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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAccording to a report from the Centers for Disease Control and Prevention (CDC), overweight or obese preschoolers are five times as likely to become overweight or obese adults as their normal weight peers [Centers for Disease Control and Prevention. \u003Cem\u003EMorb Mortal Wkly Rep\u003C\/em\u003E 2013]. Additionally, high cholesterol, high blood sugar, asthma, and mental health problems are linked to obesity in older children and adolescents. American society is characterized by environments that promote poor eating habits and physical inactivity. This article discusses intervention strategies to address some of these issues.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPediatric Nutrition\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EExclusive Article - For home page\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPediatric Nutrition\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAccording to a report from the Centers for Disease Control and Prevention (CDC), overweight or obese preschoolers are five times as likely to become overweight or obese adults as their normal weight peers [Centers for Disease Control and Prevention. \u003Cem\u003EMorb Mortal Wkly Rep\u003C\/em\u003E 2013]. Additionally, high cholesterol, high blood sugar, asthma, and mental health problems are linked to obesity in older children and adolescents.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough small decreases in the prevalence of obesity were observed among low-income preschool children in certain parts of the United States and its territories between 2008 and 2011, the rate of obesity remains high with \u223c1 of 8 children aged 2 to 5 years having an age- and sex-specific body mass index (BMI) \u226595th percentile, according to the 2000 CDC growth charts (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Centers for Disease Control and Prevention. \u003Cem\u003EMorb Mortal Wkly Rep\u003C\/em\u003E 2013]. The study included data for \u223c11.6 million low-income children aged 2 to 4 years who were participants in federally funded child health and nutrition programs.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/21\/21\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Changes in Obesity Prevalence: 2008 to 2011\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1014223391\u0022 data-figure-caption=\u0022Changes in Obesity Prevalence: 2008 to 2011\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/21\/21\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/21\/21\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/21\/21\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13411\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EChanges in Obesity Prevalence: 2008 to 2011\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EDC=Washington, DC; PR=Puerto Rico; VI=Virgin Islands.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003ESource: Morbidity and Mortality Weekly Report 2013.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EUsing a subset of the CDC data, Pan and colleagues [\u003Cem\u003EPediatrics\u003C\/em\u003E 2013] reported an overall incidence of childhood obesity of 11.0% but with several important differences among population subgroups. Obesity was more common among boys versus girls and among children aged 0 to 11 months in 2008 versus older children. The risk of obesity was 35% higher among Hispanics and 49% higher among American Indians\/Alaska Natives compared with non-Hispanic whites, but among non-Hispanic African Americans, it was 8% lower. Of the children who were obese at baseline, 36.5% remained obese at follow-up while 63.5% were nonobese. Obesity remission was proportionally significantly lower among Hispanics and American Indians\/Alaska Natives compared with other racial\/ethnic groups.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAmerican society is characterized by environments that promote poor eating habits and physical inactivity. William H. Dietz, MD, PhD, Centers for Disease Control and Prevention, Atlanta, Georgia, USA, discussed intervention strategies to address some of these issues.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EBeyond the effects of poverty, pregnancy and postnatal influences have an important influence on childhood obesity. These include maternal weight prior to pregnancy and the amount of weight gained during pregnancy, breastfeeding duration, the child\u0027s overall feeding experience and sleep patterns, as well as media exposure to food marketing strategies in older children.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDespite the fact that breastfeeding provides optimal nutrients for infant growth and development and enhances an infant\u0027s immunologic defenses, many American women opt not to breastfeed. Among the many reasons for this decision may be a mother\u0027s experience during her hospital stay. Results of a study of these experiences found that the number of \u201cbaby-friendly\u201d steps the mother experienced in the hospital effectively predicted her breastfeeding duration [DiGirolamo AM et al. \u003Cem\u003EPediatrics\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EHow we encourage our children to eat is also important to establishing healthy eating. Some of the feeding practices that influence food consumption among young children are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E. Among parenting styles, an authoritarian approach is associated with the highest risk of overweight among young children, while children with authoritative mothers have the lowest risk [Rhee KE et al. \u003Cem\u003EPediatrics\u003C\/em\u003E 2006].