December 2004
 
 
Shape Up America! Newsletter

Greetings!

Preventing Childhood Obesity
"Let's begin at the very beginning-- a very good place to start."
Obesity is an abnormally high accumulation of body fat that is the result of an imbalance between calories consumed (in food) and calories expended. It is not widely appreciated that the prevention of childhood obesity begins prior to conception. Many factors that influence childhood obesity, such as a healthy maternal diet and lifestyle during pregnancy and the choice to breastfeed, depend on parental knowledge, skills and choices about food and physical activity for themselves and their families. By the time a child starts kindergarten, a great deal of the brain development that relates to appetite and food preferences has occurred. Of equal importance, the values and attitudes about food as well as eating and exercise behaviors that impact energy balance and obesity are well established by the age of 5. So to prevent childhood obesity, it is important to start early - prior to conception. The following describes important factors that either predispose or protect against obesity during the early developmental period:

Conception - Maternal obesity at the point of conception is associated with a 4-fold greater risk of childhood obesity by the age of four. The importance of parental eating and exercise habits prior to conception can not be emphasized enough. For example, optimal maternal folate status (folic acid is a vitamin that plays a critical role in cell division) at conception is important to insure healthy brain development. The brain and nervous system is one of the very first systems to develop immediately after conception. Where do you get folate? From fruits and vegetables that are a natural source of folate and from breads and cereals that are fortified with folate.

Pregnancy - Wise food choices and a healthy lifestyle during pregnancy promotes normal brain development in the unborn baby. Sound nutrition and avoiding smoking, drugs and alcohol during the pregnancy period is especially important for obesity prevention because certain regions of the brain that develop in the first few weeks of pregnancy are involved in appetite control and the regulation of energy balance.

Infancy - Breastfeeding protects against the development of obesity in childhood. The longer a mother breastfeeds her baby and delays the introduction of supplemental foods and fluids (other than water), the stronger the protection.

Toddlers - At the age of 6 months or so, slowly weaning baby onto solid foods that are appropriate for infants is important for obesity prevention. If possible, breastfeeding may continue until the child is one year old. From birth, babies prefer sweet tastes but they must learn to like other foods that do not taste sweet. To encourage acceptance of fruits, vegetables and other wholesome weaning foods that are appropriate for toddlers, be prepared to patiently and repeatedly (up to 10 times) offer new foods (in a non-coercive manner) and take care that these foods are offered in a form that will not cause choking. Soda, candy, and desserts should be avoided altogether in infants and toddlers.

1. Whitaker RC. Predicting preschooler obesity at birth: The role of maternal obesity in early pregnancy. Pediatrics 2004; 114(1): e29-e36. 2. Committee on Prevention of Obesity in Children and Youth. Preventing Childhood Obesity: Health in the Balance. Institute of Medicine of the National Academies. The National Academies Press. Washington DC. See pages 109 and 338. 3. See pages 339 and 340 in Preventing Childhood Obesity: Health in the Balance

A Frequently Asked Question:
I have a BMI of 32 and I very much want to have a baby. Because I am overweight, I am worried about the higher risk of obesity in my baby. I don't want to delay getting pregnant, in fact, it is possible I already am pregnant. What should I do?

Answer:

Pregnancy is NOT the time to diet. Now is the time to eat a balanced diet of wholesome foods. If your BMI is above 29.0, the Institute of Medicine recommends a weight gain during pregnancy of 15 pounds or more. Ideally, before you even become pregnant is the time to focus on a healthier lifestyle and wise food choices. Now is the time to plan and take small steps in the right direction.

(1) If you feel you need more information on good nutrition during pregnancy, the American Dietetic Association has a 96 page book called Pregnancy Nutrition: Good Health for You and Your Baby that will give you tips and checklists for developing a health eating plan during pregnancy. The ADA website is www.eatright.org.

(2) To get started on an exercise regimen, it is a good idea to assess your current level of fitness and design a personal plan that will move you in a healthier direction at a pace that is suited to you. You can do that by going to the Shape Up America! "Members Only" section (you have to become a member of Shape Up America! to do this, but membership is free) so that you can visit our online or "virtual" Fitness Center. You can also purchase a pedometer (a good one should cost no more than $30) and start a walking program with the goal of building more steps into your daily routine. Check out our 10,000 steps program on www.shapeup.org to get started.

(3) The next thing to think about is whether you can exclusively breastfeed your baby for the first six months of your baby's life. If you work and won't get much in the way of maternity leave, this goal can be challenging and will take a great deal of planning. Many women feel that breast pumps do not always work very well, so it is important to do some research to learn which models work the best. If you are considering breastfeeding and want to inform yourself, a visit to the website of La Leche [www.lalecheleague.org] is one way to get started. Besides providing your child with optimal nutrition, one added benefit of exclusive breastfeeding that your physician may not even know about is that it promotes more rapid recovery of uterine muscle tone and it burns maternal body fat.

(4) Once your baby is born and your breastfeeding pattern is well established, you can consider a moderate diet but don't go overboard. Weight loss of more than 1 to 2 pounds per week might interfere with your milk production.

(5) No matter what your weight is today, remember that your own behavior (and not your weight per se) is what counts. If you make a commitment to a healthier lifestyle and wiser food choices, your actions will speak louder than words.

4. Subcommittee on Nutritional Status and Weight Gain During Pregnancy. Institute of Medicine of the National Academy of Sciences. Nutrition During Pregnancy. 1990 National Academy Press, Washington DC, page 10.

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