Childhood Obesity - Do you have an overweight child? We offer tips to help your child lose weight and get fit!

The My Overweight Child blog will help you keep informed about the latest research, findings, and resources available to parents of overweight or obese kids. There are many knowledgeable people working on the increasingly dire problem of childhood obesity - and we want to give parents a place where they can check in regularly to see the latest studies and tips available to help you help your child lose weight and maintain a healthy lifestyle.

We invite you to add your comments - if you have feedback for the blog, would like some specific topics covered, or you just want to share your experience as a parent dealing with childhood obesity.

British Town May Ban 'Obesity'

The City Council of Liverpool in Great Britain may outlaw the word "obese" as a word to describe children.

The council will use the term "unhealthy weight" in literature aimed at children because the word "obese has too many negative connotations" and may even discourage children from changing their habits, various news reports indicated.

At almost 50 percent, Liverpool has the highest rate of childhood obesity in Great Britain.

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Childhood Obesity Rates Rise in South Dakota

South Dakota's most recent height and weight survey found that overweight and obesity have risen among the state's children. For the 2008-09 school year, the Argus-Leader newspaper reported, 33.6 percent of South Dakota students were overweight or obese:
The survey defines obese as above the 95th percentile body mass index-for-age when compared to children of the same age and gender. Overweight is between the 85th and 94th percentiles.
Kristin Biskeborn, a state nutritionist, acknowledges that South Dakota has much work remaining in the effort to address obesity issues. She also acknowledges that the issue of childhood obesity didnt spring up overnight, and wont be solved overnight either.

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Early Education Program Gives Kids 'Head Start' on Obesity Prevention

A study by Temple University found that the Head Start program goes "above and beyond" federal recommendation for promoting healthy eating and exercise

According to a Dec. 7 ScienceDaily article, a Temple survey of 1,583 Head Start programs found the following:
  • Seventy percent of programs were serving only non-fat or 1 percent milk, and 59 percent never served chocolate milk.
  • Three-quarters of programs reported having children participate in at least 30 minutes of adult-led physical activity per day.
  • Ninety-four percent of programs reported serving some vegetable every day, other than French fries.
  • Ninety-seven percent reported serving some fruit every day, other than 100% fruit juice.
  • More than half (56 percent) provided children with at least 60 minutes each day of unstructured physical activity in addition to the 30 minutes of adult-led physical activity.

Labels: childhood_obesity, prevention, head start

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CNN Profiles Latino Community's Efforts to Fight Childhood Obesity

According to an Oct. 28 article by Debra Alban of CNN, members of the Latino community are facing an "uphill battle" in the effort to reduce rates of childhood obesity:
When she was about 8, Frida Sepulveda developed dark folds of skin around her neck. It's a well-known warning sign of type 2 diabetes. Frida's mother, Blanca Sepulveda, who has watched other family members struggle with diabetes and obesity, was "devastated" to see her daughter experience similar health problems.

The San Diego, California family is among a disproportionately high number of Latino-American families with overweight and obese children.

According to the 2007 National Survey of Childrens Health, 16.6 percent of Latino high school students were obese and 18.1 percent were overweight. The corresponding national averages for high school students were 13.3 percent obese and 15.8 percent overweight.

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Healthy Childhood Weight Control Begins in Infancy

Parents can do a lot to help children keep their weight in check, according to an expert from Harvard University -- and some of the steps to prevent childhood overweight and obesity begin should be taken during the infant and toddler years.

Professor Elsie Taveras said that mothers who start pregnancy at a normal weight but who gain more than 25 pounds increase their child's chances for being overweight by age three. Also, allowing children who gain too much weight in the first six months of life puts them at much higher risk for obesity by age three, Dr. Taveras warned.
  • According to a study in the journal Obesity, today's babies are almost 60 percent more likely to be overweight than were babies 20 years ago.
  • Some simple feeding practices are important, such as paying attention to your baby's cues when you are feeding him or her.
  • For example, if an infant pulls his head away from his bottle, he is saying, I don't want eat anymore.
  • It is a good idea to keep the television off while you are feeding your baby so that you can remain sensitive to his cues.
Dr. Taveras told parents to ask their pediatrician how their child is doing in terms of weight.

