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Childhood obesity: The caregiver’s role

hildren are getting fatter. Newspaper reports describe young children with weights in excess of 100 pounds. Recent surveys (U.S. Department of Health and Human Services, 2002) indicate that 10 percent of children ages 2 to 5 and 15 percent of children ages 6 to 19 are overweight.
Obesity is becoming a serious concern. Excessive weight impedes normal physical and psychological development of young children. Obesity is a detrimental cycle that gets progressively worse. Being overweight leads to inactivity, and inactivity contributes to obesity.
The cause is apparent: obesity begins when a child eats more calories than are used. However, other interrelated causes that begin in childhood have long-term consequences for a lifetime battle with obesity and health issues. For young children dealing with obesity is primarily a parental responsibility, but medical professionals, caregivers, and teachers play important roles.

Causes of childhood obesity
Limited physical activity. Obesity is a behavioral issue for all age groups and a direct consequence of lifestyle, even for young children. Young children readily adopt the lifestyle of their parents.
Today’s families are increasingly busy with many activities pulling members in different directions. Such busyness does not mean physical activity. Most often young children follow along, riding in a car seat as family members drive from dance lesson to grocery store. As a result, children have little time for play and self-selected activities.
In many neighborhoods, safety is a concern. Parents keep children inside so they can watch them at all times.

Increased sedentary activity. The nature of inside activities for children today is an important factor in obesity. The amount of time children spend with television, computers, and video games has increased and is often the major childhood activity.
Such activities may or may not be harmful in themselves, depending on the nature of programs and games. The major concern is that these activities have replaced physically active play. Not only are young children burning few calories, but watching TV and playing video games often go hand in hand with snacking on high-calorie fat foods.

Eating habits. Snacking by both adults and children most often involves foods that are high in calorie, high in fat, and low in fiber. Children who snack shortly before meals are less likely to be hungry at mealtime. Families increasingly order delivery meals such as pizza or bring home prepared meals from a restaurant or grocery.
Because of busy schedules, families are increasingly choosing to eat meals away from home. They are likely to choose high-fat and high-calorie foods from fast-food restaurants.
All of these factors contribute to a lifestyle that increases the risk for childhood obesity.

The caregiver’s role
Caregivers have a unique opportunity to provide nutrition education on a continuing basis, not just a weekly nutrition unit once or twice during the year. Ongoing discussion of nutrition and daily activities with a food and nutrition emphasis are important for teaching basic concepts. Ideally nutrition is an ongoing part of the curriculum and used to teach other concepts.
Nutrition education during the early childhood years is especially important because it is during this period that lifetime eating habits are formed. The quality of nutrition for children ages 2 to 5 is especially important because it affects growth and development. It is easier to develop healthy eating habits during this time than it is to change eating habits in adulthood. Habits established during childhood will last a lifetime.
Caregivers need to provide healthy foods that meet the recommended dietary guidelines and to offer only those food options for children to select. Children do not automatically make healthy food decisions. Without nutrition education and guidance, they tend to choose foods high in sodium, salt, sugar, and fat or those foods familiar to them. The goal is that children learn to self-regulate the intake of food and to realize when they are full.
Don’t fall into the trap of encouraging, forcing, or bribing children to eat more than they actually need. They will not starve if they don’t eat everything on their plates. The goal is to encourage children to make wise choices and assume responsibility for those choices.
The caregiver’s responsibility is to teach children to recognize the link between nutrition and physical well-being. Children need knowledge of the nutrients in foods and their effect on physical growth and development—not just for now, but for their future health and well-being.

Learning nutrition concepts
Piaget concluded that children ages 2 to 7 learn by actively participating in their environment, not by passively listening to instruction (Swadener, 1994). According to Piagetian theory, nutrition education for this age group involves interaction with food. Abstract concepts and stylized pictures have no place in nutrition education for young children. Because nutrition is an abstract concept for preschoolers, caregivers will use examples of real foods that are meaningful for children.
Research by Birch (1987) has found that early experience with food and eating is crucial to the food acceptance patterns children develop. Everyday experiences with food and eating affect food acceptance and intake.
Babies are born with a preference for sweets, but all other food preferences are acquired (Birch, 1994). The natural tendency for children is to reject anything that tastes new and unfamiliar. One study by Birch (1987) shows that the children 2 to 6 years old are initially reluctant to taste new or unfamiliar foods. However, the preference for a food increases with many exposures, regardless of one’s age.
Other studies (Birch, 1990) indicate that young children must be exposed to a new food up to 15 times before they accept it. It is not surprising that the best time to introduce children to new foods is during the toddler period before they reach the negative 2-year-old stage in which the first response is usually “no.”