How to Prevent Obesity

There is no single or simple solution to the obesity epidemic. It’s a complex problem and there has to be a multifaceted approach. Policy makers, state and local organizations, business and community leaders, school, childcare and healthcare professionals, and individuals must work together to create an environment that supports a healthy lifestyle. There are several ways state and local organizations can create a supportive environment to promote healthy living behaviors that prevent obesity.

State and Local Programs

Resources are available to help disseminate consistent public health recommendations and evidence-based practices for state, local, territorial and tribal public health organizations, grantees, and practitioners.

Knowing your body mass index (BMI), achieving and maintaining a healthy weight, and getting regular physical activity are all actions you can take for yourself to combat obesity.

Community Efforts

To reverse the obesity epidemic, community efforts should focus on supporting healthy eating and active living in a variety of settings. Learn about different efforts that can be used in early childhood care, hospitals, schools, and food service venues.

Healthy Living

The key to achieving and maintaining a healthy weight isn’t short-term dietary changes; it’s about a lifestyle that includes healthy eating and regular physical activity.

• Assessing Your Weight
  BMI and waist circumference are two screening tools to estimate weight status and potential disease risk.
• Healthy Weight
  A high BMI can be an indicator of high body fatness. Visit the Healthy Weight Website; learn about balancing calories, losing weight, and maintaining a healthy weight.
• ChooseMyPlate external icon
  Healthy eating habits are a key factor for a healthy weight. Visit the ChooseMyPlate Website; look up nutritional information of foods, track your calorie intake, plan meals, and find healthy recipes.
• Physical Activity Basics
  Physical activity is important for health and a healthy weight. Learn about different kinds of physical activity and the guidelines for the amount needed each day.
• Tips for Parents
  Learn about the seriousness of childhood obesity and how to help your child establish healthy behaviors.

Related Information

Nutrition, Physical Activity and Obesity Prevention Strategies and Guidelines provides guidance for program managers, policy makers, and others on how to select strategies.

Facts about prevention

Obesity is a chronic disease affecting increasing numbers of children, teens and adults. Obesity rates among children in the U.S. have doubled since 1980 and have tripled for teens. About 17% of children aged 2 to 19 are considered obese, compared to over 35% of adults who are considered obese.

Earlier onset of type 2 diabetes, heart and blood vessel disease, and obesity-related depression and social isolation in children and teens are being seen more often by healthcare professionals. The longer a person is obese, the more significant obesity-related risk factors become. Given the chronic diseases and conditions associated with obesity and the fact that obesity is hard to treat, prevention is extremely important.

A primary reason that prevention of obesity is so vital in children is because the likelihood of childhood obesity persisting into adulthood increases as the child ages. This puts the person at high risk of diabetes, high blood pressure, and heart disease.

Infants

According to the American Academy of Pediatrics and the CDC, breastfed babies are less likely to become overweight. The CDC also reports that the longer babies are breastfed, the less likely they are to become overweight as they grow older. However, many formula-fed babies grow up to be adults of healthy weight. If your child was not breastfed, it does not mean that he or she cannot achieve a healthy weight.

Children and teens

Young people generally become overweight or obese because of poor eating habits and lack of physical activity. Genetics and lifestyle also contribute to a child’s weight status.

Recommendations for prevention of overweight and obesity during childhood and teens include:

Gradually work to change family eating habits and activity levels rather than focusing on a child’s weight.

Be a role model. Parents who eat healthy foods and participate in physical activity set an example so that a child is more likely to do the same.

Encourage physical activity. Children should have 60 minutes of moderate physical activity most days of the week. More than 60 minutes of activity may promote weight loss and provide weight maintenance.

Reduce “screen” time in front of the television and computer to less than 1 to 2 hours daily.

Encourage children to eat only when hungry and to eat slowly.

Don’t use food as a reward or withhold food as a punishment.

Keep the refrigerator stocked with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks and snacks high in sugar and fat.

Serve at least 5 servings of fruits and vegetables daily.

Encourage children to drink water rather than beverages with added sugar. These include soft drinks, sports drinks, and fruit juice drinks.