Labels: childhood_obesity, parenting, prevention, infant

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Experts Urge Junk Food Tax as Part of Comprehensive Anti-Obesity Effort

A report released by the Institute of Medicine and National Research Council urges state and local governments to tax junk food and soft drinks as part of a comprehensive effort to combat childhood obesity. The report also suggests tax breaks for grocery stores that open in poor or blighted neighborhoods.

A Sept. 1 article by Reuters Health and Science Editor Maggie Fox provided the following details:
The report ... also suggests that governments limit television and video games in after-school programs, require restaurants to list calorie counts on their menus and open school playgrounds and athletic fields to communities.

"Childhood obesity poses a serious threat to health in the United States," it reads. The problem cannot be solved by the federal government and communities need to act, it adds.

"This is not a report that says 'this is what every community should do.' This is a menu of options," Dr. Eduardo Sanchez, Vice President and Chief Medical Officer of Blue Cross and Blue Shield of Texas, who chaired the panel that wrote the report, said in a telephone interview.



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Australian Experts Call for New Strategies to Combat Childhood Obesity

Researchers in Australia are urging doctors in the United States, United Kingdom and Australia to rethink their strategies to combat childhood obesity. They say programs that emphasize better eating and increased exercise dont work.

According to a Sept. 4 HealthDay News article, the Australian researchers reported that "brief, physician-led intervention produced no long-term improvement in body mass index, physical activity or nutrition habits

The statement comes in the wake of a study conducted in Australia which tracked the effects three months of counseling had on children who were obese or overweight. Of the 139 who received counseling related to eating habits and exercise, none made significant improvements in diet or physical activity.

"The global long-term physical, emotional, social, reproductive and economic consequences of childhood obesity are likely to be extremely serious," the study's authors wrote. "However, very little evidence exists to show this kind of intervention works."

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'Trim Kids' Working to Reverse Rising Rates of Childhood Obesity in Louisiana

In the last 25 years, childhood obesity rates have tripled in the United States. In Lafayette, Lousiana -- in a state where one of every three people between the ages of 10 and 17 is overweight or obese -- a group named "Trim Kids" is working to reverse these troubling trends.

According to Veronica White's Aug. 13 article on the website of Louisiana's KATC, Trim Kids has been offered for four years. Among the program's successes are BreAnne Justin, who lost 18 lbs. during the 12-week spring program.

KATC reports that Trim Kids teaches kids how to make important changes to both diet and activity level. Program creator Dorian Driscoll also emphasizes to parents the importance of teaching by example. The next Trim Kids session is set to start in September.

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U.S. Adults Identify Obesity as Top Threat to Children

American adults believe that obesity is the number one problem facing their children today, according to an annual poll conducted by researchers at the University of Michigan.

Dr. Matthew Davis and his colleagues found that adults' top concerns for children are obesity, drug abuse, smoking, bullying, Internet safety, child abuse and neglect, alcohol abuse, stress, not enough opportunities for physical activity, and teen pregnancy.

These concerns ranked higher than other health issues including school violence, depression, attention deficit disorder, autism, sexually transmitted diseases, suicide, etc.

This is the first year that adults ranked stress among the top 10 problems facing children today. This was also the first year that Hispanic, Caucasian and African-American adults all agreed that obesity was the top concern facing children today.

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UK Parents to Receive Notices Detailing Children's Weight Problems

Officials with The Brighton and Hove City (UK) Primary Care Trust will be sending letters to parents of Year Six students to inform them if their children are overweight. Those whose children are deemed overweight or obese will also get food and exercise recommendations. (Year Six in the United Kingdom is equivalent to fifth grade in the U.S. system.)

An Aug. 12 article by Siobhan Ryan of The Argus provided the following details on this effort:
Health bosses claim the intention is to support parents to make important lifestyle changes to help their child reach a healthy weight ... Figures from the 2007/08 measurement programme show that 21 percent of reception [kindergarten-age] children and 31 percent of year 6 children were overweight.
"Modern living can really make it hard for children to maintain a healthy weight," PCT public health development manager Lydie Lawrence said in Ryan's article. "If this trend [of childhood overweight and obesity] continues, nine out of ten children may grow up with dangerous amounts of fat in their bodies which puts them at greater risk of cancer, type 2 diabetes and heart disease as adults."

