In general, people with “flat feet” have a lowered arch at the inside of the foot, such that if they wet their feet and stood on a flat surface, they would leave a complete footprint.

All babies and toddlers have flat feet, with the arch developing during childhood; obese children are more likely than their thinner peers to retain a flat foot — as measured by footprint in studies — and it has been assumed that this is because their extra weight creates a “fallen” arch.

But the other possibility is that heavier children simply have more fat padding the soles of their feet.

This is important because flat feet caused by lowered arches, while not problematic for most people, can cause symptoms for some. Some children and adults have foot pain, and in the long-term, flat feet can contribute to ankle or back pain, for instance.

So for the new study, published in the International Journal of Obesity, Australian researchers used ultrasound tests to examine the feet of 75 obese children and 75 thinner children between the ages of 6 and 10.

They found that, in general, obese children did in fact have more fat padding the soles of their feet. But they also tended to have lower arches.

Exactly what, if anything, that might mean for obese children’s foot function or risk of future musculoskeletal problems is unclear, according to the researchers, led by Dr. Diane L. Riddiford-Harland of the University of Wollongong.

They say more research is needed to follow children over time, to see how obesity — as well as weight loss — might affect the structure and health of their feet in the long run.

When it comes to flat-footedness in children in general, recent studies have painted a positive outlook. A study published last year in Pediatrics, for example, found that among 11- to 15-year-olds, there was no relationship between the height of their arches and their performance on motor-skill tests — which included jumping, balance and speed.

In general, flat feet that cause no pain need no special therapy. If a child does have a pain, a doctor may recommend arch supports for the shoes or physical therapy.

In fact, extremely obese children have up to a 40 percent higher risk of GERD, while those who are moderately obese have up to a 30 percent higher risk of developing it, compared with normal weight children, researchers say.

“Although we know that childhood obesity, especially extreme obesity, comes with risks for serious health conditions, such as diabetes, cardiovascular disease and cancer, our study adds yet another condition to the list, which is GERD,” said study lead author Corinna Koebnick, a research scientist at Kaiser Permanente Southern California’s Department of Research and Evaluation in Pasadena.

While the causes of the chronic digestive disease are not known, obesity appears to be one of them, she noted. “With the increasing epidemic of childhood obesity, GERD may become more and more of an issue,” she added.

GERD can undermine quality of life, Koebnick said, noting that the disease can cause chronic heartburn, nausea and the potential for respiratory problems such as persistent cough, inflammation of the larynx and asthma.

GERD has already been linked to obesity in adults, many of whom are familiar with its intermittent heartburn resulting from liquid containing stomach acid that backs up into the esophagus. Untreated, GERD can result in chronic inflammation of the lining of the esophagus and, more rarely, to lasting damage, including ulcers and scarring.

About 10 percent of GERD patients also go on to develop a precancerous condition known as Barrett’s esophagus, which in a small minority will develop into cancer. Kaiser researchers noted that GERD that persists through adulthood increases the risk for esophageal cancer later in life.

Cancer of the esophagus is the fastest growing cancer in the United States, and is expected to double in frequency over the next 20 years. This increase may be partly due to the obesity epidemic, Koebnick said.

The report is published in the July 9 online edition of the International Journal of Pediatric Obesity.

For the Kaiser study, Koebnick’s team collected data on more than 690,000 children aged 2 to 19 years old. These children were members of the Kaiser Permanente Southern California integrated health plan in 2007 and 2008.

The researchers found 1.5 percent of boys and 1.8 percent of girls suffered from GERD. Among these children, obese children were much more likely to have GERD compared with normal-weight children.

This finding held true for those children 6 to 11 years old and those 12 to 19, but not for children 2 to 5, the researchers noted. The study did not find an association between GERD and BMI in young children.

The association between obesity and GERD remained even after taking race and ethnic background into account, Koebnick’s group found.

Across the United States, gastroesophageal reflux disease may affect 2 percent to 10 percent of children, according to other studies, and in one school-based study, 40 percent of teens 14 to 18 reported at least one symptom of esophageal GERD.

“Knowing that GERD is associated with obesity in children, pediatricians can counsel those children to report symptoms of GERD and make lifestyle changes that target not only obesity, but target GERD,” Koebnick said.

