Toddlers and Obesity: An Unhealthy Mix

December 2005

Toddlers and Obesity: An Unhealthy Mix that’s on the Rise
By Elizabeth Heubeck

There’s nothing quite as irresistible as a chubby-cheeked, big-bellied baby. But on a toddler, these same traits can be cause for alarm. That’s because medical experts now recognize that the road to obesity sometimes begins in toddlerhood. And they’re seeing increasing proof to support this disturbing truth.
“Since the 1970s, the incidence of obesity has doubled among 2- to 5-year-olds,” says Tiffani Hays, MS, RD, LDN, senior pediatric nutritionist at Johns Hopkins Children’s Center in Baltimore.
Currently, more than 10 percent of American children between the ages of 2 and 5 are overweight or obese, according to the 2005 annual statistics report of the American Heart Association. Obesity has become so prevalent among young children that the American Academy of Pediatrics (AAP) has labeled it an epidemic.
While there’s no telling with 100 percent accuracy whether someone who’s overweight as a toddler will continue this weight pattern into adulthood, researchers have identified a link between overweight children and adults.
“There’s a 20 percent likelihood that someone who’s overweight at age 4 will remain overweight as an adult,” Hays says.
As obesity rates among young children soar, health risks once seen only in adults are now making their way into the lives of the young.
“I have seen type 2 diabetes in children as young as 4 years old,” Hays says. “That would have been unheard of 20 years ago.”
Being overweight is a primary risk factor for type 2 diabetes. Children who are overweight are also at increased risk of developing joint problems, sleep apnea, cardiovascular disease and other obesity-related health risks once reserved for adults.

Identifying Obesity
Despite being considered an epidemic by the AAP, obesity among very young children continues to go under-diagnosed.
“It’s hard for parents to tell [if their child is overweight]. The perception is skewed because so many children are overweight,” Hays says.
But there are simple ways to gauge whether a toddler is on track, weight-wise.
“Can you see the child’s ribs? They shouldn’t be protruding, but you should be able to see them,” Hays says.
Among pediatricians, there’s a heightened awareness of the problem. Many pediatricians’ offices have replaced traditional scales, which record only weight, with those electronically calibrated to calculate Body Mass Index (BMI), a measurement that, in recent years, has become the standard for identifying overweight and obesity among adults.
If they aren’t doing so already, pediatricians should plot a child’s growth at every visit, Hays advises.
“If the child falls in a weight range higher than the 85th percentile, the pediatrician should ask questions about eating, exercise habits and parental growth,” she says.

What’s to Blame?
Diet is partly to blame for the weight problems that increasing numbers of toddlers confront. According to Hayes, 31 percent of toddlers are eating more than they’re expending. Given this unbalanced energy consumption-to-output ratio, it’s no wonder so many young children weigh more than they should. Hays says that fast food introduced at a young age, meals away from home and larger portion sizes all contribute to the problem.
One of the biggest culprits? Sweetened beverages.
“The first thing I look at when evaluating a child’s diet is what they’re drinking,” Hays says. “Sucrose should be only 6 to 10 percent of a toddler’s total calories. Studies show that, among most toddlers, it’s more like 20 to 30 percent of calories.”
Much of it coming from juice.
Then there’s the physical activity component, or lack thereof, which contributes to added pounds on toddlers. Many moms, interested in getting their prenatal shape back, think little of strapping their toddlers into stroller seats for prolonged periods of time. While moms reap cardiovascular benefits from long walks, toddlers derive no physical benefit. Nor do the toddlers who sit passively in their car seats as their parents run endless errands or chauffeur older siblings about town.
To combat this decrease in physical activity, the National Association for Sport and Physical Education recently issued its first set of physical activity guidelines for toddlers. It suggests that toddlers get at least 90 minutes daily of physical activity, broken down into 30 minutes of structured physical activity and 60 minutes of the unstructured variety.
While scrutinizing the diet and physical activity habits of a toddler may seem overwhelming to parents initially, making healthy decisions for toddlers now will make them more likely to stick later. That’s particularly true when the toddlers aren’t indulging in them alone.
“The best thing is when the family does it together,” Hays says. BC

Nutrition and Physical Activity Strategies for Fit Toddlers
Limit juice (unsweetened or other) to a maximum of 6 ounces per day.
Avoid giving your child juice in “sippy” cups throughout the day.
Structure snack- and meal-time; avoid random snacking, particularly in the car.
Eat meals together as a family whenever possible.
Avoid giving your child fast food.
Give your child appropriate portion sizes; provide seconds only when they’re requested.
Make physical activity a part of your child’s every day routine—and make it fun!
Be aware of the amount of time your child sits in a stroller and/or car seat.
Get your child in the habit of walking to destinations.
Limit television viewing. Current AAP guidelines recommend that children under 2 years of age watch no television and that older children watch no more than one or two hours a day of quality television and/or video.