Source: The Argus (UK)

Labels: childhood_obesity, UK, schools, overweight children

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NY Senator Announces Plan to Combat Childhood Obesity

Health care reform is a top priority in Washington, D.C. this year. While the debate over national health care rages on, New York Senator Kirsten Gillibrand is working to keep preventative measures at the forefront.
Senator Gillibrand is authoring legislation that would ban trans-fats in public schools. Any school that receives federal reimbursements would be required to remove food containing trans fats from the school. Schools would have a five year window to implement the policy. -- Source: News Channel 34 (Binghamton, NY)
Senator Gillibrand is also working on legislation that would give the U.S. Department of Agriculture more authority over the types of foods that are served in schools.

According to the U.S. Centers for Disease Control and Prevention, childhood obesity rates have more than doubled in the last thirty years. Senator Gillibrands legislation aims to quickly reverse that trend by making healthy foods more accessible to all school children.

Labels: childhood_obesity, legislation, prevention

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Young Overweight Children Experience Depression, Anxiety

A study of more than 8,000 children from the University of Missouri found that overweight children are at higher risk for loneliness, anxiety, and depression. Even overweight kindergartners had more social problems than did slimmer peers

"We found that both boys and girls who were overweight from kindergarten through third grade displayed more depression, anxiety and loneliness than kids who were never overweight, and those negative feelings worsened over time," Professor Sara Gable wrote in the journal Applied Developmental Science, which published the study.

Young girls felt more negative impacts of being overweight than boys, Dr. Gable noted. "Teachers reported that (overweight) girls had less positive social relations and displayed less self-control and more acting out than girls who were never overweight," she wrote.

Dr. Gable and her colleagues took into consideration the age when the children became overweight, the length of time they were overweight, and their social and behavioral development.

Labels: childhood_obesity, depression, anxiety

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Junior Leagues Fight Childhood Obesity with Kids in Kitchen Program

In an effort to promote healthy eating and reduce levels of childhood obesity, Junior Leagues in several nations have been inviting young people to participate in the "Kids in the Kitchen" program
Inspired by the Junior League of Calgary's Junior Chefs program, the Junior Leagues' Kids in the Kitchen initiative began in 2006 with the goal of engaging kids in the preparation of healthy meals as a means to educate them and their parents regarding nutrition and healthy choices.

Junior Leagues in more than 200 locations provide lessons and demonstrations related to preparation of healthy meals and snacks in partnership with local community organizations, chefs and nutritionists.

Over 215 Leagues in Canada, Mexico, the United Kingdom and the United States conducted the Junior Leagues' Kids in the Kitchen program in their communities in 2009.
(Source: Kids in the Kitchen website)
According to its website, the Association of Junior Leagues International Inc. (AJLI) is an organization of women committed to promoting voluntarism, developing the potential of women and improving communities through the effective action and leadership of trained volunteers. Its purpose is exclusively educational and charitable.

Labels: childhood_obesity, prevention, education

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Arkansas Surgeon General Encourages Kids to Stay Active

Dr. Joe Thompson, the surgeon general of the state of Arkansas, brought an important message to the kids at the Fayetteville Boys & Girls Club: Progress has been made in the fight against obesity, but theres more work yet to be done.

"Dr. Joe Thompson thanked participants in the clubs summer programs for participating in physical activities through the organization, saying places like the club are 'exactly what we need,'" reported the Arkansas Democrat-Gazette "He encouraged the students to find a physical activity they enjoy and stick with it throughout their lives."

Based on body mass index screenings, Arkansas seems to be turning a corner in its campaign to prevent childhood obesity. Dr. Thompson, a pediatrician, has served as the state's surgeon general for four years.

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Technology to Help Kids Stay Active, Lose Weight

Researchers from Keck School of Medicine at the University of California, Los Angeles, are studying how to use technology to fight childhood obesity.

Dr. Donna Spruijt-Metz is developing a program that entails having children wear wireless sensors to measure their physical activity. If the children are sedentary for a long time, they will receive a ping to remind them to be active.

A second program involves using CD-ROMs in schools to promote better health. Dr. Spruijt-Metz reported that this program was more effective for girls than boys.

"Technology gives us more objective and reliable measures than self reporting," she said. Dr. Spruijt-Metz presented her findings during the 5th Biennial Childhood Obesity Conference, which was held June 9 to 12 in Los Angeles.

