In the past three decades, the childhood obesity rate has more than tripled in the United States, according to the Centers for Disease Control.
Nearly 18 percent of adolescents age 12 to 19 were considered obese in 2008, compared with only 5 percent in 1980. The rate for 6- to 11-year-olds also skyrocketed, from 6.5 percent to almost 20 percent.
Now, obesity has become a problem for children at a younger age. Even toddlers and preschoolers can suffer from this serious medical condition that increases their risk factors for high blood pressure, high cholesterol, bone and joint problems as well as other issues including poor self-esteem.
Obese kids are also more likely to become overweight adults who are more vulnerable to heart disease, type 2 diabetes, stroke and other health problems.
“Some inappropriate habits are being established in early childhood,” said Laurel Branen, a professor at the University of Idaho Coeur d’Alene and a nationally recognized expert on nutrition issues for children ages 5 and under.
Among children between 2 and 5 years old, the obesity rate more than doubled, from 5 to 10.4 percent, according to the CDC.
The agency also reported that the condition is especially prevalent among low-income, preschool-age kids – one out of every seven has a body weight that’s significantly greater than the general weight considered healthy for his or her height.
Parents and child care providers should pay attention not only to what children eat and how much, Branen said, but also to the environment and behaviors surrounding food that impact children’s eating habits well into adulthood.
In the past 20 years, much of the research on children’s eating habits has been conducted in the home setting with parents and other guardians, noted Branen, who was recently selected to serve on the Institute of Medicine’s Committee on Obesity Prevention Policies for Young Children.
Child care centers – where many children eat snacks and one to two meals a day – weren’t included in many of the studies.
The reality for many children, however, is that they spend more waking hours at their child care, nursery or preschools, Branen noted, so it’s important to examine the practices of early childhood care providers instead of concentrating solely on the parents.
The research over the years also focused on the actual food that’s served to children instead of the behaviors around food and the environment where they ate their snacks and meals.
“Twenty years ago, ‘fair’ and ‘equal’ were considered the same thing so each child got the same amount of food,” without any consideration to a child’s height and size, Branen said. “People were more worried about children not eating enough.”
Child care providers can incorporate several practices to encourage healthy eating at an early age, she said.
At home and also at the child care setting, children benefit from eating “family-style,” when food is offered in child-size platters and bowls so that children are encouraged to serve themselves, Branen said. Adults also should sit at the table with children.
This practice not only teaches the children social skills – passing food, saying “please” and “thank you,” taking turns – they also learn from the grown-ups who sit at the table.
For the purpose of obesity prevention, eating family-style also helps children become more aware of the sensations associated with hunger and fullness, Branen said.
“You have to trust that they will eat as much as they need,” she said.
Her research found that kids who were allowed to serve themselves were more accurate at assessing their hunger and how much food they required. Grown-ups tended to overestimate.
“Adults’ eyes are bigger than children’s stomachs,” she said.
Toddlers can begin serving themselves as long as they have small and lightweight serving bowls and other dishes and utensils that their small hands can manage, Branen said.
Children are also more likely to try different kinds of foods if they serve themselves, she said.
Along with Janice Fletcher, professor of child, family and consumer studies at the University of Idaho, and other experts nationwide, Branen has gathered data and observations by videotaping children eating in child care settings.
They found that many adults who work with toddlers and preschoolers often do not sit with the children during mealtimes, nor do they eat the same food.
While the children ate, the care providers usually spent the time walking from table to table to ensure the kids were safe, Branen said.
The videotapes also showed adults eating different meals from the children. In some cases, the care providers weren’t allowed to eat the center’s food, she said. In other situations, the grown-ups didn’t like the food the children were eating.
When adults and children eat some of the same food, grown-ups serve as role models while also becoming more aware of the quality and variety of foods that they serve to the children, Branen said.
In addition to eating meals together, parents, caregivers and child care providers should pay attention to their own attitudes and behaviors surrounding food, according to Branen’s research.
Because many adults were consoled or rewarded with food when they were children, they tend to do the same with their own children, Branen said.
Don’t offer a child food if she or he is sad or bored or needs an incentive, because that desensitizes a child from his or her own internal hunger and fullness cues, she said.
Some adults also make the mistake of bribing children with dessert if they eat their vegetables and other foods. But children end up preferring the reward instead of the food they’re being forced to eat, according to Branen’s research.
Children also should never be forced to clean their plates, Branen stressed.
“There’s really no point in forcing them to eat that food – it only ends up as fat on their bodies and can lead to weight problems later on,” she said.
When it comes to portion sizes for little children, the general rule of thumb is to give them one leveled measuring tablespoon per year of age up to the age of 5.
Since they have small stomachs, toddlers and preschoolers need to eat every 2 ½ hours, Branen noted, and should be offered food on a regular schedule.
“They need to get into a rhythm of eating to help them eat according to internal cues,” she said.
So how can a parent or care provider figure out if a toddler or preschooler is overweight or obese? Appearance alone isn’t enough since some children are simply bigger than others, Branen said.
While body mass index (BMI) – which measures weight in relation to height – is one of the most common ways to screen for obesity, Branen encourages parents to talk to their child’s health care provider.
Doctors and others usually look at a child’s growth charts for signs of unusual or accelerated weight gain, she said.
If a child is overweight, it’s not appropriate to simply put him or her on a diet, Branen said. Adults need to figure out what else is going on.
Is the child rewarding or consoling herself with food? Is he stressed out? Is something unusual happening in her or his life that might be causing the child to turn to food for comfort?
At home, parents can promote healthy eating by eating dinner together, reducing screen time and encouraging active, physical play, Branen said.