Preventing Childhood Obesity - Evidence Policy and Practice.pdf

CHAPTER 9
Obesity p revention in e arly c hildhood
Ladda Mo - suwan 1 and Andrea M. de Silva - Sanigorski 2,3
1 Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai,
Songkhla, Thailand
2 WHO Collaborating Centre for Obesity Prevention, Deakin University, Geelong, Australia
3 Jack Brockoff Child Health and Wellbeing Program, McCaughey Centre, Melbourne
School of Population Health, The University of Melbourne, Melbourne, Australia
Summary and recommendations
for practice
• Early childhood is a critical period for obesity prevention.
However, prevalence in preschool children
is increasing.
• Early childhood settings (home, day care, kindergartens)
have an important role in facilitating health
promoting behaviors and healthy weight in young
children.
• Further evidence is needed to determine the effectiveness
of those behavioral interventions during
pregnancy, those that promote breastfeeding and
those that are family - based on preventing childhood
obesity. However, these approaches hold promise.
• Behavioral interventions delivered through child
care services have also shown some effectiveness on
behaviors. However, reduced unhealthy weight gain
was not achieved in most cases.
• The effectiveness of interventions with an environmental
focus is also limited. However, these
interventions hold great promise for creating environments
to support healthy eating and physical
activity and to shift social norms related to policies
and practices in early childhood services.
• Despite promising results, further trials are needed
to determine the best strategies for obesity prevention
in the early years of life.
Preventing Childhood Obesity. Edited by
E. Waters, B.A. Swinburn, J.C. Seidell and R. Uauy.
© 2010 Blackwell Publishing.
Introduction
Recent reports from several countries have documented
an increase in the prevalence of obesity among
preschool children. 1 – 5 With its associated co - morbid
conditions 6 and likelihood of persistence into adulthood,
7 these trends pose a remarkable burden in terms
of young children ’ s health and present and future
health care costs. Therefore, the need to identify effective
prevention of overweight and obesity among
young children is urgent before a level of public health
crisis is reached.
The importance of early child care settings — home/
family, day care, kindergartens — in shaping children ’ s
dietary intake, physical activity and energy balance,
and consequently in combating the childhood obesity
epidemic has been documented in a recent review 8 and
Chapter 30 . The role of the home environment
and parental dynamics in the development and
maintenance of children ’ s healthy behaviors is multi -
factorial. In addition, parental roles in preventing
obesity change as their children move through critical
developmental periods from before birth. 9 An unfavorable
pre - natal environment (e.g., maternal undernutrition
or overnutrition, smoking and diabetes
mellitus) increases a future risk of developing obesity
in the offspring. 8,10 During infancy, dietary factors such
as the extent and duration of breastfeeding, 11 – 16 and the
nutrient content and timing of introduction of complementary
foods, 17,18 have been found to be associated
with an increased risk of obesity in later childhood.
Toshcke et al 19 demonstrated that a combination of low
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