesity at 12 years

Nader, PR et al. Pediatrics 118: e594-601, 2006Nader, PR et al. Pediatrics 118: e594-601, 2006

PREVENTION: PREVENTION: PRESCHOOLERPRESCHOOLER Anticipatory guidanceAnticipatory guidance

– NutritionNutrition Discuss beveragesDiscuss beverages Do not use “clean the plate rule”Do not use “clean the plate rule” Do not use food as rewardDo not use food as reward Offer balanced diet: fruits, vegetables, Offer balanced diet: fruits, vegetables,

high fiberhigh fiber


– Physical activityPhysical activity Promote free play timePromote free play time Encourage special family time that is Encourage special family time that is

physically activephysically active Think about physical activity Think about physical activity

opportunitiesopportunities– Walk up steps instead of taking the elevatorWalk up steps instead of taking the elevator– Park at a distance from storePark at a distance from store– 50% of car trips are less than 5 miles50% of car trips are less than 5 miles


– Physical activityPhysical activity Limit sedentary timeLimit sedentary time

– Discuss screen time: <1-2 hours per dayDiscuss screen time: <1-2 hours per day– Higher rates of obesity, hypertension and Higher rates of obesity, hypertension and

hypercholesterolemia in those who watch >2 hypercholesterolemia in those who watch >2 hours per dayhours per day

Prevention of pediatric overweight and Prevention of pediatric overweight and obesity. Pediatrics 112; 424-430, 2003obesity. Pediatrics 112; 424-430, 2003

Pardee et al., American J of Preventive Pardee et al., American J of Preventive Medicine, December 2007 Medicine, December 2007

Martinez-Gomez D et al. Arch Pediatr Adolesc Martinez-Gomez D et al. Arch Pediatr Adolesc Med 2009;163:724-730Med 2009;163:724-730


– Life styleLife style Do not eat in front of TVDo not eat in front of TV

– >60% of commercials during children’s >60% of commercials during children’s programming are related to food programming are related to food

Increase appetite / desire for these foodsIncrease appetite / desire for these foods– Tend to over eat: do not pay attention to if Tend to over eat: do not pay attention to if

they are full, eat until food is gonethey are full, eat until food is gone– Children who eat in front of TV consume Children who eat in front of TV consume

higher fat and salt foods and less fruits and higher fat and salt foods and less fruits and vegetable than those who do notvegetable than those who do not


– Life styleLife style Limiting screen time in children 4-7 Limiting screen time in children 4-7

years of age associated with lower BMIyears of age associated with lower BMI Associated with decreased caloric Associated with decreased caloric

intakeintake Epstein,LH et al. Arch Pediatr Adolesc Epstein,LH et al. Arch Pediatr Adolesc

Me 162(3): 239-245, 2008Me 162(3): 239-245, 2008


– Life styleLife style Stress the fact that parents act as role models Stress the fact that parents act as role models

for nutrition, physical activity and life stylefor nutrition, physical activity and life style Promote the family mealPromote the family meal

– Conversation slows down the eating processConversation slows down the eating process– Parents determine the food that is to be Parents determine the food that is to be

consumedconsumed– Parents can monitor intake of foodParents can monitor intake of food– Family meals associated with higher consumption Family meals associated with higher consumption

of fruits, vegetables and milkof fruits, vegetables and milk– Family meals associated with lower intake of fat Family meals associated with lower intake of fat

and sweet beveragesand sweet beverages

PREVENTION: PREVENTION: PRESCHOOLERPRESCHOOLER Day care / preschoolDay care / preschool

– What and how much are the children being What and how much are the children being fed?fed?

BeveragesBeverages SnacksSnacks

– What type and how much physical activity?What type and how much physical activity? Russell, RP et al. Pediatrics 114:1258-1263, 2004Russell, RP et al. Pediatrics 114:1258-1263, 2004

– What type and how much sedentary activity What type and how much sedentary activity is there?is there?