Adults

Many of the strategies that produce successful weight loss and maintenance help prevent obesity. Improving eating habits and increasing physical activity play a vital role in preventing obesity. Recommendations for adults include:

Keep a food diary of what you ate, where you ate, and how you were feeling before and after you ate.

Eat 5 to 9 servings of fruits and vegetables daily. A vegetable serving is 1 cup of raw vegetables or 1/2 cup of cooked vegetables or vegetable juice. A fruit serving is 1 piece of small to medium fresh fruit, 1/2 cup of canned or fresh fruit or fruit juice, or 1/4 cup of dried fruit.

Choose whole grain foods, such as brown rice and whole wheat bread. Don’t eat highly processed foods made with refined white sugar, flour, high-fructose corn syrup and saturated fat.

Weigh and measure food to be able to learn correct portion sizes. For example, a 3-ounce serving of meat is the size of a deck of cards. Don’t order supersized menu items.

Learn to read food nutrition labels and use them, keep the number of portions you are really eating in mind.

Balance the food “checkbook.” If you eat more calories than you burn you will gain weight. Weigh yourself on a weekly basis.

Don’t eat foods that are high in “energy density,” or that have a lot of calories in a small amount of food. For example, an average cheeseburger with and order of fries can have as much as 1,000 calories and 30 or more grams of fat. By ordering a grilled chicken sandwich or a plain hamburger and a small salad with low-fat dressing, you can avoid hundreds of calories and eliminate much of the fat intake. For dessert, have a serving of fruit, yogurt, a small piece of angel food cake, or a piece of dark chocolate instead of frosted cake, ice cream, or pie.

Simply reducing portion sizes and using a smaller plate can help you lose weight.

Aim for an average of 60 to 90 minutes or more of moderate to intense physical activity 3 to 4 days each week. Examples of moderate intensity exercise are walking a 15-minute mile, or weeding and hoeing a garden. Running or playing singles tennis are examples of more intense activities.

Look for ways to get even 10 or 15 minutes of some type of activity during the day. Walking around the block or up and down a few flights of stairs is a good start.

Many people do not know when or where to start getting help for obesity. In general, people should try to lose weight if they have a large waist circumference, a family history of certain chronic diseases, or have preexisting medical conditions. Weight loss programs should include healthy eating plans, regular physical activity, and slow and steady weight loss plans.

Getting Help With Obesity: What Are My Options?

When to Seek Obesity Help

• A large waist circumference: Men who have waist circumferences greater than 40 inches and women who have waist circumferences greater than 35 inches are at a higher risk for diabetes, dyslipidemia (abnormal amounts of fat in the blood), high blood pressure, and heart disease.

Obesity Epidemic

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To reverse the obesity epidemic, places and practices need to support healthy eating and active living in many settings. Below are recommended strategies to prevent obesity.

Nutrition, Physical Activity, and Obesity Prevention Strategies

The CDC Guide to Strategies to Increase Physical Activity in the Community Cdc-pdf [PDF-1.2MB] provides guidance for program managers, policy makers, and others on how to select strategies to increase physical activity.

Physical Activity: Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design External
The Community Preventive Services Task Force recommends built environment strategies that combine one or more interventions to improve pedestrian or bicycle transportation systems with one or more land use and environmental design interventions to increase physical activity.

The CDC Guide to Strategies to Increase the Consumption of Fruits and Vegetables Cdc-pdf [PDF-2.1MB] provides guidance for program managers, policy makers, and others on how to select strategies to increase the consumption of fruits and vegetables.

The CDC Guide to Breastfeeding Interventions provides state and local community members information to choose the breastfeeding intervention strategy that best meets their needs.

Recommended Community Strategies and Measurements to Prevent Obesity in the United States Cdc-pdf [PDF-376KB] contains 24 recommended obesity prevention strategies focusing on environmental and policy level change initiatives that can be implemented by local governments and school districts to promote healthy eating and active living.