These changes include eating smaller meals, which will help reduce acid reflux, Koebnick said. “Whether losing weight will help isn’t known, “but we can guess that it will,” she said.

Dr. Aymin Delgado, assistant professor of pediatric gastroenterology at the University of Miami Miller School, said that “the findings confirm what we in pediatric gastroenterology have been suspecting, because it is what we see.”

Obesity affects every organ system, Delgado said. “Obesity poses clear risks for the future health of children,” she said. “Many of these risks are ones that occur later in life, and it is hard to show that they are real. However, this study, shows that they are and shows that we need to identify these risks and monitor overweight and obese children and to manage them appropriately.”

Delgado said the key is prevention. “We need to take the risk of overweight and obesity seriously and we need to do something about it now,” she said. “We need to keep the future health risks in mind when we see obese children.”

ObesityHelper reminds that best  anti obesity drug is still Phentermine.

But the program failed to reduce the overall numbers of overweight and obese schoolchildren — those numbers fell by 4 percent over three years whether the 42 middle schools in the study had such initiatives or not, the researchers report.

“The intervention, surprisingly, did not result in a [population-wide] reduction in overweight or obesity,” said lead researcher Gary D. Foster, a professor of medicine and public health and director of the Center for Obesity Research and Education at Temple University, Philadelphia. “What’s surprising is that the control group improved as well,” he said.

The school-based initiative didn’t seem to have much of an impact on children who were not already overweight or obese by sixth grade, the team found, but it did impact children who were already having weight troubles by that grade level.

For those kids, “there were small [weight-loss] effects of about 3 percent. Although that’s small, it’s enormous given the rates of obesity in this country,” Foster said. “This was an unexpected but fortunate finding — that we are actually impacting the kids at the greatest risk.”

The findings are slated to be presented Sunday at the annual meeting of the American Diabetes Association in Orlando, and they are also being simultaneously published online in the New England Journal of Medicine.

For the study, Foster’s team randomly assigned more than 4,600 students from the 42 schools to a diet, exercise and information program, or to a program where only their weight and height was assessed. The study targeted schools with high levels of minority children, because studies have shown that they are at especially high risk for obesity.

Children in the program were offered healthier food choices throughout the school: in the cafeteria, at snack bars and in vending machines, and during class events. These included: lower-fat, higher-fiber foods; more fruits and vegetables; and an emphasis on water, low-fat milk and drinks with no added sugars.

In addition, there were longer, more intense periods of physical activity for the schoolchildren, and activities and awareness campaigns to promote healthy living.

The researchers found that children who were already obese at the start of the program lost a significant amount of weight, as indicated by reductions in waist size, compared with other children.

In fact, children in program schools who were either overweight or obese in the sixth grade had 21 percent lower odds of being obese by the end of eighth grade, compared with students in schools without such initiatives. The program also lowered levels of fasting insulin, a key indicator for diabetes risk, the researchers found.

However, children from both types of schools had the same average blood sugar levels and the same percentage of students with elevated blood sugar, the study authors noted.

Foster said that it is intriguing that the rate of overweight and obesity dropped by 4 percent regardless of whether the school had an anti-obesity program in place or not. “This is potentially good news — that the rates of childhood obesity appear to be declining [naturally],” he said.

Several factors may be at work in this decrease in overweight and obesity even among those children, Foster noted, including children putting more attention on their weight. Just the fact that the researchers were measuring children’s height and weight might have made the youngsters more weight conscious, he added.

“Something has changed and we’ve got to figure out what that something is,” Foster said.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine said that “the results of this study are open to interpretation, and thus conclusions are apt to reside in the eyes of the beholder.”

People who don’t put much stock in school-based interventions will point to the lack of an effect overall, he said. “However, those who perceive value in school-based interventions — and I am among these — will focus on the obvious pattern in an array of secondary outcomes, including reductions in body fat and insulin levels, which in turn would be expected to reduce diabetes risk,” Katz said.

And the program’s effect on obese children is important, Foster said.

“There is a strong signal here that this program can make a difference,” Foster said. “If we can reduce the risk of type 2 diabetes in children by reducing the rates of obesity and reducing waist circumference, that’s an important outcome,” he said.

In a study of more than 8,500 UK adults followed since their birth in 1958, researchers found that the study participants’ young children were 50 percent more likely to be overweight or obese than they themselves had been back in the 1960s.

