Obesity in the Early
Childhood Years

STATE OF THE SCIENCE AND IMPLEMENTATION OF PROMISING SOLUTIONS

Workshop Summary

Steve Olson, Rapporteur

Roundtable on Obesity Solutions

Food and Nutrition Board

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Contract No. 20132685 from The California Endowment, Contract No. 10002863 from Highmark, Inc., Contract No. 10001561 from The JPB Foundation, Contract No. 10001518 from Kaiser Permanente, Contract No. 10001539 from The Kresge Foundation, and Contract No. 10001565 from the Robert Wood Johnson Foundation, with additional support from the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Academy of Pediatrics; American College of Sports Medicine; American Council on Exercise; American Heart Association; American Society for Nutrition; Bipartisan Policy Center; Blue Cross Blue Shield of North Carolina; ChildObesity180/Tufts University; Edelman; General Mills, Inc.; Greater Rochester Health Foundation; HealthPartners, Inc.; Healthy Weight Commitment Foundation; Kellogg Company; Mars, Inc.; Nemours Foundation; Nestlé Nutrition, North America; Nestlé USA; The Obesity Society; Partnership for a Healthier America; President’s Council on Fitness, Sports & Nutrition; Reebok, International; Salud America!; Sesame Workshop; and YMCA of the USA. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-43921-3
International Standard Book Number-10: 0-309-43921-3
Digital Object Identifier: 10.17226/23445

Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2016 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Cover credit: Design by Casey Weeks.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Obesity in the early childhood years: State of the science and implementation of promising solutions: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/23445.

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PLANNING COMMITTEE ON OBESITY IN THE EARLY CHILDHOOD YEARS: STATE OF THE SCIENCE AND IMPLEMENTATION OF PROMISING SOLUTIONS—A WORKSHOP¹

MARY T. STORY (Chair), Professor of Global Health and Community and Family Medicine and Associate Director of Education and Training, Duke Global Health Institute, Duke University

ANNE M. DATTILO, Associate Director of Nutrition Science, Nestlé Infant Nutrition

ALLISON GERTEL-ROSENBERG, Director of National Prevention and Practice, Nemours

JENNIFER MacDOUGALL, Healthy Living Senior Program Officer, Blue Cross Blue Shield North Carolina Foundation

BRENT A. McBRIDE, Professor of Human Development and Director, Child Development Lab, University of Illinois, Urbana-Champaign

RAFAEL PÉREZ-ESCAMILLA, Professor of Epidemiology (Chronic Diseases), Director of Office of Public Health Practice, and Director of Global Health Concentration, Yale University School of Public Health

SONYA SHIN, Associate Physician, Brigham and Women’s Hospital; Assistant Professor, Harvard Medical School; Director of COPE Project: Navajo Nation

ELSIE M. TAVERAS, Chief of Division of General Academic Pediatrics; and Director of Pediatric Population Health Management, Massachusetts General Hospital for Children; Associate Professor of Pediatrics and Population Medicine, Harvard Medical School; Associate Professor of Nutrition, Harvard School of Public Health

DIANNE S. WARD, Professor of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill

Health and Medicine Division Staff

LYNN PARKER, Scholar

LESLIE J. SIM, Senior Program Officer

HEATHER DEL VALLE COOK, Program Officer

AMANDA NGUYEN, Research Associate

DARA SHEFSKA, Research Assistant

RENEE GETHERS, Senior Program Assistant

Consultant

WILLIAM H. DIETZ, George Washington University, Washington, DC

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

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ROUNDTABLE ON OBESITY SOLUTIONS¹

BILL PURCELL III (Chair), Farmer Purcell White & Lassiter, PLLC, Nashville, Tennessee

RUSSELL R. PATE (Vice Chair), University of South Carolina, Columbia

MARY T. STORY (Vice Chair), Duke University, Durham, North Carolina

SHARON ADAMS-TAYLOR, American Association of School Administrators, Alexandria, Virginia

NELSON G. ALMEIDA, Kellogg Company, Battle Creek, Michigan

JEANETTE BETANCOURT, Sesame Workshop, New York, New York

CAPT HEIDI MICHELS BLANCK, Centers for Disease Control and Prevention, Atlanta, Georgia

DON W. BRADLEY, Duke University, Durham, North Carolina

CEDRIC X. BRYANT, American Council on Exercise, San Diego, California

HEIDI F. BURKE, Greater Rochester Health Foundation, Rochester, New York

DEBBIE I. CHANG, Nemours, Newark, Delaware

ABBEY COFSKY, Robert Wood Johnson Foundation, Princeton, New Jersey

YVONNE COOK, Highmark, Inc., Pittsburgh, Pennsylvania

JOHN COURTNEY, American Society for Nutrition, Bethesda, Maryland

CHRISTINA ECONOMOS, Tufts University, Boston, Massachusetts

IHUOMA ENELI, American Academy for Pediatrics, Columbus, Ohio

DAVID D. FUKUZAWA, The Kresge Foundation, Troy, Michigan

LISA GABLE, Healthy Weight Commitment Foundation, Washington, DC

PAUL GRIMWOOD, Nestlé USA, Glendale, California

MARJORIE INNOCENT, National Association for the Advancement of Colored People, Baltimore, Maryland

