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C Glossary Active play: Play that involves physical effort and action. Adiposity: The state of an excess of body fat. Artificial sweeteners: Substitutes for sugar that generally are not naturally occur- ring. Baby-Friendly Hospital Initiative: The “Ten Steps to Successful Breastfeeding” are set out in the joint World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) statement, “Protecting, promoting and supporting breastfeeding: the special role of maternity services.” The WHO/UNICEF Baby-Friendly Hospital Initiative was developed to ensure that every facility providing maternity services would fully practice all 10 steps to successful breastfeeding and to help effect the principles and aim of all Articles of the International Code of Marketing of Breast Milk Substitutes. BMI Z-score: Measure of standard deviations from BMI. Body mass index (BMI): One of the most commonly used measures for defining overweight and obesity, calculated as weight in kilograms divided by height in meters squared. 157

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Calorie-dense, nutrient-poor foods: Foods and beverages that contribute few vita- mins and minerals to the diet but contain substantial amounts of fat and/or sugar and are high in calories. Consumption of these foods, such as sugar-sweetened beverages, candy, and chips, may contribute to excess caloric intake and unwanted weight gain in children. Caries: Decay of a tooth. Child care: Supervising or providing nurturing to a child, especially by someone other than the child’s primary caretaker. Community providers: Include child care providers, faith-based organizations, librarians, and schools and teachers. Developmentally appropriate sleep durations: According to the National Sleep Foundation, developmentally appropriate sleep durations are as follows: • newborns, birth to <3 months: 10.5–18 hours in a 24-hour period; • infants, 3 months to <12 months: 9–12 hours during the night and 30-minute to 2-hour naps one to four times a day; • toddlers, 1 year to <3 years: 12–14 hours in a 24-hour period; and • preschoolers, 3 years to <5 years: 11–13 hours in a 24-hour period. Dietary Guidelines for Americans: The Dietary Guidelines for Americans have been published jointly every 5 years since 1980 by the Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA). The guidelines provide authoritative advice for those aged 2 years and older on how good dietary habits can promote health and reduce risk for major chronic diseas- es. They serve as the basis for federal nutrition assistance and nutrition education programs. Discretionary calories: The balance of calories, mainly from solid fat and added sugars, remaining in a child’s energy allowance after meeting nutritional require- ments from the intake of foods low in fat or with no added sugar. Dyslipidemia: A condition characterized by abnormal lipid and lipoprotein levels in the blood. Early Childhood Obesity Prevention Policies 158

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Dystocia: Childbirth that is difficult or abnormal. Energy-dense foods: Foods that are high in calories. Explicit marketing: Discrete, commercial messages, set off from program con- tent, designed to promote products and brands, such as television advertisements, Internet banner advertisements, and billboards. Federal poverty level: The threshold of income used to determine eligibility for government assistance programs. Food access: The extent to which a community can supply people with the food needed for health. Communities with poor food access lack the resources neces- sary to supply people with the food needed for a healthy lifestyle. The availability of high-quality, affordable food and close proximity to food stores increase food access. Food (and beverage) marketing: Promotion of the awareness, appeal, and sale of commercial food and beverage products and brands in media, retail stores, and vending machines and on billboards. Food security: Consistent, dependable access to enough food for active, healthy living. Food insecurity: A household-level economic and social condition of limited or uncertain access to adequate food. Healthy foods: Refers to foods of high nutritional quality, such as fruits and veg- etables, with minimal or no added sugar, fat, and salt; low-fat or nonfat dairy products; whole grains; and lean meats. Infant: A child from birth to 12 months of age. Light physical activity: Muscle-powered movement at a slow, easy pace; examples are slow walking, crawling, and limb or trunk motion while seated. Energy expen- diture is at a rate of 1.1 to 3.9 metabolic equivalent of task. 159 Appendix C