• Implementation and Measurement Guide Cdc-pdf [PDF-2.6MB] can help communities implement the recommended obesity prevention strategies and report on the associated measurements.
• Healthy Communities: What Local Governments Can Do to Reduce and Prevent Obesity Cdc-ppt [PPT-8.5MB] is a presentation developed for use by local government staff that makes the case for investing in CDC’s Recommended Community Strategies and Measurements to Prevent Obesity in the United States Cdc-pdf [PDF – 375KB] . Also available in a PDF version Cdc-pdf [PDF-3.8MB] .

Early Care and Education Strategies

CDC’s framework for obesity prevention, in the ECE setting is known as the Spectrum of Opportunities Cdc-pdf [PDF-666KB] . The Spectrum identifies ways that states, and to some extent communities, can support child care and early education facilities to achieve recommended standards and best practices for obesity prevention. The Spectrum aligns with comprehensive national ECE standards for obesity prevention address nutrition, infant feeding, physical activity and screen time, Caring for Our Children: National Health and Safety Performance Standards (CFOC), 3rd ed. Cdc-pdf [PDF-4.71MB] External

School Health Guidelines

School Health Guidelines to Promote Healthy Eating and Physical Activity provides nine guidelines that serve as the foundation for developing, implementing, and evaluating school-based healthy eating and physical activity policies and practices for students in grades K-12.

The following resources are designed to assist schools and program coordinators to inform stakeholders and school health services staff on obesity facts, engaging students and managing chronic health conditions.

Community Guide

The Community Guide – Obesity Prevention and Control External is a free resource to help you choose programs and policies to prevent and control obesity in your community.

Clinical Guidelines

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Cdc-pdf [PDF-3.26MB] External This resource summarizes the integrated guidelines develop by the Federal Government to address cardiovascular disease in children and adolescents.

Screening for Obesity in Pediatric Primary Care: Recommendations from the U.S. Preventive Services Task Force External Guidance for primary care providers in screening for obesity and offering or referring to comprehensive, intensive behavioral weight management interventions.

Expert Committee Recommendations External The American Academy of Pediatrics released the Expert Committee Recommendations that suggest screening all children for obesity (>=2 years) and providing tiers of care regarding the treatment and prevention of obesity.

2013 Guideline on the Assessment of Cardiovascular Risk External This is a Report of the American College of Cardiology and the American Heart Association Task Force on Practice Guidelines for reducing the risk of cardiovascular disease.

In this Article

In this Article

In this Article

• What Causes Obesity in Children?
• What Diseases Are Obese Children at Risk For?
• How Do I Know if My Child Is Overweight?
• How Can I Help My Overweight Child?
• How Can I Involve My Family in Healthful Habits?

One third of children in the U. S. is overweight or obese, and this number is continuing to rise. Children have fewer weight-related health and medical problems than adults. However, overweight children are at high risk of becoming overweight adolescents and adults, placing them at risk of developing chronic diseases such as heart disease and diabetes later in life. They are also more prone to develop stress, sadness, and low self-esteem.

What Causes Obesity in Children?

Children become overweight and obese for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Only in rare cases is being overweight caused by a medical condition such as a hormonal problem. A physical exam and some blood tests can rule out the possibility of a medical condition as the cause for obesity.

Although weight problems run in families, not all children with a family history of obesity will be overweight. Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves, but this can be linked to shared family behaviors such as eating and activity habits.

A child’s total diet and activity level play an important role in determining a child’s weight. Today, many children spend a lot time being inactive. For example, the average child spends approximately four hours each day watching television. As computers and video games become increasingly popular, the number of hours of inactivity may increase.

What Diseases Are Obese Children at Risk For?

Obese children are at risk for a number of conditions, including:

• High cholesterol
• High blood pressure
• Early heart disease
• Diabetes
• Bone problems
• Skin conditions such as heat rash, fungal infections, and acne

Continued

How Do I Know if My Child Is Overweight?

The best person to determine whether or not your child is overweight is your child’s doctor. In determining whether or not your child is overweight, the doctor will measure your child’s weight and height and compute their ”BMI,” or body mass index, to compare this value to standard values. The doctor will also consider your child’s age and growth patterns.

How Can I Help My Overweight Child?

