Obesity takes time to develop and for symptoms to appear. Therefore, children may be at risk for childhood obesity at a very young age but not yet defined clinically as overweight or obese. When children begin to show, for example, excess weight-for-height, this should not be dismissed as something “the child will grow out of with time.” The first years of life are critically important to a child’s health, well-being, and development. Excess weight at a young age can hinder movement and normal levels of activity and ultimately compromise later health and development.

The data reveal that the problem of obesity in infancy and early childhood is pervasive and growing. Approximately 10 percent of children under age 2 years have high weight-for-length (at or above the 95th percentile) (Ogden et al., 2010). The problem persists among children over age 2. Fully 21 percent of children aged 2–5 are overweight or obese, and the proportions of overweight and obese children in this age group have doubled in 30 years (Ogden et al., 2008, 2010). These statistics are of particular concern because rapid weight gain and obesity during the first years of life increase the risk for later obesity (Freedman et al., 2005; Goodell et al., 2009; Ong et al., 2009; Stettler et al., 2003).

The prevalence of overweight and obesity has increased significantly over the past 25 years among all ethnic groups, but is higher in some groups than in others. Variations in the prevalence of overweight among different ethnic groups in the United States are measured regularly in the National Health and Nutrition Examination Survey (NHANES). The Centers for Disease Control and Prevention (CDC) has published the most recent national survey data, showing that Hispanic males and African American females have a higher prevalence of obesity than other groups, particularly in the teenage years (CDC, 2011) (see Figure 1-1).

Although school-based prevention is critical, it is not where awareness and action on childhood obesity should begin. The childhood obesity epidemic requires a sense of urgency and new avenues for prevention focused on the first 5 years of life. The first years of life are characterized by rapid growth and developmental change. The newborn’s behavioral repertoire is limited to sleeping, feeding, crying, and a few reflexes, but over the next months and years, development proceeds rapidly. In these early years, children will learn to sleep through the night, drink from a cup, walk, and talk; in many cases, they also will learn to drink sugar-sweetened beverages (Fox et al., 2010; Siega-Riz et al., 2010) instead of milk or water, dislike and reject vegetables (except french fries), and watch too much

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