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Macrosomia: The condition of an infant with an excessive birth weight. Maternal and infant care practitioners: Include early Head Start educators, Healthy Start providers, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) providers, maternal hospital administrators and staff, physicians, nurses, dentists, and dietitians. Media: Include traditional print and television media and the emerging media of the Internet. Mixed feeding (los dos): Both breastfeeding and formula feeding during infancy. Moderate physical activity: Muscle-powered movement at a modest pace; exam- ples are brisk walking, hopping, jumping, and climbing. Energy expenditure is at a rate of 4.0 to 6.9 metabolic equivalent of task. Nonnutritive sweeteners: Sweeteners containing no calories or other nutrients. Nutrient-dense foods: Foods that contain substantial amounts of vitamins, min- erals, and other health-promoting components, such as fiber, and relatively few calories. Foods that are low in nutrient density supply calories but no or small amounts of vitamins, minerals, and health-promoting components. Obesity and overweight: Children and adolescents are defined as obese if they have a body mass index (BMI) above the 95th percentile for their age and sex and as overweight if they have a BMI between the 85th and 95th percentiles for their age and sex according to growth charts (http://www.cdc.gov/growthcharts). Obesity prevention: Steps that can be taken to reduce the incidence of obesity. Obesogenic environment: A set of circumstances that leads individuals to consume more calories than they expend, causing them to become obese. Peer support: In the context of breastfeeding, provided by mothers who are cur- rently breastfeeding or who have done so in the past; includes individual coun- seling and mother-to-mother support groups. Women who provide peer support undergo specific training and may work in an informal group or one-to-one Early Childhood Obesity Prevention Policies 160

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through telephone calls or visits in the home, clinic, or hospital. Peer support includes psychoemotional support, encouragement, education about breastfeeding, and help with solving problems. Physical activity: Body movement produced by the contraction of muscle that increases energy expenditure above the resting level. Policy maker: In this report, refers to a decision maker who has the authority to pass legislation affecting obesity prevention or other public health problems. Examples of policy makers are federal or state legislators, governors, and mayors. Poor sleep hygiene: Sleep habits that reduce sleep quality and impair sleep dura- tion, such as irregular bedtimes and wake times, use of caffeine or other stimu- lating substances before bedtime, inappropriate napping habits, engagement in stimulating or stressful activities close to bedtime, and sleep environments that are uncomfortable or disruptive. Preschool-age child: A child from age 3 until the time of enrollment in kindergarten. Product placement: Display of commercial food or beverage products within pro- gramming or interactive activities (usually in return for payment) in an appealing manner, or simply to reinforce recognition. Professional education: In the context of breastfeeding, includes any program designed to improve the knowledge, skills, attitudes, or behaviors of health care providers on the importance of breastfeeding, the physiology and management of lactation, or counseling related to breastfeeding. Health care providers are defined here as physicians; nurse midwives, nurse practitioners, and other nurses; nutri- tionists; lactation consultants; and other members of the health care team, such as pharmacists, social workers, speech/language pathologists, physical therapists, and occupational therapists. Responsive feeding: Feeding in which the adult interprets signals of hunger and fullness from the child and responds quickly to those signals. 161 Appendix C

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Screen time: Minutes or hours of individual exposure to television, DVD, or streaming video programming; videogames; Internet sites; enhanced cell phones; and other digital media. Structured physical activity: Activity that is developmentally appropriate and fun. Structured physical activity should include • daily planned physical activity that supports the development of age- appropriate motor skills, is engaging, and involves all children with minimal or no waiting; and • daily, fun physical activity that is vigorous (gets children “breathless” or breathing more deeply and more rapidly than during typical activities) for short bouts of time. Sugar-sweetened beverages: Beverages to which sugar, typically high fructose corn syrup or sucrose (table sugar), has been added, including soft drinks, fruit drinks, sports drinks, tea and coffee drinks, energy drinks, and sweetened milk or milk alternatives. Toddler: A child from 12 months up to 36 months of age. Unstructured physical activity: Child-initiated physical activity that occurs as the child explores his or her environment. Unstructured activity should include • activities that respect and encourage children’s individual abilities and inter- ests; and • teacher engagement with children, support for extending play, and gentle prompts and encouragement by teachers (when appropriate) to stay physi- cally active. Vigorous physical activity: Muscle-powered movement at a fast pace; examples are running, stair climbing, and cycling at a fast pace. Energy expenditure is at a rate of 7.0 metabolic equivalent of task or above. Early Childhood Obesity Prevention Policies 162