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: 3.73). 07/2011; 20(1):3-29. DOI: 10.1038/oby.2011.201
Source: PubMed


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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Available from: Lori J Stark, Nov 08, 2014
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    • "The modern society we live in imposes new lifestyles under whose conditions it is necessary to provide adequate measures of health care and nutrition for children, in accordance with the Health Kindergarten Programme[9]. A balanced diet in kindergartens is of utmost importance because it improves children's health, growth and development, as well as prevents disease and promotes the adoption of healthy habits at an early age, which in turn have an impact on reducing the incidence of obesity and other chronic non-communicable diseases in later stages of life[10,11,13]. Figure 2. Representation of foods in public and private kindergartens No 4 "
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    ABSTRACT: Background: It is necessary to ensure a variety of nutrients in weekly menus in kindergartens according to the recommendations and standards currently in effect. It is also important to follow the energy value of macronutrients, which is usually carried out by the relevant institutions quarterly in every kindergarten. However, the quality of menus in relation to the representation of different types of food is not monitored. Objective: The aim of this study was to estimate the quality of meals in relation to the representation of different types of food in state and privately owned kindergartens in one of Zagreb district in Croatia. Material and methods: Weekly menu's daily meals served in kindergarten groups for children (4 - 6 years old) were ana- lysed and compared with the Croatian Health Care, Hygiene and Balanced Diet Programme for Children in Kindergartens and with Food Plan Standards for Children in Kindergartens - Menus and Standards. The studies were performed in state and privately owned kindergartens in Zagreb, district Maksimir. Results: Except in the serving of dairy products, which were in comparison to the proscribed standard overrepresented, other foods such as grains, fruits, vegetables, meat, eggs, pulse were underrepresented. Grains, except in a smaller number of servings, were statistically underrepresented in state owned kindergartens in comparison to the privately owned ones. The largest discrepancy was shown in the low number of fish servings, equally so in the state and privately owned kindergartens. Conclusions: In recent years strides have been made to harmonise menus provided by kindergartens with standards based on scientific research on the prevention of obesity. However, further harmonisation of "old" and "new" foods intended to achieve a more substantial balance of the consumption of certain foods and the adequate amounts of their nutritional values is necessary. KEY WORDS: child, preschool, food, kindergarten.
    Full-text · Article · Dec 2015 · Roczniki Państwowego Zakładu Higieny
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    • "Children who are overweight at age 5 are four times as likely as their peers with a healthy weight to become obese later in life (Cunningham et al., 2014). Lifestyle behaviors, including sedentary activity, screen time, sweetened beverage intake, unhealthy diet, and inadequate sleep, can contribute to overweight/ obesity in preschool children (Gubbels et al., 2012; Kuhl et al., 2012; te Velde et al., 2012). Therefore, lifestyle interventions focusing on physical activity, nutrition, and sleep hold promise in preventing and managing childhood obesity. "
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    ABSTRACT: Objectives: The preschool period is a pivotal time for lifestyle interventions to begin the establishment of long-term physical activity and healthy eating habits. This systematic review sought to (a) examine the effects of prevention and management interventions on overweight/obesity among children aged 2-5 years, and (b) explore factors that may influence intervention effects. Design: A systematic review of randomized controlled studies was conducted. Data sources: Six databases, including PubMed, CINAHL, EMBASE, PsycINFO, ERIC, and Cochrane library, were searched for relevant studies. Review methods: Data were extracted and checked by two reviewers. Each study was appraised based on 4 quality indicators adapted from the Cochrane Handbook for Systematic Reviews of Interventions. A narrative summary technique was used to describe the review findings. Results: Thirty-seven articles describing 32 randomized controlled trials and 29 unique interventions were retained. Eight of 23 prevention and 4 of 6 management interventions resulted in significant weight loss, with 3 prevention and 5 management interventions showing sustained effects over 6 to 24 months. Of the 12 efficacious interventions, 10 included physical activity and nutrition components, 9 actively involved parents, and only 4 were theory-based. Interactive education was the most common strategy used for parents in prevention interventions, compared to behavioral therapy techniques in management interventions. For children, interactive education and hands-on experiences involving physical activity and healthy eating were equally used. Conclusions: Management interventions showed greater effects in weight loss compared to prevention interventions. Future prevention interventions in preschool children should target both parents and children, and focus on physical activity and nutrition through interactive education and hands-on experiences, although intervention effects were less than optimal. Management interventions should focus on parents as the "agents of change" for physical activity and nutrition while integrating behavioral therapy techniques and interactive education.
    Full-text · Article · Oct 2015 · International journal of nursing studies
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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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    ABSTRACT: To describe a systematic assessment of patient educational materials for the Growing Right Onto Wellness (GROW) trial, a childhood obesity prevention study targeting a low health literate population. Process included: (1) expert review of educational content, (2) assessment of the quality of materials including use of the Suitability Assessment of Materials (SAM) tool, and (3) material review and revision with target population. 12 core modules were developed and assessed in an iterative process. Average readability was at the 6th grade reading level (SMOG Index 5.63±0.76, and Fry graph 6.0±0.85). SAM evaluation resulted in adjustments to literacy demand, layout & typography, and learning stimulation & motivation. Cognitive interviews with target population revealed additional changes incorporated to enhance participant's perception of acceptability and feasibility for behavior change. The GROW modules are a collection of evidence-based materials appropriate for parents with low health literacy and their preschool aged children, that target the prevention of childhood overweight/obesity. Most trials addressing the treatment or prevention of childhood obesity use written materials. Due to the ubiquitous prevalence of limited health literacy, our described methods may assist researchers in ensuring their content is both understood and actionable.
    Full-text · Article · Aug 2013 · Patient Education and Counseling
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