When the researchers looked at factors that could be associated with the trend, they found that mothers’ full-time employment, which was more common in the younger generation, appeared to be one.

The findings, published in the American Journal of Epidemiology, do not prove that moms’ full-time work, per se, contributes to the risk of childhood obesity.

One possibility, according to the researchers, is that children of full-time working moms have fewer family meals or less-healthy diets in general.

So the trend in mothers’ employment over the past few decades may be one of the variables contributing to a general erosion in children’s diets; the explosion in sugary junk foods on the market, food advertising aimed at kids, and the increasing availability of high- fat, high-sugar fare in schools are among the other factors that have been blamed.

The current study lacked information on the children’s diets and exercise habits, so it is not known whether kids of working moms did in fact have poorer-quality diets or were less active.

For the study, Dr. Leah Li and colleagues at the University College London analyzed data from a project that has followed a large group of Britons since their birth in 1958. They focused on 8,552 participants who, in 1991, had a total of 1,889 children between the ages of 4 and 9.

Overall, the children were more likely to be overweight or obese than their parents had been back in 1965: 12 percent of boys were overweight or obese, versus 8 percent of their fathers in childhood; and 18 percent of girls were heavy, versus of 11 percent in their mothers’ generation.

Li’s team found that both parents’ current weight and mothers’ employment status were associated with the risk of their children being overweight.

Children of mothers who worked full-time were 48 percent more likely to be overweight or obese than children of non-working mothers. That was with factors such as socioeconomics, parents’ weight and breastfeeding (which some studies have linked to a lower risk of childhood obesity) taken into account.

When parents were obese, the odds of the child being overweight were three to six times greater than when parents were normal-weight.

Rates of both parental obesity and full-time work among mothers increased between the two generations. In 1991, 60 percent of mothers worked, including 15 percent who were full-time; that compared with 45 percent and 10 percent, respectively, in 1965.

Similarly, about 12 percent of parents were obese in 1991, versus 5 to 7 percent of the first generation’s parents in 1965.

So it’s possible, according to Li and her colleagues, that both factors (parents’ weight, in particular) contributed to the intergeneration increase in childhood weight.

However, even if mothers’ employment is a factor in the rise of childhood obesity, it would only account for a small portion of that increase, the current findings suggest.

Based on their data, the researchers estimate that in 1991, less than 8 percent of cases of childhood overweight or obesity could be attributable to mothers’ employment.

In general, experts believe that a complex mix of societal factors — from shifts in eating habits, to greater reliance on cars and increasing hours logged in front of the TV or computer — has been behind the rise in childhood weight problems in recent decades.

SOURCE: http://link.reuters.com/heh49k

American Journal of Epidemiology, online May 20, 2010.

Oregon has the nation’s lowest rate of hefty kids, according to a new government study, which found big gaps between regions and ballooning obesity rates in many states from 2003 to 2007.

More than 16 percent of American children ages 10 to 17 years were not just overweight, but obese, in 2007. That’s a 10 percent rise from 2003. Mississippi topped the nation with more than a fifth of its kids obese.

Oregon was the star, with the lowest rate of obesity — defined as body mass index in the 95th percentile or above — at just under 10 percent. And Oregon was the only state whose childhood obesity fell significantly from 2003 to 2007.

Even the best states fell short. The federal Healthy People 2010 initiative set a childhood obesity goal of 5 percent. Only Wyoming girls came close to that, according to the study appearing in May’s Archives of Pediatrics and Adolescent Medicine.

“You’ve got such wide differences at the geographic level, which means there is potential to further reduce obesity,” said lead author Gopal Singh, an epidemiologist with the U.S. Health Resources and Services Administration.

What works? It’s unclear how much states can overcome the effects of poverty, race and family history — all of which have complex links to obesity.

Black and Hispanic young people in the study were twice as likely as whites to be overweight or obese, even when the researchers took into account other risk factors like inactivity and poverty.

Oregon is 90 percent white. It also has a high rate of breast-feeding, and some research suggests that protects against obesity.

Oregon law sets nutrition standards in schools and requires chain restaurants to provide nutritional information on request. Those steps, taken recently, wouldn’t have shown up in the new study’s results, but may reflect Oregon’s inherent interest in health.

