By: Nancy Trout, MD
Despite interventions at the national, state, and local levels, the tide of childhood obesity continues to swell. Given the current level of childhood obesity, simulated models of growth trajectories across the life course predict that 57 percent of today’s children will be obese at 35 years of age. Development of obesity in early childhood predicted obesity in adulthood, according to an article published in the New England Journal of Medicine. Despite previous data that suggested childhood obesity rates had plateaued, a March 2018 article in the journal Pediatrics reported that from 1999 to 2016 in the United States, there was a steady increase in overweight and obese children ages 2 to 19, especially among adolescents. Most alarmingly, children ages 2 to 5 years showed a sharp increase in obesity prevalence from 2015 to 2016, according to that article. A particularly worrisome trend is that previously documented disparities in the social determinants of health showed no sign of decline. Upon closer examination, children ages 2 to 5 years with severe obesity had higher odds of being African American or Hispanic, and also had higher odds of being from single parent households with low educational attainment, who lived in poverty, were never breastfed, and commonly engaged in more than twice the amount of recommended screen time, according to an article published in the journal Pediatrics.
In Connecticut, the 2017 Every Smile Counts Survey data estimated that 31 percent of kindergarten and third grade students are overweight or obese, and the prevalence has not appreciably changed in the 5 years since the survey was last completed. Similar racial, ethnic and economic disparities were found in Connecticut’s children, with Hispanic and African American students more likely to be overweight or obese than their non-Hispanic white classmates, with low socio-economic status also associated with increased obesity, according to a report from the Connecticut Department of Public Health. Many children are at risk for obesity because they eat high-calorie, low nutrient foods and beverages and are physically inactive, with the majority engaging in more than the recommended screen time.
The American Academy of Pediatrics released a policy statement in February 2018: Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Recognizing that maternal prenatal nutrition and infant and toddler nutrition in the first 2 years of life (the first 1000 days) are essential factors in a child’s optimal neurodevelopment and lifelong mental health, the statement urges all providers caring for children to advocate for healthy diets that optimize essential nutrients for mothers, infants and young children. Healthy neurodevelopment that optimizes each child’s chance to achieve his or her full potential is dependent on, and must take into account, socioeconomic, family, and nutritional factors. Two areas that the policy statement highlight as opportunities for intervention are 1) supporting breastfeeding and improved infant and toddler nutrition and 2) informing providers of best practices in early childhood nutrition.
The Kohl’s Start Childhood Off Right (SCOR) initiative, which is part of Connecticut Children’s Office for Community Child Health, incorporates both of these key strategies. The program is educating physicians in Hartford and around the state about the importance of supporting breastfeeding, including the AAP’s recommendations for a breastfeeding friendly office, and about how to counsel parents about optimal infant and toddler nutrition, with support from Kohl’s and the Child Health and Development Institute. In addition, SCOR is collaborating with dozens of community partners to create an integrated network of resources to support Hartford families in achieving healthy growth for their children. SCOR aims to create a seamless process for families to access necessary resources, starting with referrals from pediatric primary care providers. Since families with young children engage with a multitude of organizations such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), home visiting programs, and family centers, SCOR is also educating community outreach workers on how to counsel families on healthy eating and activity for infants and toddlers.
The pediatric research and academic pendulum for the obesity epidemic is swinging from treatment to prevention, specifically on prevention during the first 1000 days from conception to 2 years of age. Kohl’s SCOR is working to create a system that will thwart the prediction that 57 percent of the current generation of children are headed toward obesity and its associated health challenges, especially for our poorest and most vulnerable children.
Nancy Trout, MD is co-director of Kohl’s Start Childhood Off Right, which is an initiative of Connecticut Children’s Office for Community Child Health.
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