Ten years ago, pediatrician Gary Bean began noticing a trend in his Oakland practice. Babies were increasingly bigger, and they weren’t thinning out by the time they were crawling and walking. Toddlers came to appointments clutching Jack in the Box bags, and when Bean asked parents what else their youngsters ate, they rattled off processed foods.
To help educate parents, Bean hired a chef and nutritionist and even built a kitchen in his practice where he held weekly workshops on healthful meal planning. He did it for three years, until he ran out of money. Today, 30 percent of the children in his practice continue to be clinically obese, he says.
“Girth is often associated with prosperity, but what we need to encourage now is a leaner child,” Bean says.
Bean’s practice reflects a national trend. A Wayne State University study published in this month’s issue of the American Journal of Health Promotion reveals that one third of infants in the United States are obese or at risk for obesity. Children above the 95th percentile on standard growth charts were considered obese. Those in the 85th to 95th percentile were considered at risk for obesity.
While there are many culprits, from overfeeding babies to sedentary toddlers and processed foods, Bay Area pediatricians and obesity experts say parent education is the most important factor in preventing the undesirable weight gain that can lead to obesity-related diseases later in childhood.
“There is a generation or two of parents who have not received food or nutrition education from their parents or grandparents,” Bean says. “They’ve lost the idea of what food is really for. It’s become more about picking up something on the go.”
But, obesity is surfacing before babies celebrate year one. According to Detroit sociologist Brian Moss, lead author of the Wayne State University study, 31.9 percent of 9-month-olds are obese or at risk for obesity. The study of 8,000 infants was one of the first to monitor weight status changes of a nationally representative sample of children 2 and younger.
While the study doesn’t condone putting babies on diets or even conclude that overweight babies are doomed to be obese adults, Moss says that being overweight or obese at 9 months puts you on track for being overweight or obese in childhood. And that’s a reality: According to the U.S. Centers for Disease Control and Prevention, childhood obesity has more than tripled in the past 30 years.
So, tips on breast and bottle feeding are essential. Bean says parents need to remember that hunger is observational. They should look for visual cues that their baby is satiated, like slower sucking or boredom, instead of assuming that their tears and fussiness mean they want more milk.
“There’s a misperception that more is better,” Bean says. “But remember that sucking is a reflex after eating. Babies still may suck, but it doesn’t mean they’re still hungry. It might be time to introduce a pacifier or let them soothe themselves with their thumb.”
Marinela Miclea of Pleasant Hill uses those techniques, among others. Obesity runs in her family, and even though her 3-month-old, Olivier, is not overweight, Miclea says she is aware of overfeeding and had to “retrain” herself not to go for the milk every time he cried.
“Now I know when he’s hungry,” says Miclea. “It’s something in the way he cries. It’s just different.”
Miclea has a 2-year-old toddler named Colin and admits that the cues are easier to spot the second time around. Now, if Olivier cries after he eats, she looks for other culprits.
“Maybe his big brother was bothering him, or the TV was on too loud,” she says. “You have to teach your children how to soothe themselves.” A familiar toy or blanket, or letting him suck on his fingers, works well, she says.
“If you just wait five minutes, you can find a solution,” Miclea adds. “You don’t want to train people from the time they’re babies to reach for food when they’re uncomfortable.”
Pediatric weight management expert Lydia Tinajero-Deck agrees. She says the training should start earlier — in utero. She sees patients as young as 15 months in the hospital’s Healthy Hearts weight management program.
“Pregnant women must have a healthy diet and not gain more than the suggested weight,” she says. She also advocates for exclusive breast-feeding in those first six months because it is easier to watch for satiation cues, and it’s one person tracking the feedings. “When you use a bottle, different people have different judgment,” she says.
As Tinajero-Deck puts it, proper nutrition is not just about maintaining a healthy weight and preventing obesity. It is crucial to everything, including a baby’s bone and brain development.
So, while it doesn’t mean we have to say goodbye to the beloved image of a chubby baby, we do have to change our ways before they’re struck with serious diseases, like hypertension, that were once limited to older adults.
“We’re just not seeing them (babies) thin out anymore, especially the bottle fed ones,” Tinajero-Deck says. “It’s part of a societal shift. We’ve become sedentary and rely on processed foods because they’re cheaper and easier to feed to kids. I’m not saying a child should never have a cookie, but I see toddlers coming in with orange soda in their bottles. And that’s not OK.”
Baby obesity, by the numbers
A recent Wayne State University Study of 8,000 American infants born in 2001 revealed that the obesity epidemic has reached the diaper set. The study used percentiles determined by standard growth charts, which take into account sex, age, height and weight. Here are the results:
31.9 percent of 9-month-olds were obese or at risk for obesity.
34.3 percent of 2-year-olds were obese or at risk for obesity.
17 percent of the infants were obese at 9 months, rising to 20 percent at 2 years.
44 percent of the infants who were obese at 9 months remained obese at 2 years.
Hispanic and low-income children were at greater risk for weight status gain.
Females and Asian/Pacific Islanders were at lower risk for weight status gain.
Tips to fight obesity in babies
Eat a healthful prenatal diet. Don’t gain more than what is recommended by the American Congress of Obstetricians and Gynecologists.
Don’t overfeed a baby. Look for visual cues, like slowed sucking, averted eyes, and boredom, to indicate satiation.
If a baby has been fed and is still crying, try to soothe him in other ways. Use a pacifier or familiar toy. See if his diaper needs to be changed.
Rice cereal is the first solid food for babies. After that, introduce vegetables to get them familiar with the taste. Then move on to fruit.
Avoid giving toddlers too much juice. It is high in calories.
Introduce and encourage physical activity as early as possible.
Keep TV time to a minimum, especially in children 2 and younger.