The figures for this analysis came from a representative telephone survey of parents who gave information about their children. Figures for about 47,000 children were analyzed for 2003 and about 44,000 children for 2007. That’s not as accurate as a government survey that weighs and measures children. Data from that suggest childhood obesity rates nationwide may be starting to stabilize.

In a separate paper based on the same data, Singh found that a child living in a neighborhood with unsafe surroundings, poor housing and no access to sidewalks, parks and recreation centers had 20 to 60 percent higher odds of being obese or overweight.

Experts blame the rise in childhood obesity on fast food, neighborhoods without sidewalks, television, video games, schools neglecting physical education and a host of other societal changes, said Dr. Joe Thompson, director of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity.

Now, lawmakers must move the obesity numbers in the right direction to save future medical costs, if for no other reason, Thompson said.

Right now, one of most known medicines for reducing obesity is Meridia (Sibutramine).

Of course that still means that the majority of Americans are currently overweight and at high risk of chronic health problems, such as heart disease, diabetes and certain cancers. These risks continue to propel several national campaigns aimed at preventing obesity, particularly in children, including those spearheaded by First Lady Michelle Obama and former President Bill Clinton. But some researchers say such programs, which involve school-age children, may begin too late to benefit all children. (See a special report on the science of appetite.)

Increasingly, evidence suggests that obesity-prevention measures need to be taken earlier, in infancy or even before birth. According to the CDC’s National Health and Nutrition Examination Survey, rates of obesity in youngsters ages 2 to 5 have more than doubled since 1980, from 5.0% to 12.4%. And once a child sets down the road to an unhealthy weight, it becomes increasingly difficult for him to change course: according to one study, 80% of children who are overweight between ages 10 and 15 grow up to become obese 25-year-olds.

In November 2009, with funding from the Robert Wood Johnson Foundation, the Institute of Medicine (IOM) formed the Committee on Obesity Prevention Policies for Young Children, whose members will for the first time review evidence on obesity risk factors and health effects in children from birth to 5 years old and identify potential opportunities for intervention in this age group. The committee’s first report is expected in early 2011. (See five key questions about weight loss.)

Early Warning Signs
In a recent study of more than 1,800 children, who were tracked from before birth to age 4, Harvard researchers identified several risk factors for obesity that began in pregnancy or early childhood. They included pre-pregnancy obesity; gestational diabetes; low birth weight and rapid weight gain in infancy; stopping breast-feeding early; introducing solid foods before 4 months; short sleep in infancy; TV in children’s bedrooms; and higher consumption of fast food and sugary beverages in childhood. In many cases, these early risk factors were more common in black or Hispanic families than in white families, regardless of income.

The findings, first published online on March 1 by the journal Pediatrics, help explain why minority children are at higher risk for obesity early on: 16.7% of Mexican-American children ages 2 to 5 are obese, compared with 14.9% of black children and 10.7% of white children, according to CDC data. The authors emphasize that obesity prevention must not only begin early, but also address cultural issues and include education targeted to specific groups. The good news, says study author Dr. Elsie Taveras, an assistant professor of pediatrics and prevention at Harvard Medical School and a member of the IOM obesity committee, is that many risk factors involve behaviors than can be modified and are not due only to socioeconomic inequalities. “As a pediatrician, it’s frustrating for me to think, How am I going to change this person’s household income? But what a hopeful message to know that it’s actually not that in many cases,” she says. (See a slideshow about obesity rehab for teens.)

A Tipping Point for Obesity?
How early in life that prevention efforts need to target children is quickly becoming a central question to childhood-obesity research. One intriguing notion is that there exists an obesity threshold - or tipping point - in infancy, before which a chubby child may be safely steered away from a lifetime of obesity. A small study led by Dr. John Harrington, an associate professor of pediatrics at Eastern Virginia Medical School and Children’s Hospital of The King’s Daughters, analyzed childhood medical records of 111 obese children and adolescents - those with a body mass index (BMI) equal to or higher than 85% of their same-age peers - in order to determine the age at which children first became overweight.