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7-Year-Olds Experience Symptoms of Obesity-Related Diabetes

Researchers at Louisiana State University Health Sciences Center found signs of Type 2 diabetes in children as young as seven years old.

Dr. Melinda Sothern studied 118 healthy children ages seven to nine years old. Some of the children had Metabolic Syndrome, which includes markers such as obesity, heart disease, and diabetes. This syndrome is usually seen in overweight adults.

Dr. Sothern found that the child's weight was the factor most likely to predict Metabolic Syndrome. Some of the children had fat in their liver cells and leg muscles, which is a predictor of poor insulin sensitivity and a link to Type 2 diabetes.

This study was presented at the annual meeting of the American Diabetes Association.

Labels: childhood_obesity, diabetes

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Childhood Obesity Conference Underway in Los Angeles

The 2009 Childhood Obesity Conference is underway in Los Angeles. The conference, which is scheduled for June 9 to 12, is focusing on proven strategies to improve childrens health -- an objective that organizers say is of particular importance given the nation's current economic difficulties.
[The Childhood Obesity Conference will feature] sessions in which experts discuss efforts to rebuild urban infrastructures to enable residents to live healthier lifestyles; the persistence of high-calorie, high-sugar food consumption; the impact and reach of digital food and beverage marketing that targets children; and the efficacy of school and after-school wellness policies. (Source: The Berkeley News)
The director of the California Department of Public Health and the CEO of The California Endowment are among the keynote speakers who are scheduled to address conference attendees.

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Breastfeeding, Quality Diet Weaning Help Keep Kids Lean

Children who are breastfed are less likely to be fat, regardless of their height or family background. Now a new study finds that the quality of diet a breastfed infant consumes during weaning also affects body mass index.

Researchers at the University of South Hampton in the United Kingdom studied 536 children at age six and twelve months old, and again at age four years.

"We found that independent of the duration of breastfeeding, children with higher quality weaning diets including fruits, vegetables, and home-prepared foods had a greater lean mass at four years of age," Dr. Sian Robinson of the Epidemiology Resource Center at the University of South Hampton wrote in the Journal of Endocrinology and Metabolism.

Labels: childhood_obesity, parenting, prevention

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NC Obesity Prevention Project Hosts Family FunFest

The Childhood Obesity Prevention Demonstration Project of Watauga County (NC) has spent seven months promoting healthy living. This month it is celebrating the accomplishments of all its participants by hosting Family FunFest. The fest is scheduled for Saturday, May 30, 11 a.m. to 3 p.m., at Boone Mall:
Family FunFest will feature a number of activities for participants of all ages including inflatables  a giant rock wall, giant slide, obstacle course, moon walk, and a hula hoop contest. There will also be free food samples from our Healthy Cooking Contest finalists, as well as budget-friendly cooking tips. (Source: High Country Press)
The Obesity Project partnered with the Eat Smart, Move More N.C. program, which encourages communities, schools and businesses to promote healthy eating and physical activity.

Families who are looking for additional ways to improve their children's eating and exercise habits may also want to consider the many benefits of a healthy weight loss summer camp.

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Childhood Obesity Associated with Food Allergies

Obese children are more likely to have food allergies, but this does not mean that allergies cause obesity, according to a new study in the Journal of Allergy and Clinical Immunology.

Researchers with the National Institute of Environmental Health Studies examined data that had been collected from more than 4,000 children ages two to 19. Those who had body mass indices (BMI) in the 95th percentile (or higher) were 26 percent more likely to have food allergies.

"Given that the prevalence of both obesity and allergic disease has increased among children over the last several decades, it is important to understand and, if possible, prevent these epidemics," the study's lead author, Cynthia M. Visness, said in a May 8 press release.

Labels: childhood_obesity, childhood_health, allergies

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Day Care Kids Not Getting Enough Exercise

An Ohio study has discovered that children in day care centers are not getting much exercise because directors do not want them to get hurt, and parents want them to spend time doing academics.

Dr. Kristen Copeland of the Cincinnati Children's Hospital Medical Center and her colleagues studied 34 child care centers in the Cincinnati area.

"Child care providers told us many parents were more focused on their children learning cognitive skills such as reading, writing, and preparing for kindergarten than their participation in recess," Dr. Copeland in a May 5 press release that announced her findings.

"Some of the most valuable lessons in science, nature, cause and effect, and even important social skills ... all come from playing outdoors on the playground," she said in the release. Dr. Copelands report indicated that some centers do not have adequate playground equipment.

