Ten years after Barkley's call for parents to act as role models, the United States faces an obesity problem of massive proportions (no pun intended). According to the Department of Health and Human Services, an estimated 30.5 percent of all Americans are not just overweight, but clinically obese. In children, the obesity rate has tripled since the 1960s; the American Academy of Family Physicians now estimates that between 25-30 percent of all children between the ages of 6 and 17 - roughly 13 million to 16 million children - also are clinically obese. In fact, the childhood obesity epidemic has become of such concern that health officials in several industrialized countries have estimated that if obesity levels continue to rise, the average life expectancy could actually drop for the first time in more than a century.
The results of a randomized telephone survey presented at a recent American Dietetic Association meeting may have accidentally discovered the real reason behind the increase in childhood obesity. The study, which was originally designed to help determine how many children were "picky eaters," found that an alarming percentage of children consumed too much fat, sugar and salt daily, and far too little fruits and vegetables - eating patterns that looked "startlingly familiar" to those seen in overweight and obese adults. And who was to blame for such poor eating habits? Parents.
The Feeding Infants and Toddlers Study (FITS), financed by baby food manufacturer Gerber Products, consisted of random telephone interviews with 3,022 parents or caretakers of infants between the ages of 4 months and 2 years. Survey participants were asked to name, among other things, what types of foods their children had consumed in the past 24 hours, and whether their children were "very," "somewhat" or "not" picky eaters. Among the survey's startling findings:
- The average infant or toddler was fed seven times per day. Breakfasts were higher in nutrients than other meals, and "patterns" of eating breakfast, lunch and dinner were well-established by 9 months of age.
- Children between the ages of 1 and 2 consumed an average of 1,220 calories per day - nearly 30 percent above the estimated daily requirement of 950 calories. Children between 7 months and 11 months of age consumed less overall calories, although still almost 20 percent more than required.
- By 6 months of age, only 17 percent of children received their total caloric intake through breastfeeding. (The American Academy of Pediatrics recommends exclusive consumption of breast milk for the first six months of life.) Twenty-nine percent consumed solid foods before the age of 6 months; 17 percent consumed juices. One in five infants consumed cow's milk (either whole or reduced-fat) before 12 months of age. These findings are in direct conflict with the guidelines promulgated by the American Academy of Pediatrics, which recommends, along with exclusive breastfeeding for the first six months, that solid foods should not be introduced before 4-6 months; that cow's milk should not be introduced before 12 months; and that infants should consume no more than 6 ounces of juice or other sugary drinks a day.
- Consumption of carbonated soft drinks, fruit drinks and juices rose considerably as infants aged. By age 19 to 24 months, 10 percent of children consumed carbonated beverages; almost 40 percent consumed fruit drinks, and nearly 60 percent consumed juices. These increases were associated with a slight decrease in the amount of milk consumed, resulting in lower intakes of iron, calcium and vitamin C as children got older.
- On an average day, between 18-33 percent of infants and toddlers under the age of 2 consumed no vegetables daily. For those who did eat a vegetable, the most common type for children under 15 months was French fries (if you consider that a vegetable). In fact, more than 20 percent of children ages 19 months to 24 months ate French fries at least daily.
- Up to one-third of all infants and toddlers consumed no fruits on a daily basis.
- More than 60 percent of 1-year-olds ate a dessert or candy at least once per day, and 16 percent ate a salty snack (such as potato chips). Those numbers rose to 70 percent and 27 percent, respectively, by 19 months of age. Consumption of these foods led to increased overall intake of proteins, carbohydrates, fats and sodium from 9 months to 18 months.
"Food choices of infants and toddlers transition rapidly," noted an overview of the Gerber study. "By 24 months, [eating] patterns [in children] look startlingly similar to some of the 'problematic' American dietary patterns."
Combating Obesity: Parents Must Take More Responsibility
Research has shown that childhood is one of the most important times to teach healthy eating habits. As with most traits, eating habits are formed early (usually between the ages of 2 and 3) and can be easily influenced. Research has also shown that if a child likes certain types of food at a young age, he or she is most likely to continue eating those foods into adulthood.
Some advocates are quick to point the finger at computers, television and other sources as the driving forces behind childhood obesity. While the advent of television and the Internet may contribute to obesity rates, they are not the only factors that decide whether a child becomes obese. In fact, according to the survey, parents appeared to be just as much at fault at making their children obese as outside influences. Mothers constituted 91 percent of the primary caregivers in the telephone survey, and were the ones responsible for the foods offered to (and chosen by) the children.
The influence parents can have on their children's eating habits was not lost on Jodie Shield, a dietitian from Illinois who attended the ADA's conference in San Antonio, Texas.
"[Your children] are watching you - they see what you do," remarked Shield. "We're on a very dangerous course if we do not make some changes in helping parents step up to the plate and be role models. If kids are having soda and soft drinks at such an early age, it's going to be very, very challenging to introduce other types of foods for them later."
Dr. Kathleen Reidy, director of nutritional sciences at Gerber, and one of the developers of the telephone survey, echoed Shield's sentiments.
"Parents are ... looking for convenience," Reidy said in an interview with Reuters. "Everyone's just too busy and has just too much to do, so they're feeding their young children the same things they're eating.
"The best thing they can do is change their own diets. Be role models for their children to eat in a more healthy way."
What You Can Do
As the results of the FITS study show, many American adults are unaware of the value of healthy eating habits, and to make matters worse, they are passing those traits on to their children, resulting in generation after generation that may end suffering from obesity and its related conditions.
According to the Job Analysis of Chiropractic 2000, 90.4 percent of chiropractors utilize nutritional counseling, therapy or supplementation in their practices, making it the third most utilized form of passive adjunctive care behind cryotherapy and trigger-point therapy.
This is a perfect opportunity for the chiropractic profession to make a real difference in the health of America. If you're not already doing so, now is the time to emphasize to all of your patients the importance of maintaining a healthy, balanced diet. Ask them about their eating habits and, if necessary, offer suggestions. They may not see the difference now, but decades from now, they will thank you for it - and so will their children.
The full results of the Feeding Infants and Toddlers Study (FITS) appear in the January issue of the Journal of the American Dietetic Association, accessible at the ADA's Web site (www.eatright.org).
- Bales N. Parenting. All About Families 1999;4(14).
- Moran R. Evaluation and treatment of childhood obesity. American Family Physician Feb. 15, 1999.
- Overweight and Obesity Fact Sheet: Overweight in Children and Adolescents. U.S. Surgeons General Web site: www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm.
- Badger TA. Study: Toddlers have bad eating habits. Associated Press, Oct. 25, 2003.
- Forsyth J. U.S. infants eat fries, drink soft drinks - study. Reuters, Oct. 25, 2003.
- Forsyth J. Most American toddlers have a bad diet. Reuters, Oct. 26, 2003.
- FITS: Feeding Infants and Toddlers Study. Presented at the American Dietetic Association Food & Nutrition Conference & Expo, San Antonio, Texas, Oct. 25, 2003.
- Job Analysis of Chiropractic 2000. Greeley, CO: National Board of Chiropractic Examiners, 2000.