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EARLY CHILDHOOD
OBESITY PREVENTION
POLICIES
Early Childhood Obesity Prevention Policies
Committee on Obesity Prevention Policies for Young Children
Leann L. Birch, Lynn Parker, and Annina Burns, Editors
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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing
Board of the National Research Council, whose members are drawn from the councils of
the National Academy of Sciences, the National Academy of Engineering, and the Institute
of Medicine.
This study was supported by Grant No. 61747, between the National Academy of Sciences
and The Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recom-
mendations expressed in this publication are those of the author(s) and do not necessarily
reflect the view of the organizations or agencies that provided support for this project.
International Standard Book Number-13: 978-0-309-21024-9
International Standard Book Number-10: 0-309-21024-0
Additional copies of this report are available from the National Academies Press, 500 Fifth
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Copyright 2011 by the National Academy of Sciences. All rights reserved.
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type by the Institute of Medicine is a relief carving from ancient Greece, now held by the
Staatliche Museen in Berlin.
Suggested citation: Institute of Medicine (IOM). 2011. Early Childhood Obesity Prevention
Policies. Washington, DC: The National Academies Press.
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
— Goethe
Advising the Nation. Improving Health.
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of science and technology and to their use for the general welfare. Upon the authority of the
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Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to se-
cure the services of eminent members of appropriate professions in the examination of policy
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www.national-academies.org
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COMMITTEE ON OBESITY PREVENTION POLICIES FOR YOUNG CHILDREN
LEANN L. BIRCH (Chair), Professor and Director, Center for Childhood
Obesity Research, Pennsylvania State University, University Park,
Pennsylvania
ALICE AMMERMAN, Professor, Department of Nutrition, Gillings School of
Global Public Health, University of North Carolina, Chapel Hill
BETTINA M. BEECH, Professor, Public Health Sciences, Wake Forest
University School of Medicine, Winston Salem, North Carolina
SARA BENJAMIN NEELON, Assistant Professor, Department of Community
and Family Medicine, Duke University Medical Center, Durham, North
Carolina
LAUREL J. BRANEN, Professor, Family and Consumer Sciences, University of
Idaho School of Family and Consumer Sciences, Moscow
DAVID V. B. BRITT, Retired President-Chief Executive Officer, Sesame
Workshop, Amelia Island, Florida
DEBRA HAIRE-JOSHU, Professor and Associate Dean for Research,
Washington University in St. Louis, Missouri
RONALD E. KLEINMAN, Physician in Chief, Department of Pediatrics,
Massachusetts General Hospital, Boston
SUSAN LANDRY, Professor, Department of Pediatrics, University of Texas,
Houston Medical Center
LYNNE OUDEKERK, Director, Child and Adult Care Food Program, New
York State Department of Health, Albany
RUSSELL R. PATE, Professor, Department of Exercise Science, University of
South Carolina, Columbia
DAVID A. SAVITZ, Professor, Department of Community Health, Brown
University, Providence, Rhode Island
WENDELIN SLUSSER, Associate Clinical Professor, Department of Pediatrics,
University of California at Los Angeles Schools of Medicine and Public
Health
ELSIE M. TAVERAS, Co-Director, Obesity Prevention Program, Department
of Population Medicine, Harvard Medical School, Boston,
Massachusetts
ROBERT C. WHITAKER, Professor, Center for Obesity Research and
Education, Temple University, Philadelphia, Pennsylvania
v
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Study Staff
LYNN PARKER, Study Director (from March 2011)
ANNINA CATHERINE BURNS, Study Director (until February 2011)
SHEILA MOATS, Associate Program Officer (from April 2011)
NICOLE FERRING HOLOVACH, Research Associate (until March 2011)
GUI LIU, Senior Program Assistant (from November 2010)
SAUNDRA LEE, Senior Program Assistant (until October 2010)
ANTON BANDY, Financial Officer
GERALDINE KENNEDO, Administrative Assistant
LINDA D. MEYERS, Director, Food and Nutrition Board
vi
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Reviewers
T his report has been reviewed in draft form by individuals chosen for their
diverse perspectives and technical expertise, in accordance with procedures
approved by the National Research Council’s Report Review Committee. The pur-