About 75 percent of children ages three to six years old are in child care centers at least part-time.

With childhood obesity associated with such a wide range of physical and psychological problems, experts advise parents to ensure that parents take action to get treatment for overweight children before any lasting damage is done.

Labels: childhood_obesity, causes of childhood obesity, exercise

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NY Issues Revised Diabetes Resource Guide

The New York State Department of Health has issued a newly revised resource guide on diabetes in children. Titled Children with Diabetes: A Resource Guide for Family and Schools, the document is designed to assist families, school officials and others as they work to identify and prevent diabetes in children.
Approximately 9,000 children and youth in New York State are diagnosed with diabetes. Type 1 diabetes accounts for nearly 85 percent of diagnosed diabetes among youth. There are currently no known strategies to prevent Type 1 diabetes. (Source: EMax Health)
Diagnoses of Type 2 diabetes are also increasing in children, a trend that many experts attribute to disturbing rises in the prevalence of childhood overweight and obesity. New York's new resource guide addresses issues related to Type 2 diabetes and helps parents, children, school staff and health care professionals devise plans for working together.

Labels: childhood_obesity, diabetes, overweight children, health_risks

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Experts Introduce Seven-Step Plan for Childhood Weight Loss

Health-care experts continually try to devise plans that will help overweight and obese children lose weight and maintain a healthy lifestyle. The latest plan has seven steps that progressively increase in intensity and level of commitment.
For behavioral therapy, the plan suggests starting with groups such as Weight Watchers or Take Off Pounds Sensibly that offer support, education and accountability and allow parents and children to work together. (Source: The Los Angeles Times)
The program referred to the in LA Times article includes the following seven stages:
1. Medical Management
2. Education
3. Environmental changes
4. Support groups
5 & 6. Two forms of cognitive behavior therapy
7. Bariatric surgery (only as a last result)
These steps are meant to be shared among parent, child, and physician so they can all work together to design and a comprehensive plan of action. Failing to address weight issues in childhood can lead to one of the many health issues facing overweight teens.

Labels: childhood_obesity, weight loss, overweight children

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'Negative' Moms More Likely to Give Kids Junk Food

A study of more than 27,700 mothers found that those with negative moods and mindsets are more likely to feed their children junk foods.

Psychologist Elvind Ystrom of the Norwegian Institute of Public Health asked the mothers how often they fed their (all of whom were less than 18 months old) any of 36 different fatty and sweet foods, and then inquired about the mothers' states of mind.

"We found that mothers who were emotionally unstable, anxious, sad, angry, had poor self-confidence or a negative view of the world were far more likely to give their child sweets and fatty foods," Prof. Ystrom said. "At the same time there was no link between maternal personality and how healthy a diet the child got in the form of fruits and vegetables. & Unfortunately, we could not study the fathers."

One theory is that depressed mothers could not say "no" to their children.

This study was done in conjunction with the University of Oslo.

Labels: childhood_obesity, parenting, obese-kids, overweight children, eating-habits

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Childhood Obesity Linked to Headaches

According to a new study from the Cincinnati Children's Hospital Medical Center, overweight children are more likely than their leaner peers to suffer from headaches - but if they lose weight, the headaches lessen or go away.

Dr. Andrew Hershey studied 913 children for six months, and found that the more overweight a child is, the more frequent and painful his headaches are. Some of the children had painful headaches as often as every other day.

Dr. Hershey said he believes that the cause of such headaches may be low levels of leptin, a hormone that makes people feel full after eating. Since overweight children often do not drink enough water, dehydration may be another culprit in their headaches, he said. A third possible cause is stress due to social pressures, such as teasing, bullying or being criticized, he said.

This study appears in the journal Headache.

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To Promote Anti-Obesity Initiative, Michelle Obama Visits Community Farm

On her way back from Mexico, first lady Michelle Obama stopped to visit a community farm in San Diego to help promote her anti-obesity initiative:

Obama toured the New Roots Community Farm to promote her ‘Let’s Move!’ campaign against childhood obesity. The event kicked off a $1 billion project by the California Endowment to fund healthy living initiatives in 14 communities across the state." (Source: The Associated Press)

The farm is planted, maintained and harvested by about 80 farmers who have immigrated to the San Diego area from countries around the world. Many of the workers plant the same crops that they grew in their native countries, giving the farm a decidedly international flair. The crop is used to feed the neighborhood, and is also offered for sale at local Farmer’s Markets.

