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    Louise Lambert-Lagacé, C.M., C.Q., dt.p.                                                                                                                                                        

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''Childhood obesity ; a crucial problem'' (Conference presented by Louise Lambert-Lagacé, at the Danone Institute Symposium, June 15, 2002.)  

Childhood obesity is a growing problem in many countries of the world and strategies to prevent this serious problem are greatly needed. Three years ago, the World Health Organization looked at the prevalence of overweight in preschool children around the world including developing countries; one hundred sixty nationally representative cross sectional surveys from 94 countries were analysed ; overweight was defined as a weight for height that exceeded more than 2 standard deviations from the WHO international median. The global prevalence of overweight before the age of 6 was 3.3% . US figures were 4.5 % in 1988-1994 while Canada's figure dated back to 1970 ( Nutrition Canada survey) showed a prevalence of 5.4% way back then..

A more very recent overview of childhood obesity and underweight trends is presented in the June issue of the Journal of Clinical Nutrition and was prepared by the Carolina Population Center in Chapel Hill.

        For children between 6 and 18 years old          

Brazil

1975

1997

overweight

4.1 %

13.9 %

underweight

14.8

8.6

China

1991
1997
overweight 6.4 % 7.7 %
underweight 14.5 13.1
USA 1971-1974 1988-1994
overweight 15.4 % 25.6 %
underweight 6.1 3.3
Russia 1992 1998
overweight 15.6 %

9.0 %

underweight 6.9 8.1
Canada 1981 1996
overweight 15. % 23.0 % among girls
    28.8 % among boys
obese 5. % 11.8 % among girls
    13.5 % among boys

Studies are also telling us not only that children are heavier but that heavy children are heavier. Ten or fifteen years ago, children going for treatment were 40% overweight, now they are often 80% overweight reveal some clinicians from Stanford University. Parents worry when their toddler refuses to eat, but then , they need to worry when children start to thicken …

Why are children getting heavier?
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too much television
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children watching 4 hours daily are 2.5 times more likely to be or become obese

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children from families with high television use are eating more pizzas, salty snacks, and sodas and less fruit and vegetable

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ever growing portion sizes in recipes and in restaurants

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too little physical activity in the schools

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the changing eating environment in which children learn to eat

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the changing home eating patterns

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foods prepared outside the home

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different members of the family taking charge

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frequent use of convenience foods and single serve items

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numerous and contradictory messages

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parents who can't say no

In a letter addressed to President Clinton in 1993, the American Dietetic Association wrote: " Over the past 20 years, children have become neglected. More families have become too removed to be aware of or to fulfil their children's needs. More children have become distressed by isolation, marital disruption, substance abuse, physical or sexual abuse, parental loss, or physical jeopardy. To blunt their difficult feelings, children develop excessive appetites for food or inactive pursuits, such as video games and television. Indulgence, another form of neglect, has also become more common. " The letter continued with a vibrant plea for governmental action . ADA had a long list of suggestions and I guess the list was heard.

Major Studies are going on in US at the moment:
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Healthy Lifestyles Research Study with CDC, dieticians and paediatricians , aims at creating family behaviours that support healthy life styles and ultimately lead to a decreased prevalence of childhood obesity.

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HHS and National Recreation and Park Association; A strategic partnership to promote community-based health education and activity programs

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CDC and the Institute of Medicine on a study on the nature of childhood obesity

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IRS has a new policy to give tax relief to individuals who pay out of pocket for weight loss program

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CDC state Outreach: Clinton signed on October 17, 2000 the Children's Health Act authorising CDC to assign grants to states to establish programs for the prevention of childhood obesity

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ADA sponsored program: Childhood Healthy Weight Initiative

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The HOPSCHOTH study ( Health Opportunities for Pre school children to Optimise their Cardiovascular Health) Goal: to change the mother, the child and the environment.

In Canada, nothing is being done at the national level.

What about weight reducing diets for young children? Many experts in the field express caution against strict diets for young children.

The main focus of the treatment should be to keep the weight as stable as possible so that children can grow into their weight.Some experts will add that the whole family needs to learn to eat a healthy diet because it's not the child who is selecting the doughnuts . Parents make choices and should be role models.

When one consults the recent studies carried by Lean Birch at Penn State, looking at mothers' child feeding practices. and how those feeding practices influence young children eating behaviour , one might conclude that the best predictor for a pre-school child's ability to regulate energy intake is parental control in the feeding situation.

The more self control the child has, the better able the child will be to respond to internal controls of hunger and fullness. The family sets the stage .

The observations and conclusions of a recent Birch study done with mothers and five year old daughters are thought provoking:
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A greater restrictive control is seen when...
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eating and appearance are particularly valued or problematic for one parent.

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the child is perceived to be at risk of overweight

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Higher degrees of maternal dietary restraint are related to higher degrees of mothers' restriction of daughter's food intake;

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Greater mothers' child-feeding practices influence the daughters risk of becoming overweight

A mother's efforts to control her own weight as measured by dietary restraint in combination with her perception of her daughter's risk of overweight predicted the mother's use of greater restrictive control in child feeding.

Excessive control in feeding diminishes children's capacity for self regulation:           The transfer of eating and feeding problems between mothers and daughters may begin during pre-school years.

The overall picture is frightening. Many have agreed in the past that diets don't work or very rarely work. Now we are seeing that diets may in fact lead to pervasive ill effects and trigger weight problems for the next generation. Maternal dieting could lead to childhood obesity

And, now we see that countries that have been dieting for more than one generation have the highest prevalence of weight problems during childhood. Obesity has become a major public health issue in our country

There are many avenues to counter act this trend? The one I propose is to ban advertising of all weight reduction diets and weight reduction products in order to deflate the weight obsession and favor a more relaxed, pleasurable relation with food during childhood and thereafter… Before this happens, many questions have yet to be answered

Do we know what thin children are eating? ...what they are doing differently ?... how , when , and where they are eating ?... what their families are doing differently?... are mealtime rituals still existent?

We need to measure the quality of foods served instead of counting calories, and grams of fat We need to take into account the enjoyment and the pleasure of eating?

The challenge should be on everyone's agenda. 

     

 

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