Outlook: Obesity

JULY 11, 2011

New Guidelines Aim to Curb Rising Obesity Rates in Children

As part of an effort to curb the increasing obesity rates among US children, the Institute of Medicine has released guidelines that focus on preventing excessive weight gain in infants and toddlers by implementing interventions in the preschool and child care settings.

About 10% of children younger than 2 years and more than 20% of children aged 2 to 5 years are overweight or obese, according to the report, which also found that the rates of obesity among children aged 2 to 5 years have doubled since the 1980s.

“We used to think that chubby babies would ‘grow out’ of their baby fat, but increasing scientific evidence suggests that we need to be concerned about extra weight in very young children, because a chubby baby often becomes an overweight adult,” said Alice Ammerman, DrPH, of the University of North Carolina at Chapel Hill.

The committee’s recommendations included:

• Counseling parents about age-appropriate sleep times and good sleeping habits

• Limiting television viewing and use of electronic devices to less than 2 hours per day for children aged 2 to 5

• Stepping up efforts to encourage breastfeeding

• Measuring body mass index in infants and toddlers “Child care providers, health professionals, and policy-makers can be helpful partners to parents in reducing obesity risk by creating healthy environments and implementing positive practices during the crucial early years of development,” said committee chair Leann Birch, PhD, of Pennsylvania State University.

Small Changes May Have Big Impact on Long-Term Weight Gain

In a series of 3 separate studies looking at how changes in dietary and other lifestyle factors relate to long-term weight gain, Harvard School of Public Health (HSPH) researchers found that modest changes in specific foods and beverages were strongly linked with long-term weight gain.

“Because the weight gain is so gradual and occurs over many years, it has been difficult for scientists and for individuals themselves to understand the specific factors that may be responsible,” said lead author Dariush Mozaffarian, MD, DrPH, of Brigham and Women’s Hospital and Harvard Medical School.

In the study, which is published in the June 23, 2011, issue of the New England Journal of Medicine, researchers evaluated changes in multiple lifestyle factors and weight gain every 4 years over 12 to 20 years of follow-up in 3 large cohorts. Study participants gained an average of 3.35 lb during each 4-year period, which corresponded to a weight gain of 16.8 lb over 20 years.

When relations of lifestyle changes with weight gain were evaluated, the findings were extremely similar in all 3 studies, according to the study.

The foods associated with the greatest weight gain over the 20-year study period included potato chips, other potatoes, sugar-sweetened beverages, unprocessed meats, and processed meats, whereas consuming vegetables, whole grains, fruits, nuts, and yogurt was linked to less weight gain. Participants in the lower 20% of dietary changes gained nearly 4 lb more each 4 years than those in the top 20%—an amount equivalent to the average weight gain in the population overall.

The most useful dietary metrics for preventing long-term weight gain included eating less liquid sugars and other sweets and consuming more minimally processed foods.

“These findings underscore the importance of making wise food choices in preventing weight gain and obesity,” said senior author Frank Hu, MD, PhD. “The idea that there are no ‘good’ or ‘bad’ foods is a myth that needs to be debunked.”

Dash Diet Linked to Lower BMI in Teen Girls

Adolescent girls who follow the Dietary Approach to Stop Hypertension (DASH) experienced smaller gains in overall body mass index (BMI) over 10 years, according to a report in the June issue of Archives of Pediatrics & Adolescent Medicine.

Jonathan P. B. Berz, MD, MSc, of Boston University Medical Center, and colleagues evaluated the effects of DASH-style diet in a racially diverse sample of adolescent girls.

Higher DASH scores were associated with higher total energy intake and higher average intake from each food group (whole grains, vegetables, fruits, lean meats, low-fat dairy, and nuts/seeds/legumes). Girls in the highest quintile of DASH scores had the smallest gains in BMI during the study and had the lowest BMIs at the end of follow-up. Conversely, at age 19 years, girls in the lowest DASH score quintile had an average BMI that was greater than the threshold for overweight as defined by the 85th percentile for age.

“In particular, higher consumption of fruits, whole grains, and low-fat dairy products led to less weight gain,” the authors noted. “We found that higher adherence to a DASH-style diet resulted in a consistently lower BMI between the ages of 9 and 19 years. Such an eating pattern may help prevent excess weight gain during adolescence.” PT

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