‘Engage the village’ to reverse childhood obesity

An estimated 36% of U.S. children are overweight; recent changes in society and lifestyle play a role.

Issue: May 2008

ByKathleen Gold, RN, MSN, CDE

Between 1963 and 2004, obesity rates rose in children aged 2 to 5 years, from 5% to 14%; quadrupled in children aged 6 to 11 years, from 4% to 19%; and tripled in adolescents, from 5% to 17%. It is believed that 36% of children living in the United States are overweight.

There are a number of reasons for the increase in overweight and obese children in the United States today. Nutrition and lifestyle most likely play the largest role.

Changing lifestyles

In recent decades, children have increased their caloric intake and decreased their physical activity. Society has changed — both parents frequently work, restricting outside play time after school. Children spend a great deal of time in cars, going to activities, school, and after-school care. They no longer walk, and many communities lack sidewalks and safe places for children to play. Only 25% of all U.S. children have physical education five days a week. Children, like adults, take the elevator and escalator rather than the stairs.

Today we know that children are spending more time watching television, playing video games, surfing the Internet, and texting friends than engaging in any form of physical activity.

Children spend 1,500 hours per year watching television and they spend 900 hours in school. On average, the TV is running seven hours a day. The rate of obesity is 8% higher among children who watch TV more than five hours a day compared with children who are limited to two hours of TV a day. Not surprising, 70% of day care centers utilize TV as an activity. Sadly, 25% of U.S. children are classified as sedentary. As we have become technologically advanced we have become physically deficient.

Regarding caloric intake, one third of American children aged 4 to 19 years eats fast food at least once a day. The portion size of fast food restaurants has doubled in the past 20 years, and we know that children are eating fewer vegetables and drinking less milk. They are eating more high-sugar, high-fat fast foods and drinking more sugar-laden soda and juice. According to an article in the Journal of Preventive Medicine, 94% of food advertising on one popular children’s TV station was for foods of poor nutritional value. Recent studies have shown that food preferences are influenced by TV commercials.

Program to address issues

In order to address the increase of overweight in children, the National Institutes of Health’s National Heart, Lung, and Blood Institute, in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Child Health and Human Development, and the National Cancer Institute have come together to promote We Can! (Ways to Enhance Children’s Activity & Nutrition). We Can! is a turn-key, science-based prevention program designed for families and communities to help children maintain a healthy weight.

The program focuses on three behaviors: improved food choices, increased physical activity, and reduced screen time. It offers tested resources, curricula and materials that may be used to complement activities already in existence to combat childhood overweight or assist groups in establishing a prevention program. There are four different curricula available: We Can! Energize Our Families: Parent Program; Media-Smart Youth: Eat, Think Be Active; CATCH Kids Club; and S.M.A.R.T. (Student Media Awareness to Reduce Television).

In addition, We Can! provides a variety of program resources to support organizations in planning, promoting and implementing programming. Most program materials can be downloaded online at no cost. These include:

A community toolkit.

Nutrition and physical activity tip sheets for parents and physicians.

A promotional video.

Online flash animations.

A program brochure.

A program poster.

Slide presentations.

Drop-in news articles.

Print PSA’s.

Sample press releases.

We Can! Energize Our Families: Parent Program is a multiple session curriculum that covers the basics of maintaining a healthy weight. The core concept is “energy balance,” or the long-term balance between energy in (calories from food) and energy out (calories used through activity). The fun and hands-on lessons focus on helping participants learn skills that can help their families make healthful food choices and become more physically active. The program, piloted in 14 community sites around the country, is available in both six- and four-lesson versions. Facilitators may also use the Family Guide, a workbook for parent participants.

Media-Smart Youth: Eat, Think, Be Active! is an after-school program designed to help young people aged 11 to 13 years become aware of how media may influence the nutrition and physical activity choices they make. The program culminates with the “Big Production,” an opportunity for youth to create a media project to motivate their peers. Media-Smart Youth was pilot tested in after-school settings and reviewed by the NIH, USDA and education experts. The program is now being implemented by youth-serving organizations across the nation.

CATCH Kids Club is an after-school program targeted to elementary school aged children to educate them about improved nutrition and increased physical activity. The program uses a coordinated approach to help children adopt healthy dietary and physical activity behaviors by positively changing the health environments of recreation programs, schools and homes. CATCH Kids Club is an adaptation for the after-school setting of the highly successful CATCH study, funded by the NHLBI, and mentioned in over 80 scientific publications.

S.M.A.R.T. is an in-school curriculum designed to teach third and fourth grade children about the need to reduce TV viewing and video and computer game use. S.M.A.R.T. was developed by child health and behavior researchers in the Department of Pediatrics, at the Stanford Prevention Research Center, Stanford University School of Medicine. The curriculum was tested in 11 schools with over 1,000 schoolchildren. The curriculum has been evaluated and studies have shown it is an effective intervention.

To date, more than 500 local community organizations have committed to implementing We Can! in over 45 states — from hospitals, health departments and tribal organizations, to faith-based organizations, YMCAs and schools. Last year We Can! launched a city and county program to assist towns and cities across the nation in mobilizing their communities to prevent childhood obesity. To date, eight cities have joined the effort. For more information about starting a We Can! program in your institution or community call 1-866-35WECAN, visit the website at http://wecan.nhlbi.nih.gov or email nhlbiinfo@nhlbi.nih.gov.

Kathy Gold, RN, MSN, CDE, is a Diabetes Education Specialist at the Diabetes Research and Wellness Foundation, Washington D.C.

For more information:

Batada A, Wootan MG. Nickelodeon markets nutrition-poor foods to children. Am J Prev Med. 2007;33:48-50.

Colapinto CK, et al. Children’s preference for large portions: prevalence, determinants, and consequences. J Am Diet Assoc. 2007;107:1183-1190.

Fox R. Overweight children. Circulation. 2003;08: e9071.

Gable S, et al. Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of schoolaged children. J Am Diet Assoc. 2007;107: 53-61.

Nowicka P, Flodmark CE. Physical activity — key issues in treatment of childhood obesity. Acta Paediatr Suppl. 2007;96: 39-45.

Ogden CL, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295: 1549-1555.

Proctor MH, et al. Television viewing and change in body fat from preschool to early adolescence: The Framingham Children’s Study. Int J Obes Relat Metab Disord. 2003;27:827-833.

St-Onge MP et al. Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. Am J Clin Nutr. 2003;78:1068-1073.

Troiano RP. Physical inactivity among young people. N Engl J Med. 2002;347:706-707.