PREVENTION: SCHOOL PREVENTION: SCHOOL AGED CHILDAGED CHILD Measure and plot BMIMeasure and plot BMI

– Monitor BMIMonitor BMI– If increasing BMI % even if “normal” If increasing BMI % even if “normal”

this is a red flagthis is a red flag– Review BMI curve with parents and Review BMI curve with parents and

childchild– Provide positive reinforcement if Provide positive reinforcement if

normalnormal

PREVENTION: SCHOOL PREVENTION: SCHOOL AGED CHILDAGED CHILD Anticipatory guidanceAnticipatory guidance

– NutritionNutrition Discuss beveragesDiscuss beverages

– Soda consumption has increased 300% in Soda consumption has increased 300% in last 20 yearslast 20 years

– 20% of adolescent males consume >4 sodas 20% of adolescent males consume >4 sodas per dayper day

– Promote consumption of low fat dairy Promote consumption of low fat dairy products and waterproducts and water

Soft drinks in schools. Pediatrics Soft drinks in schools. Pediatrics 113:152-154, 2004113:152-154, 2004


– NutritionNutrition Portion sizePortion size

– 3 year olds will eat what is appropriate despite 3 year olds will eat what is appropriate despite how much is on the plate. Older children how much is on the plate. Older children consume more if portion size is larger.consume more if portion size is larger.

– Portion size has increased over the years Portion size has increased over the years especially at fast food restaurants: “Biggie especially at fast food restaurants: “Biggie sized” sized”

– Read labels on food regarding portion size Read labels on food regarding portion size (adult portion size)(adult portion size)

– www.mypyramid.govwww.mypyramid.gov


– NutritionNutrition Eat regular mealsEat regular meals

– Skipping breakfast is a risk factor for obesitySkipping breakfast is a risk factor for obesity– Children who eat breakfast do better in Children who eat breakfast do better in

school vs. those who do notschool vs. those who do not– Skipping meals does not result in decrease Skipping meals does not result in decrease

caloric consumption, tend to over eat at caloric consumption, tend to over eat at other meals or snack frequentlyother meals or snack frequently


– Physical activityPhysical activity Ask the child how much physical activity Ask the child how much physical activity

they dothey do What type of activities are they involved What type of activities are they involved

inin What are the barriers to doing physical What are the barriers to doing physical

activityactivity CDC recommends 60 minutes of CDC recommends 60 minutes of

moderate physical activity per daymoderate physical activity per day


– Physical activityPhysical activity Activity needs to be funActivity needs to be fun Do this with family and or friendsDo this with family and or friends Promote life long activitiesPromote life long activities Have a variety of activitiesHave a variety of activities

““NO CHILD LEFT ON NO CHILD LEFT ON THEIR BEHIND!”THEIR BEHIND!”


– LifestyleLifestyle Promote <1-2 hours of screen timePromote <1-2 hours of screen time

– 25% watch more than 4 hours per day25% watch more than 4 hours per day– For overweight children decreasing For overweight children decreasing

sedentary activity was more effective at sedentary activity was more effective at inducing weight loss than promotion of inducing weight loss than promotion of physical activityphysical activity

Prevention of pediatric overweight and Prevention of pediatric overweight and obesity. Pediatrics 112; 424-430, 2003.obesity. Pediatrics 112; 424-430, 2003.


– LifestyleLifestyle No TV in bedroomNo TV in bedroom

– TV in bedroom associated with:TV in bedroom associated with:– More TV timeMore TV time– Worse eating and exercise habitsWorse eating and exercise habits– Poorer academic performancePoorer academic performance

Barr-Anderson et al. Pediatrics April 2008Barr-Anderson et al. Pediatrics April 2008 TV, computer and video games are a TV, computer and video games are a

privilege, not a rightprivilege, not a right


– LifestyleLifestyle Eat as a familyEat as a family Special family time being physically Special family time being physically

activeactive Parents act as a role modelParents act as a role model Promote healthy life long habits of Promote healthy life long habits of

physical activity and nutritious eatingphysical activity and nutritious eating


– LifestyleLifestyle Eating out / take out foodEating out / take out food

– Approximately $0.50 of every nutrition dollar is Approximately $0.50 of every nutrition dollar is spent on food out side the homespent on food out side the home

– The portion size tends to be largerThe portion size tends to be larger– The food tends to be higher in fat and saltThe food tends to be higher in fat and salt– When eating out try to make healthier choicesWhen eating out try to make healthier choices

Baked potato or salad instead of french friesBaked potato or salad instead of french fries Water or low fat milk instead of sodaWater or low fat milk instead of soda Nutrition information for fast food available Nutrition information for fast food available

on line and in some restaurantson line and in some restaurants

PREVENTION SCHOOL PREVENTION SCHOOL AGED CHILDAGED CHILD Anticipatory guidanceAnticipatory guidance