pose of this independent review is to provide candid and critical comments that
will assist the institution in making its published report as sound as possible and
to ensure that the report meets institutional standards for objectivity, evidence,
and responsiveness to the study charge. The review comments and draft manu-
script remain confidential to protect the integrity of the deliberative process. We
wish to thank the following individuals for their review of this report:
Sarah E. Barlow, Associate Professor of Pediatrics, Section of Gastroenterology,
Hepatology and Nutrition, Baylor College of Medicine, Houston, Texas
Debbie Chang, Vice President, Policy and Prevention, The Nemours Foundation,
Washington, DC
Myles Faith, Assistant Professor of Psychology, University of Pennsylvania School
of Medicine, Philadelphia
Doris Fredericks, Executive Director, Choices for Children, San Jose, California
Bernard Guyer, Professor Emeritus, Department of Population, Family and
Reproductive Health, Bloomberg School of Public Health, Johns Hopkins
University, Baltimore, Maryland
Dale Kunkel, Professor of Communication, University of Arizona, Tucson
vii
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Trish MacEnroe, Executive Director, Baby-Friendly USA, East Sandwich,
Massachusetts
Alan F. Meyers, Associate Professor, Department of Pediatrics, Boston
University School of Medicine, Massachusetts
Lisa Pawloski, Associate Professor and Chair, Global and Community Health,
George Mason University, Fairfax, Virginia
Virginia A. Stallings, Jean A. Cortner Endowed Chair in Gastroenterology and
Nutrition, Children’s Hospital of Philadelphia, Pennsylvania
Dianne S. Ward, Professor, Department of Nutrition, University of North
Carolina at Chapel Hill
Dawn Wilson, Professor, Department of Psychology, University of South
Carolina, Sumter
Although the reviewers listed above provided many constructive com-
ments and suggestions, they were not asked to endorse the report’s conclu-
sions or recommendations, nor did they see the final draft of the report before
its release. The review of this report was overseen by Neal A. Vanselow,
Professor Emeritus, Tulane University, and Elena O. Nightingale, Scholar-in-
Residence, Institute of Medicine. Appointed by the National Research Council
and Institute of Medicine, they were responsible for making certain that an
independent examination of this report was carried out in accordance with
institutional procedures and that all review comments were carefully consid-
ered. Responsibility for the final content of this report rests entirely with the
authoring committee and the institution.
viii Reviewers
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Preface
T he obesity epidemic has not spared even the nation’s youngest children;
about 20 percent of children are already overweight or obese before they
enter school, and rates are even higher among low-income children and among
African American and Latino children. These statistics are of particular concern
because, contrary to popular belief, children do not “grow out of” their “baby
fat.” Evidence indicates that excessive weight gain in the first years of life can alter
developing neural, metabolic, and behavioral systems in ways that increase the
risk for obesity and chronic disease later in life. Although few attempts have been
made to prevent obesity during the first years of life, this period may represent
the best opportunity for obesity prevention. During infancy and early childhood,
lifestyle behaviors that promote obesity are just being learned, and it is easier to
establish new behaviors than to change existing ones.
This report is one of a series of publications dedicated to providing suc-
cinct information on childhood obesity prevention specifically for policy makers.
Funded by The Robert Wood Johnson Foundation, the report addresses some
of the same themes as previous Institute of Medicine (IOM) reports on obesity
(including Local Government Actions to Prevent Childhood Obesity and Bridging
the Evidence Gap in Obesity Prevention), but focuses on young children from
birth to age 5. A number of key factors influence the risk for obesity in an infant
or young child, including prenatal influences, eating patterns, physical activity and
sedentary behavior, sleep patterns, and marketing and screen time. Young children
are dependent on parents, caregivers, and others to provide environments that can
ix
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help shape these factors in positive ways by, for example, supporting the develop-
ment of lifestyle behaviors that promote growth and development, making healthy
foods available in appropriate amounts, and providing safe places for active play.