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13414\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13414\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13414\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EFeeding Practices That Influence Food Consumption in Young Children\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003ESeveral government programs like the Let\u0027s Move Child Care Challenge are attempting to help manage the obesity issue, but only one study has looked at the effect of these programs [Quattrin T et al. \u003Cem\u003EPediatrics\u003C\/em\u003E 2012]. The study tested the efficacy of an innovative family-based intervention for overweight preschool-aged children and overweight parents conducted in the primary care setting. After 6 months, parents and children (aged 2 to 5 years) in the intervention group had significant reductions in BMI with parent and child weight changes correlating. The lessons from this study suggest children\u0027s diets cannot be considered in the absence of parenting practices. Parental input is an important component to good infant and childhood eating habits. This information should be incorporated into existing programs and messaged across all areas dealing with childhood obesity with consistency.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EWhen all other means of intervention have failed for weight loss, Thomas H. Inge, MD, PhD, University of Cincinnati, Cincinnati, Ohio, USA, believes bariatric surgery is a viable option for children. The use of weight-loss surgery has tripled since 2000 [Kelleher DC et al. \u003Cem\u003EJAMA Pediatr\u003C\/em\u003E 2013] especially in the severely obese, who often suffer from a number of comorbid illnesses, including dyslipidemia, sleep apnea, and hypertension [Inge TH et al. \u003Cem\u003EPediatrics\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThere are three main approaches to weight-loss surgery: laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding. The Swedish Obese Subjects (SOS) study reported significant weight loss using all three approaches (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Sj\u00f6str\u00f6m L et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/21\/21\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Swedish Obese Subjects Study Results\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1014223391\u0022 data-figure-caption=\u0022Swedish Obese Subjects Study Results\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/21\/21\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/21\/21\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/21\/21\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13413\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003ESwedish Obese Subjects Study Results\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EGBP=gastric bypass; VBG=vertical-banded gastroplasty.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced from Sj\u00f6str\u00f6m L et al. Bariatric surgery and long-term cardiovascular events. \u003Cem\u003EJAMA\u003C\/em\u003E 2012; 307(1):56\u201365. With permission from the American Medical Association.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003EMaximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20% [Sj\u00f6str\u00f6m L et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007]. Weight losses from baseline stabilized at 25%, 16%, and 14%, respectively, after 10 years. The cumulative risk of mortality was significantly less in the surgery group compared with controls (p=0.01).\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EThe Roux-en-Y gastric bypass approach is the gold standard and offers rapid and sustainable weight loss. Disadvantages include potentially serious complications and the development of common vitamin deficiencies (iron, vitamin B\u003Csub\u003E12\u003C\/sub\u003E, vitamin D, and thiamine). Advantages of vertical sleeve gastrectomy include technical ease, no gastrointestinal anastomosis, no mesenteric defects, GI tract accessible to endoscopy, vitamin and mineral adsorption not altered, ability to convert procedure to two other operations, no device to erode, and no adjustments needed. Lap adjustable gastric banding is a relatively quick procedure (45 to 60 minutes), with same day or next day discharge and with no stapling or cutting of the stomach or intestine, and is currently approved only for patients aged \u226518 years in the United States. There is less weight loss with the band, however.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EIn summary noted Dr. Inge, severe pediatric obesity is becoming more common. Weight-loss surgery offers dramatic reduction in BMI and enhanced quality of life. Caution is advised in that surgical therapy may produce early complications and later nutritional complications. Ongoing clinical research efforts will be needed to improve technique.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EIn a poster session, Jamie L. Pula, PhD, RD, St. Joseph\u0027s Regional Medical Center, Paterson, New Jersey, USA, presented data regarding parental perceptions regarding obese and nonobese school-aged children of predominately Hispanic and African heritage [Pula J, Lamacchia M. ASN 2013 (abstr 36)]. She reported that parents of overweight or obese females, compared with parents of overweight or obese males, are more perceptive of the impact of obesity on their child\u0027s emotions, health, and quality of life.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EDr. Pula also presented data from a school-based, prospective, case-control, before and after, interventional study in inner-city children based on the United States Department of Agriculture wellness programs MyPlate and Let\u0027s Move [\u003Ca href=\u0022http:\/\/www.choosemyplate.gov\u0022\u003Ewww.choosemyplate.gov\u003C\/a\u003E]. Measured outcomes included changes in the 3-minute step test and vertical jump test [Pula J, Lamacchia M. ASN 2013 (abstr 37)]. After 12 weeks, the 3-minute step test (p=0.0011) and vertical jump test (p=0.0437) scores significantly improved in the female students. In addition resting heart rate also significantly (p=0.0008) improved. Similar findings were not noted in the boys.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EDr. Pula suggested that the weight management program may have helped the female students develop stronger muscles and a more efficient cardiovascular system. Why this did not occur among the male students was not explained.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/21\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl0g1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl0g1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzl0g1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}