– Physical environmentPhysical environment Proximity of fast-food restaurants to schoolProximity of fast-food restaurants to school Fast food restaurant within ½ mile of schoolFast food restaurant within ½ mile of school

– Consumed fewer fruits and vegetablesConsumed fewer fruits and vegetables– Consumed more sodaConsumed more soda– Were more likely to be overweightWere more likely to be overweight

Davis, B et al. Proximity of fast-food Davis, B et al. Proximity of fast-food restaurants to schools and adolescent restaurants to schools and adolescent obesity. Am J Public Health 99:505-510, obesity. Am J Public Health 99:505-510, 20092009


– LifestyleLifestyle Encourage to participate in organized Encourage to participate in organized

sportssports– Weintraub DL et al. Arch Pediatr Adolesc Weintraub DL et al. Arch Pediatr Adolesc

Med 162(3):232-237, 2008Med 162(3):232-237, 2008 Participate in after school activitiesParticipate in after school activities VolunteerVolunteer

PHYSICIAN AS PHYSICIAN AS COMMUNITY COMMUNITY ADVOCATEADVOCATE School / preschoolSchool / preschool

– Educate administrators, teachers Educate administrators, teachers and parents about obesityand parents about obesity

– Be part of School Health Advisory Be part of School Health Advisory BoardBoard

– Promote nutrition, physical Promote nutrition, physical education and lifestyle educationeducation and lifestyle education

PHYSICIAN AS PHYSICIAN AS COMMUNITY COMMUNITY ADVOCATEADVOCATE

– Promote appropriate use and items in vending Promote appropriate use and items in vending machinesmachines

73% of elementary schools, 97% of middle schools 73% of elementary schools, 97% of middle schools and 100% of high schools have 1 or more sources of and 100% of high schools have 1 or more sources of competitive foodcompetitive food

– Improving child nutrition policy: Insights from national Improving child nutrition policy: Insights from national USDA study of school food environments. RWJF Policy USDA study of school food environments. RWJF Policy Brief 2/09Brief 2/09

Students in schools where competitive foods are Students in schools where competitive foods are restricted consumed less sweet beveragesrestricted consumed less sweet beverages

– Briefel R et al. J Am Dietetic Assoc 109:S9a-S107, Briefel R et al. J Am Dietetic Assoc 109:S9a-S107, 20092009

Soft drinks in schools. Pediatrics 113:152-154, 2004.Soft drinks in schools. Pediatrics 113:152-154, 2004.

PHYSICIAN AS PHYSICIAN AS COMMUNITY COMMUNITY ADVOCATEADVOCATE School / preschoolSchool / preschool

– Promote nutritious mealsPromote nutritious meals 42% of schools do not offer fresh fruit or raw 42% of schools do not offer fresh fruit or raw

vegetables every day for lunchvegetables every day for lunch Less than 5% offer whole grain bread productsLess than 5% offer whole grain bread products Commercially prepared food products ie pizza, Commercially prepared food products ie pizza,

chicken nuggets, beef patties etc account for chicken nuggets, beef patties etc account for 40% of lunch entrees40% of lunch entrees

Fewer than 1/3 of schools met Fewer than 1/3 of schools met recommendations for total and saturated fatsrecommendations for total and saturated fats

Crepinsek MK et al. J Am Dietetic Assoc Crepinsek MK et al. J Am Dietetic Assoc 109:S31-S43, 2009109:S31-S43, 2009

Condon E et al. J Am Dietetic Assoc 109:S67-Condon E et al. J Am Dietetic Assoc 109:S67-S78, 2009S78, 2009

PHYSICIAN AS PHYSICIAN AS COMMUNITY COMMUNITY ADVOCATEADVOCATE CommunityCommunity

– Advocate for safe and accessible places for children Advocate for safe and accessible places for children to be physically activeto be physically active

– Need to develop neighborhoods that are Need to develop neighborhoods that are environmentally friendly and conducive to physical environmentally friendly and conducive to physical activityactivity

Franzini L et al. Influences of physical and social Franzini L et al. Influences of physical and social neighborhood environments on children’s physical neighborhood environments on children’s physical activity and obesity. Am J Public Health 99:271-278, activity and obesity. Am J Public Health 99:271-278, 20072007