Moreover, all of these factors come into play in the policy environment that sur-
rounds and influences parents and children and must be addressed in a coordinat-
ed manner if progress is to be made against the early onset of childhood obesity.
This report addresses all of these factors and offers policy recommenda-
tions that together form an action plan for addressing obesity in young children.
It focuses on the environments in which young children spend their time and is
directed at the adults who shape those environments. Parents play the primary
role in shaping children’s development and influencing their obesity risk through
genetics and home environments. However, the focus of this report is on poli-
cies that are developed and implemented by policy makers and by caregivers who
interact with parents and young children. Thus the report’s recommendations are
not made directly to parents but to these “intermediaries,” to ensure that early
childhood obesity prevention policies are implemented in a way that complements
and supports parents’ efforts to maintain healthy weight in their young children.
In particular, it is the committee’s hope that the report will find its way to federal,
state, and local government policy makers who work in areas that impact young
children in infancy and early childhood. The committee attempted to make the
report user-friendly so that what we have learned about obesity prevention for
young children can be put to good use in efforts to improve the present and future
health of the nation’s children.
I want to express my sincere appreciation to the other committee members
for their commitment to our task and the countless volunteer hours they con-
tributed to this study and the development of the report. I also want to thank
our workshop speakers for their insight and perspectives on preventing obesity
in the first years of life. In addition, many thanks to Rona Briere for her editing
of the report. Finally, I want to express my gratitude to the dedicated IOM staff
who worked with the committee on this project: Annina Catherine Burns, study
director; Nicole Ferring Holovach, research associate; Gui Liu, senior program
assistant; Sheila Moats, associate program officer; Lynn Parker, scholar; and Linda
Meyers, director, Food and Nutrition Board.
Leann L. Birch, Chair
Committee on Obesity Prevention Policies for Young Children
x Preface
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Contents
SUMMARY 1
1 INTRODUCTION 17
Obesity in Early Childhood, 19
Purpose and Scope of the Report, 22
Study Approach, 24
Organization of the Report, 30
References, 30
2 ASSESSING RISK FOR OBESITY IN YOUNG CHILDREN 35
Goal: Assess, Monitor, and Track Growth from Birth to Age 5, 35
Growth Monitoring, 35
Prenatal Influences, 45
References, 52
3 PHYSICAL ACTIVITY 59
Goal: Increase Physical Activity in Young Children, 60
Goal: Decrease Sedentary Behavior in Young Children, 70
Goal: Help Adults Increase Physical Activity and Decrease
Sedentary Behavior in Young Children, 72
References, 76
xi
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4 HEALTHY EATING 85
Goal: Promote the Consumption of a Variety of Nutritious Foods, and
Encourage and Support Breastfeeding During Infancy, 86
Goal: Create a Healthy Eating Environment That Is Responsive to
Children’s Hunger and Fullness Cues, 98
Goal: Ensure Access to Affordable Healthy Foods for All Children, 101
Goal: Help Adults Increase Children’s Healthy Eating, 107
References, 108
5 MARKETING AND SCREEN TIME 119
Goal: Limit Young Children’s Screen Time and Exposure to
Food and Beverage Marketing, 120
Goal: Use Social Marketing to Provide Consistent Information and
Strategies for the Prevention of Obesity in Infancy and
Early Childhood, 126
References, 129
6 SLEEP 135
Goal: Promote Age-Appropriate Sleep Durations Among
Children, 135
References, 142
APPENDIXES
A METHODS 149
B EMERGING ISSUES IN EARLY CHILDHOOD OBESITY
PREVENTION 153
C GLOSSARY 157
D ACRONYMS 163
E WORKSHOP AGENDA AND SPEAKER BIOGRAPHICAL
SKETCHES 165
F BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS 173
INDEX 183
xii Contents