If you have an overweight child, it is very important that you allow them to know that you will be supportive. Children’s feelings about themselves often are based on their parents’ feelings about them, and if you accept your children at any weight, they will be more likely to feel good about themselves. It is also important to talk to your children about their weight, allowing them to share their concerns with you.В Your child’s doctor can also help you set healthy weight goals for your child’s height. The doctor can even guide on a timeline to achieve that healthy weight.

It is not recommended that parents set children apart because of their weight. Instead, parents should focus on gradually changing their family’s physical activity and eating habits. By involving the entire family, everyone is taught healthful habits and the overweight child does not feel singled out.

How Can I Involve My Family in Healthful Habits?

There are many ways to involve the entire family in healthy habits, but increasing the family’s physical activity is especially important. Some ways to accomplish this include:

• Lead by example. If your children see that you are physically active and having fun, they are more likely to be active and stay active for the rest of their lives.
• Plan family activities that provide everyone with exercise, like walking, biking, or swimming.
• Be sensitive to your child’s needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren’t embarrassing or too difficult.
• Make an effort to reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.
• Try toВ make healthy meals together often and shop together for healthy food choices.

Continued

Whatever approach parents choose to take regarding an overweight child, the purpose is not to make physical activity and following a healthy diet a chore, but to make the most of the opportunities you and your family have to be active and healthy.

Strong state policies play a critical role in preventing obesity and promoting health. They impact our access to healthy affordable foods and our opportunities to be physically active.

Updated in January 2019, this interactive feature includes the latest data about individual state requirements in early childhood education settings, schools and communities.

You’ll find information about a number of policies and regulations aimed at promoting healthy eating and physical activity, including how many states have adopted requirements and how many policies each individual state has implemented. For example:

• Across the country, 34 states and Washington, D.C. require licensed early childhood education programs to provide meals and snacks that meet the Dietary Guidelines for Americans, which provide baseline nutritional standards for many settings.

• Shared use agreements can help increase opportunities for physical activity in communities. Forty-six states and Washington, D.C. have adopted a shared use policy that either requires or recommends cooperation between schools and communities to allow local residents access to schools’ recreational facilities outside of school hours.

• Complete streets policies incorporate safe and convenient walking and biking into transportation planning. They also improve conditions and opportunities for walking and biking. Nationwide, 29 states and Washington, D.C. have adopted complete streets policies with mandatory requirements.

Update january 2019

State Policy Interactive

See the complete set of more than 20 state policies aimed at preventing obesity and supporting health in early childhood, schools and communities. e Policy Interactive

Update january 2019

Profiles For 50 States And D.C.

Find your state’s full profile, including its obesity rates and rankings, obesity prevention policies, and more.

Updated: January 2019

Stories and Expert Perspectives

Hear from experts about the impact of policies and programs in their communities, read interviews with researchers about data releases, and learn how some communities are taking action to help more children grow up healthy, including from places that have measured a decline in childhood obesity rates.

Long term, the Foundation’s goal under this initiative is to reduce the proportion of adults, adolescents and children in Kentucky who are obese. Among the strategies for achieving this are increasing opportunities for physical activity, ensuring that healthy food and beverages are available to all, supporting diabetes prevention initiatives. In addition, we can increase media campaigns that promote healthier living. Specifically, the Foundation is working to:

• Increase the number of local health coalitions that are better equipped to influence policies and practices in their communities that prevent obesity.
• Support local coordination with diabetes prevention initiatives, including county Diabetes Prevention Programs.
• Help establish a Statewide School Health Coalition to coordinate support for better nutrition and increased physical activity in schools.
• Increase coordination and partnerships between governmental and non-governmental agencies to advance state and local school health efforts around physical activity and nutrition.
• Increase the number of media campaigns, public service announcements, and programs that support obesity prevention (promoting healthy eating, increased physical activity, breastfeeding, etc.)

Reports

For more information, contact Amalia Mendoza, [email protected], 502-326-2583.

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Yasmine Ali, MD, is board-certified in cardiology. She is an assistant clinical professor of Medicine at Vanderbilt University School of Medicine and an award-winning physician writer.

