Start Toddlers Walking Down a Healthy Path

One of the biggest threats to our nation’s children is a product we are exposed to every day — food. Something has gone awry when the No. 1 vegetable consumed by children 18 months of age in this country is the French fry, and the Centers for Disease Control and Prevention notes that more and more children are being diagnosed with Type 2 diabetes, a disease typically seen in adults aged 40 years or older.

The obesity epidemic has officially reached the youngest members of our society. According to data from the 2003-2004 National Health and Nutrition Examination Surveys (NHANES), the prevalence of overweight children ages 2 to 5 and those at risk of being overweight has tripled in the past 30 years, increasing from 5 percent in the early 1970s to 26.2 percent in 2004.

“The rate of obesity is climbing quickly in the 2 to 5 [year] age group” says Sheree Vodicka, registered dietician and healthy weight communications manager for the N.C. Division of Public Health.

A cultural shift in this country toward fast-paced work lives, super-sized foods and sedentary lifestyles has made it challenging for today’s parents to teach children
healthy eating habits, normal portion sizes and sufficient activity levels.

“These families that are so busy, they go for packaged foods and fast foods,” says Rebecca Brouwer, coordinator of a project at Duke University called KAN-DO (Kids and Adults Now: Defeat Obesity) that is aimed at improving the healthy habits of preschoolers.

“Fast food is a huge issue because kids like it, and that is what they will eat and that is what they see advertised,” adds Brouwer, who is working with Truls Ostbye, Ph.D., professor and vice-chair of research, Department of Community and Family Medicine, to enroll 400 participants from the Triangle and Triad area in the study.

North Carolina, like many Southern states, has some of the highest numbers of overweight children and adults in the country. Current data shows nearly half of the children ages 2 to 4 in Durham County are overweight or at-risk of being overweight. Numbers in Wake and Chatham counties are slightly lower, but still indicate a trend toward overweight (see table).

Vodicka admits it’s not easy when toddlers are watching television commercials for sugar-packed cereal and soda, but even taking small steps toward a healthier lifestyle can make a difference.

Teach Healthy Habits Early
The best time to encourage healthy eating and physical activity is with children younger than 5, experts say. These younger children are more likely to listen to internal cues about hunger. It’s also a good age to introduce a variety of foods.

Toddlers certainly do not need to be “put on a diet,” Vodicka says. But if pressed to pick one food many preschoolers have too often, besides French fries, Vodicka would choose juice and soda. These drinks offer little nutritional benefits and lots of unnecessary sugar, she says. The American Academy of Pediatrics recommends children drink only up to 6 ounces of juice a day, or less than one cup.

Statewide Programs Fight Fat

Several programs in North Carolina are leading the fight against fat for preschool-aged children. These state programs have grown out of a concern for the health of North Carolina’s citizens. The 2007 report, “F as in Fat: How Obesity Policies are Failing in America,” by the Trust for America’s Health Report, shows that North Carolina ranks 17th among states for obesity in adults and fifth for most overweight youth (ages 10-17).

The following are some of the state programs working to counteract these statistics.

Color Me Healthy

In 2001, Carolyn Dunn, Ph.D., professor and nutrition specialist at N.C. State University, co-founded “Color Me Healthy,” a program that targets preschoolers and their families. The program received the 2003 Education Award from the North Carolina Association of Cooperative Extension Specialists and the Dannon Institute Award for Excellence in Community Nutrition.

“Color Me Healthy” is designed to interact with children 4 and 5 years of age in their preschool environment. The program, developed by the N.C. Cooperative Extension and the Physical Activity and Nutrition Unit of the N.C. Division of Public Health, teaches parents, children and preschool staff about healthy eating habits and activity levels.

“It’s really hard to take this small subpopulation out of context, because this is a societal issue,” Dunn says. “Preschoolers live in families and go to preschool outside of the family unit.” Parents are a major player in a child’s fitness and nutrition, because the old adage that children “do as we do and not as we say” holds true, Dunn says.

“It is not overstating the situation to say this is a public health epidemic,” Dunn says. “One in three children born today will be diabetic if we don’t do anything about this.”

The KAN-DO Program

The Duke KAN-DO program currently is enrolling participants in a two-year study designed for overweight women who have a child ages 2 to 5 in the home. By helping new mothers implement healthy eating and lifestyle changes, researchers hope to reduce the child’s risk of overweight and obesity.

“Many women at midlife will look back and say, ‘It was after my second baby that this began to be a problem.’ If we can intervene at this critical period, it can turn things around for them,” says Ostbye, principal investigator of the study with Nancy Zucker, Ph.D., director of Duke University Medical Center’s Eating Disorders Program and Cheryl Lovelady, R.D., Ph.D., of the University of North Carolina at Greensboro Department of Nutrition.