SCOTT I. KAHAN, George Washington University, Washington, DC

SHIRIKI KUMANYIKA, University of Pennsylvania, Philadelphia

CATHERINE KWIK-URIBE, Mars, Inc., Germantown, Maryland

THEODORE KYLE, The Obesity Society, Pittsburgh, Pennsylvania

ALICIA LARA, United Way Worldwide, Alexandria, Virginia

MATT LONGJOHN, YMCA of the USA, Chicago, Illinois

LISEL LOY, Bipartisan Policy Center, Washington, DC

MARY-JO MAKARCHUK, Canadian Institutes of Health Research, Toronto, Ontario

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. Responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

SHELLIE PFOHL, President’s Council on Fitness, Sports & Nutrition, Rockville, Maryland

BARBARA PICOWER, The JPB Foundation, New York, New York

NICOLAAS P. PRONK, HealthPartners, Inc., Minneapolis, Minnesota

AMELIE G. RAMIREZ, Salud America!, San Antonio, Texas

OLIVIA ROANHORSE, Notah Begay III Foundation, Santa Ana Pueblo, New Mexico

SYLVIA ROWE, S.R. Strategy, LLC, Washington, DC

JOSE (PEPE) M. SAAVEDRA, Nestlé Nutrition, Switzerland

JAMES F. SALLIS, University of California, San Diego

EDUARDO J. SANCHEZ, American Heart Association, Dallas, Texas

BRIAN SMEDLEY, National Collaboration for Health Equity, Washington, DC

LAWRENCE SOLER, Partnership for a Healthier America, Washington, DC

LOEL S. SOLOMON, Kaiser Permanente, Oakland, California

MARION STANDISH, The California Endowment, Oakland, California

ALISON L. STEIBER, Academy of Nutrition and Dietetics, Chicago, Illinois

MAHA TAHIRI, General Mills, Inc., Minneapolis, Minnesota

KATHLEEN TULLIE, Reebok, International, Canton, Massachusetts

TISH VAN DYKE, Edelman, Washington, DC

HOWELL WECHSLER, Alliance for a Healthier Generation, New York, New York

JAMES R. WHITEHEAD, American College of Sports Medicine, Indianapolis, Indiana

TRACY WIEDT, National League of Cities, Washington, DC

Health and Medicine Division Staff

LYNN PARKER, Scholar

LESLIE J. SIM, Senior Program Officer

HEATHER DEL VALLE COOK, Program Officer

AMANDA NGUYEN, Research Associate

DARA SHEFSKA, Research Assistant

RENEE GETHERS, Senior Program Assistant

GERALDINE KENNEDO, Administrative Assistant

ANN L. YAKTINE, Director, Food and Nutrition Board

Consultant

WILLIAM H. DIETZ, George Washington University, Washington, DC

Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

Although the reviewers listed above provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Martin A. Philbert, University of Michigan. He was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution.

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Contents

1 INTRODUCTION AND OVERVIEW

2 THE STATE OF THE SCIENCE

Prevalence and Trends of Overweight and Obesity in the Early Childhood Years

The Epigenetics of Childhood Obesity

The Flavor World of Childhood: Basic Biology and Health Implications

Discussion Session: Opportunities for Interventions

3 MODIFIABLE RISK AND PROTECTIVE FACTORS ASSOCIATED WITH OVERWEIGHT AND OBESITY THROUGH AGE 5

Pregnancy Factors in Relation to Childhood Obesity

Breastfeeding and the Risk of Childhood Obesity

Complementary Feeding

Responsive Parenting

Sleep, Activity, and Sedentary Behavior

Discussion Session: Guidelines for Young Children

4 EFFECTIVE INTERVENTIONS: WHAT WORKS?

Effective Interventions in Pregnancy and the First 2 Years of Life

A Clinician’s Perspective on Interventions Effective in Early Childhood

Effective Interventions in Early Care and Education

Effective Interventions in the Home Setting

Discussion Session

5 PROMISING AND INNOVATIVE CROSS-SECTOR SOLUTIONS

Programs at the U.S. Department of Agriculture

Obesity Prevention in New York City

Obesity Prevention Through Health Care Partnerships

Three Lessons for Obesity Prevention

Discussion Session

6 CLOSING COMMENTS

REFERENCES

APPENDIXES

A WORKSHOP AGENDA

B ACRONYMS AND ABBREVIATIONS

C SPEAKER AND MODERATOR BIOGRAPHIES