Jenny Sweigard, MD, is board-certified in internal medicine. She is an in-patient physician at Novant Health Huntersville Medical Center in North Carolina.

• Overview
• Symptoms
• Causes
• Diagnosis
• Treatment
• Coping
• Prevention

That age-old advice to get a good night’s sleep turns out to have more to it in terms of health benefits than ever imagined.

In addition to preventing heart disease, stroke, depression, and other disorders, getting an adequate amount of high-quality sleep every night can prevent weight gain and obesity. What is the right amount? Most studies have shown that seven to nine hours of uninterrupted sleep per night are required to reap the health benefits of good sleep, including those related to preventing obesity.

What happens when we sleep? The body gets a chance to repair and restore itself. If it does not have enough time to do this over the long-term (chronically), then stress hormones and other inflammatory factors are released, as the body begins to react as if it were under chronic stress (which, without enough sleep, it is). One of the main players in terms of stress hormones is cortisol, which is released in response to chronic stress.

Among many other of its influences on the body, cortisol causes glucose (sugar) to be released into the bloodstream so that it is more readily available to feed the brain. As an evolutionary response to chronic stress, this probably worked quite well, enabling a person under stress to respond with more brain power.

However, in today’s world, an unwanted side effect of cortisol’s actions is the tendency for weight gain (makes sense that our ancestors would need to store or hold onto weight if they were truly under stress from a harsh environment). That weight gain, over time, can translate into obesity.

Indeed, studies have shown that lack of adequate sleep can result in overeating. And for those who are trying to lose weight, getting enough sleep (again, at least seven hours per night) increases the chance of success with weight loss.

According to Braunwald’s Heart Disease, time spent sleeping can make up as much as a third of our lifetime! This gives an idea of just how important sleep is for our bodies.

How can you be sure to get an adequate amount of sleep? First, you must make it a priority in your daily schedule. Secondly, good sleep hygiene is very important, especially if you suffer from insomnia.

Sleep Hygiene

According to the American Academy of Sleep Medicine, sleep can be improved in many cases of chronic insomnia by practicing good sleep habits, or sleep hygiene. Daily routines play a major role in how much good-quality sleep we get, so paying attention to these routines in the form of sleep hygiene is important.

Some examples of good sleep hygiene include: avoiding caffeine and alcohol prior to bedtime; preparing a sleep environment that minimizes light exposure and minimizing light exposure in the hours leading up to bedtime; going to sleep at the same time every night; and exercising regularly but not just before going to bed.

If you are practicing good sleep hygiene consistently and still suffer from chronic insomnia, it is important to check with your doctor regarding your situation, as other conditions can affect the amount and quality of your sleep, and multiple treatment options exist, depending on the underlying cause(s).

In both developed and developing countries, the prevalence of overweight and obesity in children has risen substantially in recent decades, with a global increase of 47% since the 1980s. 1

This trend is concerning to experts because of the numerous comorbidities that have been linked to overweight and obesity in children, including poor mental health, chronic diseases such as asthma, and cardiovascular risk factors such as hypertension. 2 In addition, overweight and obesity are associated with significant healthcare costs, including an estimated $113.9 billion in the United States annually. 3

Noting the increasing interest in potential interventions for the prevention or management of weight gain in children and adolescents, the authors of a 2017 systematic review examined evidence regarding these types of strategies implemented in various nonclinical settings for youth aged 2 to 19 years in many parts of the world.

A total of 56 studies (randomized controlled trials, quasi-experimental studies, and natural experiments) met the selection criteria, such as a minimum follow-up duration of 12 months (6 months for school-based interventions) and the inclusion of a control group. Studies also had to include at least 1 of the following primary outcomes: body mass index (BMI), BMI percentile, BMI Z score, waist circumference, body fat percentage, skinfold thickness, or prevalence of overweight or obesity.