The program targets preschool children, but takes a family-oriented approach, since children typically mirror parent activity levels and eating patterns. Mothers in the study will receive two classes, monthly family kits with fun items to help with physical activity and healthy eating, and telephone counseling. A control group will receive only a monthly newsletter about reading skills.

NAP SACC – A Model for Other States

More than two million American preschoolers attend day care in this country, and North Carolina health professionals have been so successful reaching that population through Nutrition and Physical Activity Self-Assessment for Child Care, or NAP SACC, that the model will be rolled out across the nation this year. NAP SACC helps child-care centers assess and change their policies to improve healthy habits.

Researchers first introduced the evidence-based model in eight counties in 2003. Evaluations that followed its expansion in 2005-2006 to 96 child-care centers in 33 counties confirmed its success.

NAP SACC provides child-care centers with tools to assess performance in the areas of nutrition and physical activity. Consultants review the assessment with the center, and policy-makers then choose areas they wish to improve. For example, some centers choose to replace whole milk products with 2 percent milk.

“Generally, we observed measurable changes at most centers. Some made great changes, depending upon readiness, motivation and support from consultants,” says Dianne Ward, director of the UNC-Chapel Hill School of Public Health nutrition department’s intervention and policy division. “We found that, on average, centers were able to address 10 percent of the entire nutrition and physical activity environment at child care.”

Ward’s work has recently been in the national spotlight. The December 2007 issue of USA Today highlighted Ward’s study of playground equipment. She was principal investigator of the study, which found children at child-care centers were more active when provided balls, jump ropes, hula hoops and large playground equipment in an outdoor setting.

With 60 percent of our nation’s children in child-care centers, any positive changes in these environments can impact a large number of children younger than 5. An added plus to NAP SACC is that health professionals can work within the existing infrastructure to reach children and families.

Ostbye at Duke says a child’s health behaviors will be cemented during the early years of development. Hopefully, a combination of good public health programs and parents who model healthy habits will be the one-two punch the next generation needs to ignore our super-sized society and live healthy adult lives.

Carol McGarrahan is a Triangle-area writer.

Top 10 Ways to Instill Healthy Habits

1. Breastfeed Infants if Possible
Research suggests breastfeeding infants can reduce the risk of obesity later in life. An article in the May 2005 issue of Pediatrics Studies bears this out, as does a 2001 article in the Journal of the American Medical Association. The American Medical Association study of more than 13,000 infants showed the longer an infant is breastfed, the lower the child’s risk of obesity later in life. Breastfed children also may be more accustomed to different flavors of food.

2. Dump High-Calorie Drinks
A 2003 study in the Journal of the American Dietetic Association reported that beverage choices are a culprit in the poor diets of children. Consumption of soft drinks has increased from 1 to 1.4 servings per day. More than 80 percent of soft drinks consumed by children are sweetened beverages that contain empty calories. Further, whole milk can be replaced with 2 percent milk in children older than 2 who are not underweight.

3. Introduce Vegetables First
When introducing solid foods, nutritionists suggest parents introduce vegetables first, since fruits are sweeter and children may choose them over vegetables.

4. Limit Television Time
Many studies have shown a link between television viewing and childhood obesity, but a June 2002 study of preschool-aged children in the journal Pediatrics aimed confirmed the link between excessive television viewing and being overweight for this age group. The impact was higher when the television was in a child’s bedroom. The American Academy of Pediatrics recommends children older than 2 watch no more than two hours of television and children younger than 2 not watch television at all.

5. Shop Smart
Pay attention to nutrition guidelines when grocery shopping. Fill up with plenty of fruits, vegetables, low-fat dairy products and whole grains. Frozen and canned fruits and vegetables count. Avoid foods full of “empty calories.”

6. Get Moving
Make physical activity part of family time. Take a walk, ride bikes, jump rope or play a game of basketball.

7. Check Portion Sizes
Everything has become larger than life in the food service industry. A child’s meal at a restaurant is often an adult portion. Consider sharing your plate with a child rather than ordering an additional kid’s meal.

8. Communicate with Your Child-Care Center
Check with your child’s day-care center or caregiver to gauge the type of nutrition and physical activity opportunities offered on site.

9. Plan Family Meals
Family meals are important for both the emotional well-being and the nutritional habits of families. Try to plan menus in advance to make family meals possible. Get creative. Have breakfast for dinner if that’s easier.

10. Partner with the Pediatrician
Work with your child’s pediatrician to understand your child’s specific needs based on his or her weight and growth charts over time.

Useful Resources
Color Me Healthy *

Eat Smart, Move More, Weigh Less *

Duke University Kids and Adults Now: Defeat Obesity (KAN-DO) * 1-877-WE-KANDO

American Academy of Pediatrics *

American Dietetic Association *