Angela Wicks, 10, front, Lindsay Mosher, 10, middle, and Ariana Afshari, 9, back, swing during recess at Tarwater Elementary School in Chandler.
Take the TV set out of the children's bedroom. Teach kids to eat only when they're hungry. Don't restrict their playtime as a punishment.
These are among the recommendations in a new report from the Institute of Medicine (IOM), one of the first comprehensive studies analyzing what should be done to help prevent obesity in children up to five years of age.
In recent years there has been much emphasis on fighting overweight in school-age kids, but weight problems often begin in younger children, the report says.
About 20% of kids are overweight or obese before they go to school, with higher rates among low-income children and African-American and Hispanic children, the report notes. Government data shows a third of school-age children are overweight or obese.
Many young children don't grow out of their baby fat, and that extra weight increases their risk of obesity later in life, says Leann Birch,chair of the IOM committee that prepared the report and director of the Center for Childhood Obesity Research at the Pennsylvania State University.
Debra Haire-Joshu, a committee member and director of the Obesity Prevention and Policy Research Center at Washington University, St. Louis, says obesity is "a multifaceted problem for young children, just like it is for adults," and it needs to be addressed on many fronts.
The report is aimed at child-care regulatory agencies, child-care providers and early childhood educators, but much of the advice could apply to parents, too. Among the recommendations:
•Increase physical activity in young children. Kids should have the chance to be physically active throughout the day.
For instance, toddlers and preschool children should have opportunities for light, moderate and vigorous physical activity for an amount of time that averages out to at least 15 minutes per hour while children are in care. "This would average out over the course of a day," Birch says.
Adults should avoid using restriction of play as a disciplinary measure, and kids should have opportunities for daily outdoor time for physical activity whenever possible.
•Decrease sedentary time for young children. Activities for toddlers and preschoolers should limit sitting or standing time to no more than 30 minutes at a time.
•Encourage and support breastfeeding during infancy. Adults who work with infants and their families should promote and support exclusive breastfeeding for 6 months and the continuation of breastfeeding in conjunction with complementary foods for one year or more.
•Limit screen time and exposure to food and beverage marketing. This includes television, cell phone or digital media. Child-care providers should limit television viewing and use of computers, mobile devices and other digital technologies to less than two hours a day for children ages 2 to 5. Child-care facilities and preschools should restrict screen time of any form to 30 minutes in half-day programs and one hour in full-day programs.
•Encourage age-appropriate sleep durations. Adults should create environments that ensure restful sleep, such as allowing no screen media in rooms where kids sleep. Now, about 40% of children, ages 4 to 6, have TVs in their rooms, Haire-Joshu says.
Places where children are sleeping need to have low noise and light levels, the report says.
There is a lot of data that establish a connection between shorter sleep duration and higher weight status, Birch says. "There is a fair amount of evidence for adults and some data for children."
•Monitor and track weight and length or height on growth charts from birth to age 5 at every well-child visit. By doing this health professionals can identify children at risk for obesity and discuss with parents the health problems associated with weighing too much. The report says that many parents don't understand the health consequences of excess weight in infants and young children.
The study was sponsored by the Robert Wood Johnson Foundation.