March 2005
Shape Up America! Newsletter


NEAT is an acronym that stands for "non-exercise activity thermogenesis" which is a technical phrase that is used by scientists to describe the calories expended in everyday activities rather than exercise. NEAT represents the calories expended while sitting or standing or moving around the house or office. NEAT explicitly excludes the calories expended when you go out for a jog or some other form of intentional exercise.

An important new study points to the critical importance of getting out of the chair and moving more. James Levine and his co-workers at the Mayo Clinic in Rochester, MN equipped human volunteers with devices that were capable of monitoring activity throughout the day. In this study, half of the people studied were lean (with a BMI under 25) and the other half were obese (with a BMI above 30). The purpose of the study was to examine NEAT in both lean and obese subjects who are non-exercisers. ALL of the study subjects described themselves as "couch potatoes" - meaning they all were healthy, but inactive.

What was found is that the obese subjects spent much more of their day sitting than the lean subjects. The difference was very large - with obese subjects spending more than two and a half hours sitting than the lean subjects. The amount of time sleeping in both groups was virtually identical. The big difference was that the people in the lean group spent a lot more time standing and walking whereas the people in the obese group spent a lot more time sitting.

Unless you are new to Shape Up America! you have heard us encourage plenty of exercise, especially for people who have lost weight and want to keep it off. That still is an important message. But this new study points to the rest of your lifestyle - the way you live your everyday life. If you can choose to be more active - walking more as you go about your daily life - it can make a big difference in your weight management success. That is why choosing not to sit in front of the TV and finding ways to get up and move about is an important lifestyle choice. The same is true when you are working. If you can get up and talk to a co-worker rather than struggling to compose a letter or e-mail you are expending more calories than you do when you sit. You may not think it matters, but this study of NEAT shows that it all adds up. The study subjects with the highest level of activity had the lowest level of body fat.

Bottom Line: For good health, please do go for a walk or engage in some other form of exercise each day. But for successful weight management, when you are at home or at work, figure out ways to sit less and move more.

1. Levine, JA et al. Interindividual variation in posture allocation: Possible role in human obesity. Science 2005; 307:584-586.

Burdette and Whitaker have published an important analysis of children's play - particularly active, unstructured, outdoor play - and how it contributes to the social, emotional and cognitive development of children. "Play is the spontaneous activity in which children engage to amuse and to occupy themselves. It is also a way children optimize their own brain development." (p. 46 in Ref. 2) Although these authors acknowledge that encouraging physical activity in young children may yield the significant benefit of preventing childhood obesity, they argue that play has even more value for the developing brains and bodies of young children and should be encouraged for its own sake.

Outdoor play is especially valuable because it promotes the 3 A's that underlie healthy development of children: attention, affiliation and affect. Because it involves impulse control, attention is "highly valued by parents because of its ability to enhance learning." (p. 47 in Ref. 2) It is pointed out that outdoor environments are usually varied and require decision making, problem solving and creative thinking and imagination - all of which require and cultivate attention. That playing with other children or parents or siblings involves affiliation may be obvious. Play involves deciding what to play and can often involve rules, negotiations, conflict and compromise. In a very real sense, playing with others contributes to the development of "emotional intelligence" that is essential to getting along with others and forming social connections that signal emotional health. In their discussion of affect, the authors point out that "even more than being smart and getting along with others, parents want their children to be happy, and it is the happiness that children can achieve through play that may be the most important message to communicate to parents. " Play can contribute to the emotional well-being of children because it can minimize anxiety, depression, and aggression and it may help alleviate sleep problems. As has been shown in adults, mood can be improved by the physical activity itself and also by exposure to sunlight if the play occurs outdoors. (p. 48 in Ref. 2)

Because physical activity and outdoor play is vitally important for the healthy development and well-being of young children, it is alarming that children's free playtime is decreasing and less of it is occurring outside. Evidence is building that play is important for brain development. Activity levels of all children who are old enough to play independently are increased by playing outside in both structured and free play. Experts agree that children can not get enough or the right type of exercise when playing indoors either in a preschool or at home. Active play involving all large muscle groups throughout both the upper and lower body is important for healthy development and skill building. Children need two or more hours of active play each day. Remember that younger children play in brief spurts, rather than continuously. Also keep in mind that many children (especially young children) do not enjoy competitive sports. That is not unusual and should be viewed as perfectly normal. Encourage forms of physical activity that are non-competitive for children who do not enjoy competitive sports. The idea is to encourage unstructured outdoor play - a word that implies that it must be fun from the child's perspective.

Safe neighborhoods, playgrounds, sidewalks, bike paths and recreational facilities are essential to support children's active outdoor play. Parents are encouraged to become activists for safe neighborhoods and, if necessary, to create "playground watch" groups that will insure safe play areas for children.