On average, researchers found, overweight individuals first crossed the threshold into overweight territory before 22 months of age. In some kids it was even earlier, with about 25% of children already having gained more weight than recommended for their age and height at 3 months. The trajectory typically began early and remained consistent: the BMI of overweight children continuously diverged from that of normal-weight children, the difference increasing by 0.072 units per month starting at birth and crossing the 85th-percentile mark at about 21 months. Within the small sample, half of the overweight children became overweight before age 2, and 90% became overweight by age 5. “You’ve got to look at it in terms of intervention and prevention,” Harrington says. “If you’re trying to intervene at age 5, you’ve already missed the boat.” (See why we get fat.)

Part of the problem is that parents and pediatricians tend to overlook early signs of obesity. Many people view children with excess baby fat as healthy, and believe they’ll shed the weight as they grow. Harrington advises physicians to start screening babies earlier for immoderate weight gain and to broach the topic sooner with parents. There’s a lot parents can do at home to encourage healthy weight in their children, Harrington says, and making even one or two small changes can lead to lowered risk. For instance, Harrington advises parents to adhere to infants’ own cues for fullness and hunger, rather than encouraging them to eat more. And toddlers are “grazers,” so it’s perfectly healthy for them not to conform to an adult schedule of three square meals per day, he says.

Harrington’s study, first published online in February by the journal Clinical Pediatrics, suggests that the optimal age for instilling healthy eating and activity behaviors is before age 2. As children get older, it becomes more difficult to unlearn behaviors and reverse the trend, Harrington says. “The first thing to do is to recognize that there’s a problem and to see that maybe it didn’t start at age 4 or 5, or 6 or 7, but maybe before then,” he says. “The longer you’re overweight, the more likely it is that you’re going to be overweight as an adult.” (Read about the bugs in your gut.)

Getting a Head Start
Not all chubby kids grow up to be overweight adults; indeed, many heavy babies do shed their baby fat and remain slim thereafter. Determining which children are at higher risk, however, is easier said than done. The study that could answer that question has not yet been conducted. “The only way to do that is to do a prospective study of 10,000 kids, following them from birth to see what their trajectories are,” Harrington says. One such study is in the works - the National Children’s Study, which aims to follow 100,000 babies from the womb to age 21, was authorized by Congress in 2000 - but results from that research are still years away. (Read about good fat.)

For now, researchers say national childhood obesity prevention and education efforts should include families with newborns and toddlers, and promote healthy habits starting in pregnancy or earlier. Even seemingly minor actions, such as reminding pregnant women that they should not in fact be “eating for two” - in spite of their grandmother’s best advice - could reduce children’s chances of becoming obese, says Taveras. “Some of these things become so embedded in our thinking that they actually become our standard of care for our children,” she says. “If we really try to start focusing on prevention earlier, we might have a greater impact.”

The news is even worse for black and Hispanic kids: Among black teenage girls, 11.9 percent were classified as extremely obese, as were 11.2 percent of Hispanic teenage boys. Extreme obesity among children is defined as weighing more than 1.2 times the 95th percentile, or having a body-mass index (BMI) of 35 kilograms per meter squared.

“There is an alarming high frequency of extremely obese children,” said study author Corinna Koebnick, a research scientist at Kaiser Permanente Southern California Department of Research and Evaluation in Pasadena.

Koebnick said the obesity epidemic is driven by a combination of lack of physical activity and poor eating habits. “It’s unhealthy eating habits — fast food versus slow food,” she said.

Parents need to be role models for their children, Koebnick stressed. “There are studies suggesting parent’s weight has a significant influence on the child’s weight,” she noted.

Extreme obesity can lead to serious health problems such as diabetes and heart disease, Koebnick added.

“We need to watch these extremely obese kids more carefully, and we need to try to prevent adverse health effects that may come up in the near future,” she said.

“Children who are extremely obese may continue to be extremely obese as adults, and all the health problems associated with obesity are in these children’s futures. Without major lifestyle changes, these kids face a 10 to 20 years shorter life span and will develop health problems in their 20s that we typically see in 40- [to] 60-year-olds,” Koebnick said in a Kaiser Permanente news release.

Although these findings cover only children in southern California, Koebnick thinks they are representative of what is happening throughout the United States.

The report is published in the March 18 online edition of the Journal of Pediatrics.

For the study, Koebnick’s team collected data on 710,949 children and teens aged 2 to 19 who belonged to Kaiser Permanente Southern California integrated health plan in 2007 and 2008.

Using these data, the researchers found that 7.3 percent of boys and 5.5 percent of girls were extremely obese, which is more than 45,000 extremely obese children among all the children studied.

