Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 29
tissue deposition related to growth in case of infants,
children and adolescents were added to the estimate
of daily energy expenditure. The recommendations
also include a need for physical activity to maintain
fitness and health, and to reduce the risk of developing
obesity and diseases associated with sedentary lifestyles.
Moreover, different requirements are given for
populations with lifestyles that involve different levels
of habitual physical activity, starting at 6 years of age.
In the case of infants, the new recommendations are
based on breastfed infants rather than those who are
formula fed; for the first year of life the mean values
for the former are 5 – 10% lower than figures for
formula - fed babies. The present recommendations
based on expenditure are also substantially lower for
children up to age 10 years in comparison to those
derived on observed food intake as used in 1985 by
FAO/WHO/UNU.
Breastfeeding
The new recommendations will serve to strongly
support exclusive breastfeeding since, as energy needs
drop, the sufficiency of breast milk energy supply is
prolonged. Recent meta - analyses of published observational
studies have suggested that breastfeeding is
associated with a lower prevalence of obesity 33 and
BMI later in life 34 in a dose - dependent way (i.e. longer
duration of breastfeeding is associated with lower risk
of overweight). 35 The mechanisms by which breastfeeding
would decrease the risk of obesity could be
broadly summarized in three categories: nutritional
components of milk; growth pattern of breastfed
babies; and behavioral. There is some concern that
the association between breastfeeding and obesity
may not be causal but confounded by unmeasured
factors, 36,37 and the only available randomized controlled
trial based on an intervention to promote
exclusive and prolonged breastfeeding showed that
the intervention increased duration and exclusivity of
breastfeeding but did not reduce adiposity at age 6.5
years. 38
Other e arly l ife - r isk f actors for o besity
A number of other potential early life predictors of
obesity have been identified in studies conducted
mainly in developed countries. The most consistent
associations point to a role of maternal overweight,
maternal feeding behaviors, low physical activity
levels, low socio - economic status, and obesogenic
environments. 39
Physical a ctivity and i nactivity
in y oung c hildren
Physical a ctivity
Physical activity in childhood years has been identified
as a key factor in the prevention and control of overweight
and obesity. 40 – 48 Benefits include improvement
in children ’ s general health status, their ability to
maintain normal growth and development, and delay
prevent the onset of obesity. 49,50 Evidence shows that
patterns of physical activity established early can carry
over into adulthood 49,51 and a positive relationship has
been shown between being physically active during
preschool years and lower weight gain by early adolescence,
41 con fi rming the importance of the early
years. Additional benefits of physical activity during
childhood are enhanced psychological well - being,
self - esteem, moral and social development, developing
an active lifestyle and decreasing the prevalence of
chronic disease factors. 52
Physical activity for children may be planned
(structured) or incidental (unstructured). The activity
of day - to - day living can be described as unstructured,
whereas structured activities include more formal
sporting games and activities. 49,50,53 Although young
children have a natural tendency to be somewhat
physically active, there is evidence to show that over
50 – 52
recent decades, children have become less so.
Physical activity is important for maintaining
normal growth and development during childhood
and adolescence 50 and the 2005 US national physical
activity guidelines for preschool - aged children recommended
at least two hours of physical activity a day,
half in structured physical activity and half in unstructured,
free play settings. 54
Play is the “ spontaneous activity in which children
engage to amuse and occupy themselves ” and is critically
important for preschool children. 55 Movement
and activity can satisfy a child ’ s curiosity, promote
good feelings and happiness, enhance problem -
solving skills and assist in developing lifelong attitudes
towards physical activity. 56 Children are also able to
gain success through activity challenges and enhance
social interaction through games and activities.
Learning and mastering the fundamental motor skill s
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