2. Burdette HL and Whitaker RC. Resurrecting free play in young children. Arch Pediatr Adolesc Med (2005) 159:46-50. 3. See page 352 in Preventing Childhood Obesity: Health in the Balance published by National Academy Press, Washington, DC

Russell Pate and his colleagues have published a study in Pediatrics that is a lesson for parents who want their preschoolers to get plenty of physical activity. This study was undertaken because little is known about the amount of physical activity that children are getting when they attend preschool nor is much known about what influences the amount of activity the children engage in. This study was designed to shed light on these important questions.

In this study, 281 children from 9 different preschools in South Carolina were outfitted with a technical device (called an accelerometer) that measured their physical activity. The methodology used was sensitive enough to detect group differences. For example, boys were found to be generally more physically active than girls and black children were found to be generally more physically active than white children. But the most significant factor that predicted how active the children were was the school the child attended. In other words, some preschools appeared to encourage and support more physical activity than other schools, and the preschool was the most important factor influencing activity that was identified in this study.

The children in this study were 3 to 5 years old. They spent the majority (40 minutes) of each hour engaged in sedentary pursuits. For an average of 20 minutes out of every hour they engaged in physical activity. Of those 20 minutes, 10 to 12 minutes could be described as "light" activity and most of the rest was described as "moderate" activity. The children spent only 2 minutes per hour engaged in what could be described as "vigorous" activity. The children were active in spurts which means they would alternate periods of activity with periods of inactivity.

The important lesson of this study is that parents who have a choice of preschools should discuss the opportunities for physical activity their child will receive each day BEFORE they enroll their child. If you have no choice about which preschool your child can attend, it is important to join with other parents with children in the same school to become an advocate for a healthy level of physically active outdoor play for your children. Insist that your preschool allocate plenty of time for physically active play and ask that as much of that play time as possible be carried out outside.

4. Pate, RR et al. Physical activity among children attending preschools. Pediatrics (2004) 114: 1258- 1263

Preventing Childhood Obesity
What's a parent to do ???

Starting at birth, parents should insure their baby's health care provider uses the pediatric growth charts to monitor the growth and development of their baby. Starting at the age of two, parents should ask that a historical record of their child's BMI Percentile be started and regularly updated throughout childhood. Visit the Shape Up America! pediatric BMI Percentile calculator at http://www.shapeup.org/oap/entry.php to learn about an automated system that makes it all easy.

What is BMI Percentile? A child's BMI Percentile offers a way to compare the growth of your child to the growth pattern of a large population of healthy children of the same age and sex. The pediatric growth charts were derived from and apply to children of all ethnicities. All children should be measured (both height and weight) and BMI evaluated at least yearly.

The BMI is then plotted on the growth chart to determine the BMI percentile for that child. For example, a child may be fairly steadily tracking at the 50th percentile for several years in a row. Then he or she may jump up to the 75th percentile, which may indicate a problem. A significant change in a child's BMI percentile may signal a need for intervention. This should be verified by a properly trained and qualified health care professional.

If intervention is determined to be appropriate, the intervention that is recommended should involve the entire family and all caregivers (grandmothers, sisters, fathers, etc.) who play a role in shaping the feeding habits and activity levels of the child. There is no need to target the overweight child directly for the purpose of weight management. Targeting the entire family is less stigmatizing and traumatic for the child, as well as more effective in the long run.

1. Institute of Medicine. 2005. Preventing Childhood Obesity: Health in the Balance. Washington, DC: The National Academies Press, See pages 360 and 361.

Parents/Caretakers are the role models for the eating behavior of their children. That means that the food and beverage choices of parents/caretakers represent the single most important influence on young children's food preferences and choices. To help children learn to regulate their own intake in a healthy manner, parents/caretakers should:
  • Allow children to determine their own portions at meals.
  • Encourage children to pay attention to their own internal signals of fullness
  • Permit children to decide when they have finished eating a meal. Do not insist on "cleaning the plate"
  • Avoid using food to manipulate the mood or behavior of children. For example, avoid using food (such as candy or ice cream) as a reward. This practice dissociates eating from hunger and clearly establishes preferences for those foods used as rewards.
  • Make fruits and vegetables readily available in the home to encourage selection of these foods as snacks and desserts.
  • Limit calorie dense snacks and sodas of low nutritional quality
  • Offer smaller portions of foods and encourage going back for seconds if still hungry. 4

Recreational screen time includes more than just TV viewing. It includes the viewing of movies, DVDs, video games, gameboys, and other forms of "screen time." TV viewing by infants and toddlers should not be permitted. Removing the television from bedrooms and reducing all forms of recreational screen time to less than two hours a day can help prevent obesity. If parents/caregivers have a TV in the bedroom or watch more than two hours of TV each day, this is sending the wrong message to children. Remember that your actions speak louder than words.

2. See Golan et al. American Journal of Clinical Nutrition 1998; 67(6):1130-1135 3. See pages 358-359 in Preventing Childhood Obesity: Health in the Balance (Ref. 1) 4. This list is taken from page 347 in Preventing Childhood Obesity: Health in the Balance 5. See page 353-357 in Preventing Childhood Obesity: Health in the Balance

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