Obesity peaked at age 10 for boys and age 12 for girls. The most extremely obese were black teenage girls and Hispanic boys. The least extremely obese were Asian-Pacific Islanders and white children, the researchers found.

Samantha Heller, a dietitian, nutritionist and exercise physiologist, said that “the results of this survey are not surprising, but are heartbreaking when you consider the health consequences that these children will be facing, not to mention the social, emotional and psychological repercussions.”

It is critical for parents to learn how to provide healthy food for their families, Heller noted. “Healthy food can be affordable and delicious but consumers are led to believe that fast food, junk food and sweets are the easiest and cheapest way to go,” she said.

The public is bombarded with food advertising that targets children, Heller said. The 2008 Federal Trade Commission Report to Congress found that more than $1.6 billion was spent in 2006 marketing food and beverages to children.

“Imagine if that money, or even a fraction of it, was used to promote healthy foods like vegetables, fruits, whole grains and beans, and nutrition education for the public,” she said. “People would learn how to buy and prepare healthy foods on a budget and we could reduce the prevalence of obesity and chronic diseases like diabetes, heart disease and cancer, in our children,” Heller explained.

“Health professionals, food companies and local and state governments need to find ways to help educate, motivate and empower adults and children to lead healthier lives before it is too late to save our children,” Heller added.

ObesityHekper reminds that top anti obesity medications are phentermine and hoodia.

Researchers led by Jeanne Van Cleave, a doctor at Massachusetts General Hospital for Children in Boston, looked at the prevalence of conditions that lasted a year or longer in three groups of children, starting with a first cohort of more than 2,000 kids in 1988.

That group was tracked for six years, after which a second group was studied between 1994-2000 and finally a third group from 2000- 2006.

Mothers of the children were asked whether their kids had any “physical, emotional or mental condition that prevented him or her from attending school regularly, doing regular school work or doing usual childhood activities, or that required frequent attention or treatment from a doctor or other health professional.”

The information gathered was classified into one of four categories of chronic condition: asthma, behavior or learning disorders, obesity and other physical conditions.

“We found that prevalence of a chronic condition at any point during the study period was very high and increased over time,” the authors of the study, published in the Journal of the American Medical Association, said.

“Many factors may have contributed, including environmental changes, which may affect rates of chronic respiratory conditions and obesity,” and greater access to health care for children during the study period, which would have boosted diagnoses of childhood chronic conditions, the study says.

Reports of all chronic conditions, including the much-talked-about childhood obesity, rose from just under 13 percent at the end of the six-year follow-up for the first group of children to 26.6 percent in 2006, the study shows.

The obesity rate rose from 13.3 percent at the end of the first study group, in 1994, to nearly 16 percent at the end of the third cohort in 2006.

In the third and last group the researchers looked at, 51.5 percent of eight- to 14-year-olds “at one point in the six-year study period reported a chronic condition compared with 27.8 percent in cohort one,” the study says.

But unlike chronic conditions in adults, the childhood conditions were not necessarily long-lasting, the study said.

More than half of children who showed asthma-like wheezing before they were four years old had stopped having breathing difficulties by age six, and children with certain behavior disorders overcame them within a year.

The study also confirms what other recent research has shown: that obesity in the United States has reached a plateau.

There were fewer new cases of obese children reported in the third group of children — between 2000-2006 — than in the second group, a finding “consistent with previous reports of flattening childhood obesity rates in recent years,” the study says.

Four-year-olds in homes that followed these practices had a nearly 40 percent lower prevalence of obesity than children who did none of these things.

Of course childhood obesity - a soaring phenomenon in America - ultimately is fueled by poor diet and lack of exercise. But increasingly scientists have been able to tie other lifestyle factors to weight gain.

Obesity raises the risk of diabetes, heart disease and even cancer. The prevalence of obesity among children aged 6 to 11 years increased from 6.5 percent in 1980 to 19.6 percent in 2008, according to the U.S. Centers for Disease Control and Prevention.

Each routine on its own was associated with lower obesity, and more routines translated to lower obesity prevalence. The links held up even when other obesity risks were factored in.

“The routines were protective even among groups that typically have a high risk for obesity,” said Sarah Anderson, assistant professor of epidemiology at Ohio State University and lead author of the study. “This is important because it suggests that there’s a potential for these routines to be useful targets for obesity prevention in all children.”

