Article

Obesity in Preschoolers: Behavioral Correlates and Directions for Treatment

Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Obesity (Impact Factor: 4.39). 07/2011; 20(1):3-29. DOI: 10.1038/oby.2011.201
Source: PubMed

ABSTRACT Nearly 14% of American preschoolers (ages 2-5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi-component, family-based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers.

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    • "Unless, effective and sustainable interventions are developed to reverse these trends, future generations will face significant health challenges. Overweight and obesity patterns often cluster in families and evidence supports parental influence as a contributing factor to rates of overweight and obesity among children [5] [6] [7]. It is imperative then that efforts to improve behaviors associated with obesity target both adults and children of the same household. "
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    • "Findings from our study begin to address this gap. The modest diet and activity changes observed for preschoolers in our study support the literature suggesting that lifestyle behavior modification in early childhood is particularly challenging (Kuhl et al., 2012). Ensuring preschoolers consume a healthy diet and are physically active is undoubtedly important to their overall growth and development. "
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    • "Children also readily form preferences for high fat foods, which are commonly served as dessert (Birch, 1992; Cooke & Wardle, 2005). Since these types of foods may have high reward properties to stimulate eating even in the absence of hunger, modifying the timing of serving dessert might be particularly powerful in preschool aged children who have demonstrated a strong preference for high-fat and high-sugar foods commonly served as dessert (Birch, 1992; Cooke & Wardle, 2005; Kuhl et al., 2012). To determine if modifying when dessert is served would have an impact on children's total energy consumed at meals, the portion size of the meal must be increased to determine if children will increase intake at a meal. "
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