Labels: childhood_obesity, prevention, awareness, obese teens

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Obama Administration Releases Recommendations to Fight Childhood Obesity

Across the country, parents, teachers and health professionals are weighing in on the best ways to prevent childhood obesity. Recently, the Obama Administration offered 70 recommendations aimed at reducing childhood obesity.

“Missing from the plan are any proposals to raise taxes on sugary drinks or snacks. But the strategy does include specific benchmarks for making progress toward cutting the obesity rate, including a goal of increasing the breast-feeding rate from 30 percent to 50 percent. Breast-fed babies are less likely to become obese, according to research.” (Source: Des Moines (IA) Register)

The plan also calls for more families to apply for food stamps, adding five million kids to federal school meal programs, and increasing incentives for farmers to produce more fruits and vegetables.


 

Labels: childhood_obesity, government, prevention

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How Can Computers Contribute to Fight Against Childhood Obesity?

IBM’s Almaden Research Center in San Jose, California, is known for innovation, but most of its work is focused on databases and disk drives. Now, however, the tech savvy crew is teaming up with health care providers and government policymakers to tackle complex health issues.

“The first target will be childhood obesity, a growing phenomenon that has been declared a national concern by first lady Michelle Obama. Experts say excess weight in childhood is linked to a host of expensive health problems in adulthood, including heart disease and diabetes.” Source: Contra Costa (CA) Times]

The overarching, and very aggressive goal of the Research Center’s efforts is to answer the question: “If you have extra money to spend, would it be better to spend it on building another park, or having another part, or having more physical education in schools, or improving school lunch programs?”

All of these strategies have been proven effective, but rarely are they compared to each other. Experts hope this type of comparison will help both government and the private sector put their limited resources to the best use.

Labels: childhood_obesity, government, prevention, computers

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Neck Size May be Better than BMI for Determining Weight Problems in Children

It may be easier to tell if a child is overweight simply by measuring his neck rather than calculating his or her body mass index (BMI), according to a new study from the University of Michigan.

  • Dr. Olubkola Nafia studied of ,children ages 6 to 18 years old and found a link between larger necks and above average BMIs.
  • A six-year-old boy whose neck circumference is greater than 11.22 inches and a girl that age whose neck is over 10.62 inches are probably overweight.
  • For 18 year olds, those figures are 15.35 for boys, and 13.62 for girls.

Dr. Nafia pointed out that measuring the neck is a very quick procedure for doctors to perform, and not as invasive as measuring the waist.

The study appears in the journal Pediatrics.
 

Labels: childhood_obesity, overweight, bmi

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Community Health Interventions More Effective with Younger Children

Community interventions that promote increased exercise and healthy eating for overweight children work best with very small children, according to a study from Deakin University in Australia.

  • Dr. Boyd Swinburn and his colleagues studied more than 12,000 children, and found that interventions lose effectiveness as the children get older.
  • They were most effective with children under five, and achieved few results for children in elementary and high schools.
  • Children in the preschool group had rates of overweight and obesity at 3 percent less than the control group.
  • Some of the older children who participated in community interventions had slower levels of weight gains.

"Once you get to high school aged children, trying to implement an intervention at the whole community level becomes more difficult." Dr. Swinburn said during his presentation at the International Congress on Obesity.
 

Labels: childhood_obesity, nutrition, prevention, exercise

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Parents Struggle to Identify Obesity in Children

Though some progress is being made in the fight against childhood obesity, not everyone is on board. Studies continue to show that an alarming number of parents still don’t recognize that their kids are overweight or obese.

“In another survey, only 38% of parents had taken steps, or were planning to take them, to help their obese child lose weight. Several factors may be contributing to this indifference among parents, experts say. Some parents believe their child’s excess weight is just ‘baby fat,’ for instance, and some may simply be in denial.” [Source: Health.com]

Other parents assume their kids are “normal” because their friends are overweight, too. So many kids today are overweight and obese, that they don’t stand out anymore, making obesity appear normal. But parents need to look past what everyone else is doing, and consult with their family doctor regarding healthy weight for all the family members.

Labels: childhood_obesity, awareness, infant, parents

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