Health Care

March 19, 2014

Concerted effort targets childhood obesity in NC

For more than two years, some of North Carolina’s best minds in childhood development have been huddling to figure out how to slow the decades long increase obesity among kids. Now they and others who are trying to fight early childhood weight problems are sallying forth with a blueprint for how to wage that battle.

For more than two years, some of North Carolina’s best minds in childhood development have been huddling to figure out how to slow the decades-long increase in obesity among kids.

Now they and others who are trying to fight early childhood weight problems are sallying forth with a blueprint for how to wage that battle.

On Wednesday, members of a statewide task force that had been studying the problem came together in a summit with other heath care professionals, policy and public health experts, child care providers and parents to pore over the task force’s final report, which includes detailed recommendations for how to tackle the problem.

From 1981 to 2011, the obesity rate among North Carolina children ages 2 to 4 more than doubled, to 15.4 percent. The percentage of overweight children in the same age group also increased. Nearly 3 out of every 10 low-income children from ages 2 to 4 were either overweight or obese.

Obese children are more vulnerable to health problems, and they often become obese adults. Obesity can trigger a host of health problems in children and adults, including diabetes, cardiovascular disease, stroke, arthritis and certain cancers.

The summit, twice rescheduled because of winter weather, was the first public opportunity to discuss the 169-page “Promoting Healthy Weight for Young Children: A Blueprint for Preventing Early Childhood Obesity in North Carolina.” The blueprint was the culmination of two years of work by the N.C. Institute of Medicine’s Task Force on Early Childhood Obesity. It was created in collaboration with the Blue Cross and Blue Shield of North Carolina Foundation and the N.C. Partnership for Children.

The recommendations in the blueprint, which was funded by the foundation, form a multipronged strategy that involves health care providers, policymakers and community-targeted efforts. The aim is to reach as many kids as possible, whether or not they attend day care.

Issues with childhood obesity have made news for years as weights climbed. News last month of a study that showed an unexpected 43 percent drop in obesity among children ages 2 to 5 over a decade was initially encouraging, but the result is now being attacked as a statistical anomaly, and some believe the rate actually continues to increase.

A program in a handful of North Carolina child care centers, though, has begun having at least modest success in easing kids back into healthy weight ranges.

Solid results

Shape NC: Healthy Starts for Young Children just finished its third year. It’s a relatively small program, reaching about 1,000 kids in 19 communities, but it is reporting solid results. The percentage of children getting 90 minutes or more of physical activity a day jumped from 51 percent to 80 percent; those eating vegetables two or more times daily increased from 32 percent to 60 percent; and those getting fruit twice or more a day went from 34 percent to 80 percent.

There were modest but real improvements in the weight of the kids, according to a report on the first three years. The BCBS Foundation, which paid $3 million to cover the first three years, announced in January that it would fund another three at the same amount. One goal now is to expand it into dozens of additional child care facilities across the state.

Much of the discussion Wednesday was about how to spread the lessons from the Shape NC program throughout the state’s child care centers and homes, perhaps via a voluntary rating system that parents could use when trying to select the best option for their kids.

Some of the challenges to reducing obesity in infants were underlined by a new national study led by one of the speakers, Dr. Eliana Perrin, associate vice chancellor for research at UNC-Chapel Hill and a professor of pediatrics at the university’s medical school. Among other things, the study made clear that everyone involved in the effort probably should be paying attention to the problem much earlier in a child’s life than they might have thought.

The study, which will appear in the April issue of the journal Pediatrics, asked a group of more than 860 low-income, racially and ethnically diverse parents of 2-month-old children about various practices that are believed to increase the risk of obesity later in childhood.

Among the findings was that on average, half the parents put their infants in front of a television set for nearly half an hour a day, and that 90 percent of infants were in rooms with television sets on for an average of nearly six hours a day.

“That wouldn’t be so striking, except that they are just 2 months old,” Perrin said in an interview. “As pediatricians, we’ve been taught to counsel parents about TV watching because of the relationship between that and obesity and ADHD, but I think many would begin that counseling at 12 months, or 18 months, so we obviously need to be thinking about it earlier.”

More than 40 percent of parents put their babies to sleep with bottles, and fewer than one-fifth said their babies were solely breastfed – something widely considered more healthy than formula. Studies have shown breastfeeding is less likely to lead to unhealthy weight gain.

Ethnic variations

The study shows significant variation between African-American, Latino and white parents in the way they dealt with several aspects of child-rearing that could affect weight. Among them: Black parents were far more likely to fortify bottles of formula with cereal than white or Latino parents, something that could lead children to become overweight. Latino parents were more likely to breastfeed their children than African-American or white parents but also were more likely to encourage babies to finish a bottle or breastfeeding even after they had lost interest in eating.

The findings, Perrin said, suggest that interventions such as counseling should be tailored differently for families of different races and ethnicities.

She told the crowd at the summit that findings also signaled something else. The researchers had thought they were wise to start working with extremely young children, so that they could measure effects before potentially problematic choices by parents became an issue.

“One of the things we found is we may have started too late,” she said.

The statewide task force’s main chore was complete when it finished the blueprint, but in another sense its work is just starting.

The task force included key players from across the state in child care, health care and policymaking. Pam Silberman, president and CEO of the N.C. Institute of Medicine, said those involved will likely continue to hammer away at their part of the issue and have forged networks of contacts among those working on the other parts.

“The genius of these is – and it’s always really gratifying – when you engage so many different partners, they take ownership of it and they work on it afterwards,” she said. “In about three years, we’ll reconvene this group and say, OK, what happened as a result of this? And historically, what we see in about three years is anywhere from 50 percent to 75 percent, as high as 90 percent, of our recommendations have been acted on.”

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