Interventions were based in the following settings: school or after-school setting (n=41) studies, preschool (n=6), community (n=7), and home (n=2). According to the results, the most effective approaches were school-based and involved both diet and exercise components, as well as a home element. Of these interventions, there were 24 randomized controlled trials (RCTs), 15 quasi-experimental studies, and 2 natural experiments. Several examples of these studies are highlighted here:

• In 1 RCT, 342 kindergarten students were assigned to a control group or an intervention that included 45 minutes of daily, game-based physical activity and techniques such as games and stories to teach the children about nutrition. 4 At the 1-year follow-up, the BMI of intervention participants had decreased significantly more than that of control patients (−0.73 kg/m 2 vs −0.33 kg/m 2 ; P =.005).
• A cluster randomized trial conducted across 16 primary schools in Spain used an educational intervention that “encouraged self-efficacy in health-related decisions and involved families through presentations and newsletters,” as described in the review. 5 At the 6-year follow-up, a smaller increase in BMI was observed in the intervention group vs controls (2.79 kg/m 2 vs 3.85 kg/m 2 ; P =.023).
• An RCT involving 253 adolescent girls in Brazil employed an intervention consisting of enhanced physical education classes, nutrition lessons, and workshops. 6 At 6 months, a significant effect was observed in the intervention group for waist circumference (difference −2.28 cm; P =.01) but not BMI.
• A cluster randomized trial of 318 children in the UK used 20 weekly lessons on nutrition and physical activity. 7 Ten weeks postintervention, there was a significant reduction in BMI Z score (difference −0.24; P =.04), but not waist circumference or BMI.
• In a quasi-experimental study conducted in 6 middle schools in Italy, an intervention that included environmental aspects such as educational posters and reinforcement techniques such as text messaging was linked to a significantly lower BMI Z score at 2 years (difference, −0.18; P = .003). 8

The small number of studies conducted in other settings produced less consistent results, partly as a result of heterogeneity in characteristics and design. The 5 RCTs conducted in preschool settings, however, showed moderate evidence for the effectiveness of physical activity interventions alone, as well as strategies that combined diet and physical activity.

Related Articles

• Risk for Childhood Obesity Increased With Low Maternal Vitamin D Levels
• Effect of School-Based Intervention on Preventing Childhood Obesity
• Childhood Obesity Rates Have Flattened in High-Income Countries

Endocrinology Advisor discussed these findings with the following experts: review coauthor Sara Bleich, PhD, professor of public health policy at the Harvard TH Chan School of Public Health, Boston, Massachusetts; and Roy Kim, MD, MPH, head of pediatric endocrinology at the Cleveland Clinic Children’s hospital in Ohio.

Endocrinology Advisor: In summary, what are the main takeaways of this review?

Roy Kim, MD, MPH: Among their findings is that school-based prevention programs tended to be more successful than programs based in the other settings. The results also suggest that among school-based programs, those that combine diet and physical activity, rather than focusing on 1 approach alone, tend to be more successful at preventing overweight and obesity. Furthermore, success was also promoted by the inclusion of a home-based component to the school program.

Endocrinology Advisor: In light of these findings, and in general, how can healthcare providers support efforts to prevent overweight and obesity in children?

Sara Bleich, PhD: This review did not focus on the clinical setting. Given our finding that school-based interventions combining diet and physical activity are more effective, healthcare providers can support efforts to prevent childhood obesity by adopting complementary strategies. For example, health systems, and particularly those targeting children, should consider modifying their food and beverage options to support healthy choices and incorporating play areas where children can be active, such as playgrounds.

Endocrinology Advisor: What are the direct or indirect treatment implications for clinicians?

Dr Bleich: During each clinical encounter, healthcare providers should encourage healthy behaviors among children and their families that can help reduce obesity risk; for example, not drinking sugary beverages and reducing screen time. There is no single factor that can solve the problem of childhood obesity, but interactions with healthcare providers that encourage healthy habits are 1 important piece of the puzzle.

Dr Kim: Their review omits primary care settings; the findings do not diminish the importance of other interventions to prevent overweight and obesity, many of which occur in primary care settings. The study was not designed to assess the role of prenatal care to promote healthy weight during pregnancy, for example, or other early life interventions.

Endocrinology Advisor: What should be the focus of future research on this topic?

