Chubby cheeks and dimpled arms may be dismissed as baby fat in a toddler, but a study of Virginia children suggests pediatricians need to raise concern about weight for tots as young as 2.
That's the age the new study tags as a “tipping point” when children who become overweight start putting on more pounds than others. Some begin outpacing peers even earlier.
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Doctors affiliated with Children's Hospital of The King's Daughters teamed with a medical resident from Eastern Virginia Medical School to review the records of overweight children in South Hampton Roads, Va. The cases were from pediatric practices that serve Chesapeake, Norfolk, Suffolk and Virginia Beach.
Medical resident Vu Nguyen looked at the most recent wave of records this summer. They included 111 children with an average age of 12. Each child had at least five pediatric visits during which height and weight were measured.
The children were classified as overweight if their body mass index — a measurement of a child's weight to height — exceeded 85 percent of the population. The charted information showed that more than half the children became overweight at or before their second birthdays, and 90 percent became overweight before reaching their fifth birthdays.
The information mirrored data that Dr. John Harrington, a Children's Hospital pediatrician, had gleaned from records of 91 children in 2007 at a pediatric practice at the Norfolk-based hospital. Harrington cautioned that the study of children's health records, which has yet to go through a peer review, is retrospective and only includes children identified as overweight.
“It doesn't mean every child who weighs more than average at 2 will go on to be overweight,” Harrington said. However, the study does suggest that children who fight the bulge begin outweighing their peers at an early age, rather than at ages 8, 9 or 10, said Harrington, who worked with Nguyen and CHKD pediatrician Lawrence Pasquinelli on the study.
“We were looking for the point when they break off from regular kids,” Harrington said. He said he believes interventions by doctors and other health professionals — such as reviews of diet and activity level — need to happen earlier.
“We need to be more adamant about changing families' lifestyles,” Harrington said.
He said pediatricians often feel uncomfortable bringing up the topic of weight with families, especially when children are young. However, he said, the longer they wait, the harder it is for a family to make changes.
A weight-management program called Healthy You at Children's Hospital is targeted for children 8 and older, but the department recently developed a nutrition and health pamphlet to give to families with children of all ages. Parents, too, need to be aware that cute pudginess can turn into a more serious issue.
Harrington said families today tend to eat larger portions and go out to restaurants more often than families did a decade ago, and their children are more apt to watch TV and play video games.
The study grew out of concern nationally about the rate of childhood obesity. The Centers for Disease Control and Prevention estimates that 16 percent of children 2 to 19 years old in the United States are obese, a dramatic increase from past generations.
The American Academy of Pediatrics recently issued new cholesterol screening guidelines calling for children with a family history of high cholesterol or heart disease and those who are overweight to be screened as young as 2, and no later than age 10. Harrington said the researchers will continue to collect more data and hope to have the study accepted by a peer-reviewed journal.
Children's Hospital of The King's Daughters recently began handing out “5-4-3-2-1” health pamphlets to families of children of all ages, recommending:
5 servings of fruits and vegetables:
—Choose whole fruits and vegetables over juice.
—Keep fresh cut-up fruits and vegetables around for snacks.
4 servings of water:
—Give your children water bottles and keep them filled.
—Keep track of how much they drink, especially during play or sports.
—Put a pitcher of water on the table at dinner.
—Avoid soft drinks and sweetened drinks.
3 servings of low-fat dairy:
—Blend low-fat or skim milk or yogurt with fruit and ice.
—Add low-fat cheese to soups and salads.
2 hours or less of screen time:
—Work with your children to select age-appropriate shows and turn the television on only for those programs.
—Limit overall television, computer and video-game time.
—Make TV a reward, not a daily routine.
1 hour or more of physical activity:
—Scatter activities throughout the day.
—For short trips, walk instead of driving, and take the stairs when possible.
—Enroll your children in after-school or weekend activities, or plan for active family time.
For more information, visit www.chkd.org/HealthyYou or call (757) 668-7035.