– Need access to full service grocery stores with Need access to full service grocery stores with reasonable cost for healthy foodsreasonable cost for healthy foods

Obesity Prevalence Among Low-Income, Preschool-Aged Obesity Prevalence Among Low-Income, Preschool-Aged Children --- United States, 1998—2008Children --- United States, 1998—2008, , MMWR July 24, MMWR July 24, 2009 58(28): 769-7732009 58(28): 769-773

PHYSICIAN AS PHYSICIAN AS COMMUNITY COMMUNITY ADVOCATEADVOCATE StateState

– Participate in local chapter of AAPParticipate in local chapter of AAP– Encourage policy / law makers to Encourage policy / law makers to

support healthful lifestyle for all support healthful lifestyle for all childrenchildren

– Encourage insurance coverage for Encourage insurance coverage for obesity preventionobesity prevention

– Advocate for social marketing intended Advocate for social marketing intended to promote healthful food choices and to promote healthful food choices and increased physical activityincreased physical activity

CONCLUSIONCONCLUSION

Pediatric obesity is increasing at Pediatric obesity is increasing at an alarming ratean alarming rate

Pediatric obesity is associated Pediatric obesity is associated with significant adverse effects in with significant adverse effects in childhood and adulthoodchildhood and adulthood

Treatment of pediatric obesity is Treatment of pediatric obesity is availableavailable

Prevention should be our goalPrevention should be our goal


Major areas to focus onMajor areas to focus on– Measure and plot BMI / Weight for Measure and plot BMI / Weight for

lengthlength– Discuss beveragesDiscuss beverages– Limit screen time to less than 2 Limit screen time to less than 2

hours per dayhours per day


Major areas to focus onMajor areas to focus on– Promote breastfeedingPromote breastfeeding– Avoid excessive weight gain in infancyAvoid excessive weight gain in infancy– Promote physical activityPromote physical activity– Encourage family mealsEncourage family meals– Educate parents about being role Educate parents about being role

modelsmodels– Pediatricians need to be advocates in Pediatricians need to be advocates in

communitycommunity


52105210 5 servings of fruits and 5 servings of fruits and

vegetables per dayvegetables per day Less than 2 hours of screen timeLess than 2 hours of screen time 1 hour of physical activity1 hour of physical activity 0 sweet beverages0 sweet beverages


If we are to seriously have an impact If we are to seriously have an impact on pediatric obesity, there has to be a on pediatric obesity, there has to be a comprehensive and multifaceted comprehensive and multifaceted approach involving the child, family, approach involving the child, family, communities, health care providers, communities, health care providers, insurance companies, government and insurance companies, government and corporate America.corporate America.

REFERENCESREFERENCES

William J. Cochran: Weight William J. Cochran: Weight Management Childhood and Management Childhood and Adolescence: Frequently Asked Adolescence: Frequently Asked Questions. B C Decker, 2007Questions. B C Decker, 2007


Preventing Childhood Obesity. Institute of Preventing Childhood Obesity. Institute of Medicine. The National Academies Press, Medicine. The National Academies Press, Washington, DC 2005Washington, DC 2005

Pediatric Obesity: Prevention, Intervention Pediatric Obesity: Prevention, Intervention and Treatment Strategies. Sandra and Treatment Strategies. Sandra Hassink, American Academy of Pediatrics, Hassink, American Academy of Pediatrics, 20062006

A parents guide to childhood obesity. A parents guide to childhood obesity. Sandra Hassink, American Academy of Sandra Hassink, American Academy of Pediatrics, 2005Pediatrics, 2005


Davis MM et al. Recommendations for Davis MM et al. Recommendations for prevention of childhood obesity. Pediatr prevention of childhood obesity. Pediatr 2007;120;S229-S2532007;120;S229-S253

We Can Prevent ObesityWe Can Prevent Obesity– www.nhlbi.nih.gov/health/public/heart/obesity/wecawww.nhlbi.nih.gov/health/public/heart/obesity/weca

n/get-involvedn/get-involved– 1-800-359-32261-800-359-3226

Weight-control Information NetworkWeight-control Information Network– 1-877-946-46271-877-946-4627

www.activelivingbydesign.orgwww.activelivingbydesign.org www.aap.org/obesitywww.aap.org/obesity

prevention of pediatric obesity william j. cochran, md, faap department of pediatric nutrition...

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