Dr Bleich: Future research should examine how integrating information about a child’s community into the electronic medical record can help healthcare providers provide more meaningful advice about reducing obesity risk. For example, if there are no safe parks near a child’s home, a healthcare provider might encourage indoor games that promote physical activity.

Dr Kim: Additional studies should focus on longer-term results, include settings in developing countries, and identify what aspects of the diet and physical activity interventions are most effective. Research should also focus on interventions to reach toddlers and preschool age children, as early intervention is likely going to be more effective and durable.

Scientific review published in Advances in Nutrition concludes, “starting early isn’t an option, it’s essential.”

Today in the United States, some 18% of children are obese. These children carry an increased risk of asthma, type 2 diabetes, and orthopedic disorders. Studies have also found a link between childhood obesity and poor academic performance.

The roots of childhood obesity can begin in utero. Maternal obesity and excessive weight gain during pregnancy, for example, both correlate with a higher risk of childhood obesity. Moreover, other determinants of childhood obesity, such as rapid weight gain during infancy, are well established before age five.

Obese children are more likely to become obese adults. As obese adults, they will have a higher risk of many of the major causes of adult mortality, including coronary artery disease, hypertension, stroke, chronic kidney and liver disease as well as many types of cancer. Collectively, the direct health care costs related to childhood and adult obesity are estimated to be more than $275 billion dollars annually.

Current guidelines recommend initiating screening for childhood obesity between ages six and twelve. However, according to the authors of “Childhood Obesity Requires New Strategies for Prevention,” a Perspective published in Advances in Nutrition, the international review journal of the American Society for Nutrition, “this may miss an important window during which obesity may be developing in many younger children.” Instead, the authors argue that childhood obesity prevention must start early, beginning with the implementation of strategies to achieve healthy maternal weight prior to pregnancy.

The authors then advocate for a broad range of infant and early-childhood interventions to reduce childhood obesity risk, including:

• Improving the rate of exclusive breastfeeding for the first 6 months of life, which could reduce childhood obesity up to 30%.
• Establishing early home health interventions and frequent weight and feeding monitoring for newborns identified as high risk for obesity.
• Imposing taxes on sugar-sweetened beverages, which studies have shown reduces the consumption of added sugars in children’s diets.
• Reducing obesity among adolescent and young adult women, leading to an estimated 10 to 22% reduction in childhood obesity, with ongoing effects for subsequent generations.
• Investing in nutritional support for populations at highest risk for childhood obesity, including low-income families.
• Increasing research, government, and industry efforts to reduce the public’s exposure to environmental obesogens, chemicals that alter the body’s ability to control weight gain.

Obesity is a chronic disease associated with a shortened life expectancy. Because the determinants of obesity in childhood are well established before the age of five, this Perspective makes the case that “new policies directed at reducing obesity at the earliest stages…could alter the trajectory of childhood and adult obesity and improve population health, longevity, and quality of life throughout the life course.” The authors conclude, “starting early isn’t an option, it’s essential.”

How is obesity treated?

The best way to lose weight is to eat less and move more. Little steps mean a lot. Losing just 10% of your body weight can make a difference in your health.

You’ll have the most success if you make a long-term plan with your doctor. Your first goal will likely be to improve your health, not to reach an ideal weight.

Some people take medicines or have surgery to help them lose weight. Your doctor may also suggest counseling. If you use food to cope with depression, loneliness, anxiety, or boredom, you can learn new skills to deal with those feelings.

You might want to try weight-loss medicines or have weight-loss surgery if:

• You do not lose weight after you have tried healthy eating and more activity for 6 months.
• You keep gaining weight.
• You have lost weight several times only to regain it.
• Your doctor is concerned about a health problem related to obesity, such as heart disease or diabetes.

Lifestyle changes

Most people have more success when they make small changes, one step at a time. For example, you might eat an extra piece of fruit or add more vegetables to your meals.

One of the best ways to increase your activity is by walking.

Medicines

Medicine may help you lose a small amount of weight. But without permanent changes in eating and exercise habits, most people gain weight again after they stop taking the medicine.

Surgery

After surgery, you will need to make big, lifelong changes in how you eat, including smaller portions and different foods.