WallStreet Journal
The War on Obesity Targets Toddlers
Monday June 9, 2008 11:24 pm ET
By Shirley S. Wang

When took her daughter to a routine check-up two years ago, the pediatrician delivered surprising news: Melody, who had just turned 3, was overweight.

Like many parents of toddlers and preschoolers, Mrs. Matlack thought her daughter was too young to have weight issues. Still, she agreed to enroll Melody in an experimental weight-management program for very young children near their home in suburban Cleveland.

Mrs. Matlack says she and her husband, who struggle with their own weight, didn't want their children to face a lifelong battle with obesity. "We wanted to get them started on the right foot," she says. At weekly meetings, Melody learned about "thumbs-up" and "thumbs-down" foods and worked on arts-and-crafts projects about fruits and vegetables.

The Cleveland program is one of a growing number cropping up across the country, as more pediatricians and obesity experts subscribe to the view that it is never too early to start managing children's weight. "We used to think that chubby babies were cute and we didn't have to worry about it," says , the pediatrician who diagnosed Melody as overweight. But, "this is the age at which lifestyle food choices need to be made to prevent the kid from being a chubby adult."

The jury is still out on whether obesity programs for toddlers work or are even desirable. Because such programs are so new, their effectiveness hasn't been well-documented and the limited research that exists is mixed. Experts also caution that children need a balanced diet and should be able to eat unlimited amounts of nutritious foods, like vegetables. Children up to about the age of 5 need a higher percentage of fat in their diet than do adults, so following professionals' nutrition advice is critical for parents who want to manage their children's weight.

The Cincinnati Children's Hospital Medical Center launched a weight-management group for 2- to 5-year-olds in February. Children's Healthcare of Atlanta, which has been running FitKids, a program for 6- to 12-year-olds, recently began training health-care providers to counsel parents of newborns to 5-year-olds. Children's Healthcare says it started the new program after hearing from local physicians that they were seeing younger and younger overweight kids in their practices.

Preschool programs that increase physical activity for all kids, not just the overweight, are also on the rise, including Hip Hop to Health Junior in the Chicago area and the Spark program, which is used in hundreds of preschools across the U.S.

Not all families are receptive to the message that their young children are overweight. Some are offended or dismissive, often arguing that the weight is just "baby fat," pediatricians say. Many simply don't bring their child back for a follow-up visit.

When recently learned that her 3-year-old daughter was overweight, she had mixed feelings. "I don't want to make her feel like it's a big deal," says Mrs. West, who like the Matlacks lives in the Cleveland area. "I don't want to stress her to be anorexic."

Still, Mrs. West says her own childhood as an overweight girl had been difficult and she wanted to spare her two children the experience. For now, Mrs. West is reluctant to go to a nutritionist or join a program. She is trying to "police" what her kids eat and limit their consumption of "junk stuff" and time spent watching television.

There is no research to suggest that simply talking about health and weight to a preschooler can cause eating disorders, such as anorexia. But a parent who says to a daughter, "you're too chubby, you need to lose weight," can do damage, says Christine Wood, a pediatrician in Encinitas, Calif., and author of the book "How to Get Kids to Eat Great and Love It."

Still, Dr. Wood says: "You still have to address the issue. If people are just skirting it because, 'Oh I might create an eating disorder,' that's not going to work."

Indeed, obesity rates among 2- to 5-year-olds rose to 12.4% on average for the years 2003-2006, compared with 5% in 1980, according to the Centers for Disease Control and Prevention. Many obesity experts say this is partly due to poor eating habits and greater availability of junk food. Obesity can have serious health consequences in young children, such as stunted hip and leg-bone growth, says David Ludwig, director of the Optimal Weight for Life Clinic at Children's Hospital Boston. Some children as young as 5 now suffer from Type II diabetes and high cholesterol, conditions that primarily used to affect adults. Overweight toddlers also have a higher risk of being heavy later in life, studies show.

Lisa DaSilva, of Fairhaven, Mass., tried to be sensitive and diplomatic when she raised the subject of a weight-management program with her youngest child, Mitchell, two years ago. She told Mitchell, who was 5 and weighed nearly 90 pounds at the time, that the doctor wanted him to enroll in the program "to make sure you're healthy." Mitchell liked the idea because he wanted to lose weight to look like his brother, Myles, and because other kids called him fat.

Mitchell attended sessions at the Optimal Weight for Life Clinic in late 2006. He was weighed and given prizes for his hard work. He now tries to "listen to his tummy" tell him whether it is full.

Since December 2006, Mitchell has slimmed down to 72 pounds. He can run around longer without getting tired and, sometimes, when finished with a bath, he will say, "Mom, I look good," his mother says.

Eyeballing whether a child is too heavy is difficult because young kids often don't look overweight, says Jeannie Huang, an assistant professor in pediatrics at the University of California, San Diego. Parents should get their children's body-mass index -- a weight-to-height ratio commonly used to estimate body fat -- calculated once a year by a pediatrician, she says. If a young child is overweight, parents should make sure the youngster is getting balanced meals with fruits and vegetables, and should monitor the child's weight, says William Dietz, director of the CDC's division of nutrition, physical activity and obesity. Parents don't need to discuss weight with their child before making changes in the household, he says.

Mrs. Matlack, Melody's mother, was persuaded her daughter was too heavy after the girl was weighed during a doctor's visit. Melody was 37 inches tall and weighed 35¾ pounds, giving her a body-mass index of 18.4. That put Melody in the 97th percentile for kids her age and height, meaning that 97% of children her age and height have a lower body-mass index. Children at or above the 95th percentile are considered overweight by the CDC.

When his wife told him of the diagnosis, Rick Matlack says he felt that Melody was fine. But Mr. Matlack was aware that the eating habits he picked up early in life in a household that indulged in what he calls "comfort foods" and soda were probably partly to blame for his own weight issues.

At the pediatrician's suggestion, Mrs. Matlack signed Melody up for an experimental program for 3- to 5-year-olds, which is now called Healthy Kids, Healthy Weight, run by Rainbow Babies & Children's Hospital in Cleveland. For nearly three months, Melody and Mrs. Matlack attended weekly meetings with two other families. Melody learned to use a "thumbs-up" gesture to identify healthy foods she enjoys like fruit salad with lemon sprinkled on top, and a "thumbs-down" sign for those she doesn't like. For homework, she tried different fruits and vegetables and rated how much she liked them.

In separate parent sessions with pediatric psychologist Carolyn Landis, Mrs. Matlack learned which types of foods to keep in the house, age-appropriate portion sizes and how to set boundaries around eating.

The sessions, a mix of classroom-type learning and problem-solving discussions, involved talking about family habits, which was difficult for Mrs. Matlack at first. "It's a little uncomfortable, other people judging you on what you do in your house."

Mrs. Matlack credits the program for making a difference in her child's life. Melody is now eating smaller portions and drinks less juice and milk than she used to. Two years after following the program, she no longer qualifies as overweight. A body mass index reading in March put her in the 81st percentile of 5-year-olds her height. A boisterous girl with flowing blond hair, Melody still remembers "thumbs-up" foods. When asked to name one at a recent doctor visit, she answers, "Fruit!" with a wide smile on her face.

Write to Shirley S. Wang at shirley.wang@wsj.com

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