Anderson and Robert Whitaker, professor of public health and pediatrics at Temple University, will detail their findings in the March issue of the journal Pediatrics.

Previous studies have conclusively linked poor diet to obesity. Increased consumption of fast food, sugary cereals, soda and other highly processed foods, at the expense of fruits, vegetables, whole grains and lean meats is considered a key cause of weight gain and poor overall health.

The new research was based on data collected in 2005 on 8,550 4-year-olds around the United States. Benchmarks for healthier children were set at: eating the evening meal as a family more than five times per week; obtaining at least 10.5 hours of sleep per night; and watching less than two hours per day of TV on weekdays.

Based on body mass index (BMI), 14.3 percent of the children whose households practiced all three routines were obese. In contrast, 24.5 percent living in households without any of the routines were obese. None of the three routines seemed to offer more health benefits than the others.

“Each one appears to be associated with a lower risk of obesity, and having more of these routines appears to lower the risk further,” Anderson said.

The research was funded by the U.S. Department of Agriculture’s Economic Research Service.

The recommendations from the U.S. Preventive Services Task Force (USPSTF) update those issued in 2005. At that time, the group said there was insufficient evidence to recommend routine obesity screening in children.

However, “since 2005, a series of randomized clinical trials have demonstrated that there is effective therapy, so we felt compelled to change the recommendations,” said the UPSTF panel chair Dr. Ned Calonge, chief medical officer of the Colorado Department of Public Health in Denver.

“This is an encouraging message. There’s hope for successful treatment, and we hope that parents will ask their pediatrician if their child needs intervention,” said Calonge.

He said it’s better to address the problem as early as possible in childhood instead of waiting until your child is grown.

“Once you become an overweight adult, it’s more difficult to change your behavior,” Colange said. “We do believe that childhood behaviors can be changed, and investing in changing these behaviors in kids is an investment that can pay off lifelong.”

The new recommendations will be published in the February issue of Pediatrics, and are available online on Jan. 18 on the Pediatrics Web site.

Although recent statistics suggest that the rate of childhood obesity may be leveling off, one out of every six U.S. children is still obese, according data from the U.S. National Center for Health Statistics released last Wednesday.

The new recommendations now urge doctors to screen all children between 6 and 18 years of age for obesity. Screening should be done using height and weight measurements used to calculate body mass index (BMI), and findings should be compared to other children of the same sex and age. Kids whose BMI is over the 95th percentile for their gender and age are considered obese.

For children or teens who meet the definition of obesity, the task force recommends that doctors refer children and teens to intensive weight-management programs. Such programs should include more than 25 hours of contact with the child or teen over the first six months, and include three components:

* Counseling for weight loss
* A physical activity program or counseling on physical activity
* Behavioral management counseling, such as teaching goal-setting and self-monitoring behaviors

In an editorial in the same issue of the journal, Dr. Sandra Hassink, a member of the American Academy of Pediatrics’ board of directors, wrote that the current USPSTF report is “significant because it provides evidence that obesity treatment can be effective and beyond the immediate intervention.” However, she also wrote that the recommendation fell short because it should have included younger children, from age 2 and up.

Another concern is that there may not be enough weight-management treatment programs available for all the children who meet the task force’s threshold for obesity.

“The recommendation is that any program for children should be at least 25 hours over six months, and it’s not easy to find programs that are 25 hours in duration,” explained Dr. Goutham Rao, clinical director of the Weight Management and Wellness Center at Children’s Hospital of Pittsburgh.

“Very intense programs like this are usually very expensive and private-pay, and they may take in few kids,” he said.

Calonge said that at least for now, there may be a shortage of programs. But, he said, as more children are referred, and more insurers start reimbursing for the treatment, more programs should become available. He pointed out that when mammograms were first recommended, few centers were available to address this need, but that hospitals and private companies quickly filled the gap.

Rao agreed that more programs will likely become available, and said that new ways to help children change their behaviors may be developed. At his own center, they’ve recently developed on online weight-loss program where children keep daily food logs and have email contact with a dietician.

And, despite the potential shortage of treatment programs, Rao said, these recommendations “are a major step in the right direction. The longer you wait to address obesity, the more habits are entrenched. The younger children are, the easier it is to make changes.”