Heavy concern: when preschoolers gain weight too fast, their lifelong risk of obesity surges

At Shining Stars Family Childcare in San Francisco, toddlers and preschoolers celebrate birthdays with quinoa cakes sweetened only with sweet potatoes.

There’s no juice at snack time. Instead, the children sip water flavored with berries or cucumbers.

And they do work up a thirst, salsa dancing and running around the center’s backyard.  

The children may not know that they are engaged in an obesity prevention program backed by research. They just know that “they love it,” Shining Stars owner Zonia Torres says.

Researchers say early embrace of healthy habits is a key ingredient in tackling an urgent problem: Preventing excess weight gain in very young children.

Researchers have long known that heavy children often grow up to become heavy teens and adults. But the latest research, a study that followed 50,000 German children, found an especially strong risk when children gain weight too rapidly between ages two and six. 

An early weight surge “is the most powerful predictor of subsequent obesity in adolescence,” says Michael Freemark, a professor of pediatrics at Duke University School of Medicine.

And the longer a child stays heavy, the more likely the pounds are to stick, says Freemark, who wrote an editorial accompanying the study, published this month in the New England Journal of Medicine.

Many obese adults were never obese children, he says, but obese children and teens are at very high risk for becoming obese adults.

Researchers do not do how much of the extra risk is genetic and how much is driven by unhealthy habits and exposure to fast foods, comfy sofas and alluring screens. It’s possible, Freemark says, that an early weight surge changes the body in ways that make it harder to control weight later.

For the next 9 months, USA TODAY plans to explore the key health challenges that confront people in all 50 states.  This story is second in that series. The first was on Alzheimer’s.

The findings are concerning at a time when obesity rates in the United States continue to rise. Nearly 40 percent of adults are now obese, according to the federal Centers for Disease Control and Prevention. Previous hopes for a decline in young children were dashed by a recent study that found 15 percent of children ages 2 to 5 were obese in 2015-16, up from 11 percent in 2013-14. 

A different and more encouraging survey, from the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), found that the obesity rate among low-income children ages 2 to 4 enrolled in that program fell to 14.5 percent in 2014, down from 15.9 percent in 2010. The next round of WIC data, from 2016, has not yet been released.

Whatever the exact numbers, Freemark wrote in his editorial, it’s clear that “we are now witness to an evolving epidemic of childhood obesity” that’s putting youngsters at risk for eventual complications ranging from type 2 diabetes to fatty liver disease.

And we now know, he says, that the early years are a critical window – and perhaps the best time to prevent future harm.

Parents are key to prevention – but face obstacles 

Alvin Eden, a pediatrician in Forest Hills, New York, and a clinical professor of pediatrics at Weill-Cornell Medical Center, has practiced for more than 40 years. He wrote his first book about obesity prevention in the mid-1970s; his most recent is Obesity Prevention for Children: Before It’s Too Late: A Program for Toddlers & Preschoolers.

“Many many years ago, when I first started, I went out to California and visited Disneyland,” Eden recalls. “As I walked along, I started noticing families where the mother and father were obese and there would be three or four children behind them who were also obese.

“Then I went back and started to notice the same thing in my practice.”

The numbers of obese parents and children in his office keep increasing, he says. He says he tries to help high-risk families with straight-forward advice based on good science: Cut down on juice, add fruits and vegetables, get your child outside to play, limit TV, make sleep a priority.

He also talks about health consequences.

“There’s more and more evidence showing that even a child at four or five who is obese is already developing high cholesterol, higher blood pressure,” he says. “The kid isn’t going to have a heart attack now, but is getting set up for it.” 

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Zonia Torres, childcare provider and educator dances with preschoolers at Shining Stars Family Child Care in San Francisco on Oct. 24, 2018.
Shining Stars Family Child Care in San Francisco is part of an obesity prevention program that uses research-backed approaches (like serving lots of fruits and vegetables and getting kids active for 2 hours a day Ð in her case, with salsa and merengueÊdancing, as well as backyard play).

Martin E. Klimek, USA TODAY

But even when parents know the risks, they can find it difficult to follow the guidelines laid down by pediatricians, dietitians and fitness groups.

John Auerbach is president and CEO of Trust for America’s Health, a nonprofit based in Washington.

“Parents want their children to be healthy, but there are sometimes significant obstacles they can’t overcome,” he says.

Fresh fruits and vegetables can be more expensive than junk food, he says. And many families, he says, don’t live in neighborhoods where sidewalks, playgrounds and other amenities make physical activity an easy choice. 

Auerbach says communities, food marketers and policymakers could do more to help.

Even the promising data from WIC show uneven progress. The obesity rate among children in that program ranged from 8.2 percent in Utah to 20 percent in Virginia in 2014. While rates had fallen in 31 states since 2010 – thanks in part to a healthier food mix introduced to the program in 2009 – they rose in four (Ohio, West Virginia, North Carolina and Nebraska), the CDC reported, and were unchanged in others.

Child care centers can make a difference

One way in which states vary: how many obesity-prevention practices they require at child care centers. For example, while all states require licensed providers to have healthy eating programs, just half specify that they need to follow U.S. dietary guidelines, according to a recent report from Auerbach’s group and the Robert Wood Johnson Foundation. Just nine states and the District of Columbia require at least an hour of moderate to vigorous physical activity in all-day programs. And just four states and D.C. say centers must provide private space for breastfeeding mothers.

Utah, the state with the lowest rate of early childhood obesity in the WIC program, follows 8 out of nine such policies recommended in the report. 

Dianne Ward is a professor of nutrition at the University of North Carolina at Chapel Hill. 

“Most parents want the best for their children,” she says.

Ward helped develop some of the best known obesity prevention practices for child care centers. The program used by Torres in San Francisco, called Healthy Apple, is administered by the city’s Children’s Council and uses materials developed at North Carolina.

The centerpiece is a set of questionnaires that providers use to assess how well they incorporate healthy practices such as offering plenty of water, vegetables and outdoor play.

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Hummus on multi-grain crackers and fresh mango and raspberries are prepared for snack at Shining Stars Family Child Care.

Martin E. Klimek, USA TODAY

Providers choose which goals they want to pursue, and can attend workshops to learn how. They can earn awards for progress.

A pilot study published in 2017 found the program slowed weight gain in children who participated.

Ward says it’s impossible to say how many child care providers have changed their practices for the better as the result of such programs, and the higher profile they gained during former first lady Michelle Obama’s Let’s Move campaign.

But no matter how much progress has been made, she says, “we have not done enough yet.”

San Francisco mom Lindsay Mason says she was lucky to find Torres’ childcare center for her three-year-old daughter, Clare. Other places she considered were still “serving chicken fingers and hamburgers on a daily basis.”

Mason’s family doesn’t have a history of obesity, she says, but it does have a history of diabetes. So she is happy her daughter is learning so many good habits.

“We are confident she is being fed the right foods and we know she is not just being propped in front of a TV,” Mason says. “She is moving and learning to play and having fun doing what kids are supposed to do. … She is getting a wealth of knowledge.”

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