uses the term “parents” in its broadest sense to incorporate all those who are primary caregivers to children in the home.

Although treatment of childhood obesity is beyond the scope of this report, treatment studies have demonstrated that intensive involvement of parents in interventions to change obese children’s dietary and physical activity behaviors has contributed to success in weight loss and long-term weight maintenance (Coates et al., 1982; Kirschenbaum et al., 1984; Epstein et al., 1990, 1994; Golan et al., 1998; Golan and Crow, 2004). It is plausible that family-based strategies that prevent weight re-gain in these studies are likely to be informative in the prevention of obesity. The fundamental influence of parents on the eating behavior of their children has also been demonstrated in the prevention of eating disorders (Graber and Brooks-Gunn, 1996). Finally, a 10-year longitudinal study conducted in Denmark has identified parental neglect as a powerful predictor of the subsequent development of obesity (as compared to putative biological predictors such as obesity in one or both parents) (Lissau and Sorensen, 1994).

While the home is an influential setting, it is also the least accessible for health promotion efforts. Mechanisms for parent education are varied and many provide only brief opportunities for health-care professionals, teachers, or others to interact with parents and share information and resources. As discussed throughout the report, there are resources in the school and the broader community that can support and inform parents and caregivers, children, and youth (see Chapters 6 and 7).

In the remainder of this chapter, the committee explores some of the ways in which parents and families can encourage healthful eating behaviors and increased physical activity. This report is not the place for an exhaustive discussion of diet and physical activity, nor is it meant to be the definitive source for parental advice; rather, the committee sought to present some actionable steps that can be taken by parents, families, children, and youth. It is important to note that many families are already quite physically active and put time and effort into providing healthful meals. It is important that parents and children extend these efforts and priorities to their schools, neighborhoods, and communities (Chapters 6 and 7) and become involved in ensuring that opportunities are made available and expanded for all families.

PROMOTING HEALTHFUL EATING BEHAVIORS

For decades, scientists have suggested that there are critical periods in the brain development of animals and humans that may profoundly affect food intake and body weight (in particular, body fat) beginning in utero—when many of the systems that regulate food intake and body weight initially develop. The factors that influence the quantity and quality of the



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