Fat babies are not healthy, says new report on preventing obesity

BMJ 2011; 342 doi: (Published 28 June 2011) Cite this as: BMJ 2011;342:d4074
  1. Bob Roehr
  1. 1Washington, DC

Obesity often begins in the cot and so too should measures to tackle it, says a new report from the US Institute of Medicine that focuses on the period from birth to 5 years of age.

“Contrary to the common perception that chubby babies are healthy babies and will naturally outgrow their baby fat, excess weight tends to persist,” said Leann Birch, the Pennsylvania State University professor who chaired the report’s committee.

The report says that a fifth of American children aged 2 to 5 years are overweight or obese, double the proportion 30 years ago.

“Precisely because this early period is one of rapid development, it may afford the best opportunities for altering development in ways that can reduce obesity risk,” says the report. It adds, “Excess weight at a young age can hinder movement and normal activity and ultimately compromise later health and development.”

Its primary recommendations are structural and legal in nature, directed more at policy makers and organisations that work with parents rather than at parents themselves.

Paediatricians and other healthcare providers should use the opportunity of every routine visit to “measure weight and length or height in a standardised way” against guidelines of the World Health Organization and the US Centers for Disease Control and Prevention and to counsel parents on how to achieve a healthy weight.

Breast feeding to 12 months should be encouraged, with cow’s milk and water used as a supplement as needed, and the introduction of sugar sweetened drinks should be deferred and limited, says the report.

Once children are weaned, their diets should be high in fresh fruits, vegetables, and whole grains and low in added sugar and salt, as should the diet of the whole family. Government policies should promote access to fresh foods.

The next round of US dietary guidelines, scheduled for an update in 2015, should include recommendations from birth to age 2 years, which they currently omit.

The report also recommends that the regulation of daycare providers should include a review of sleeping arrangements, as insufficient sleep has been linked to metabolic changes associated with unhealthy weight gain. Studies also indicate that infants and young children are getting much less sleep in recent years.

The report recommends that children of all ages be given ample opportunity for physical activity. The use of restraint devices, such as high chairs and car seats, should be limited to the original purpose for which they were designed. Daycare facilities should allow at least 15 minutes active play per hour of care provided, preferably outside. Time spent in front of a television or computer screen should be restricted to no more than two hours a day, with no more than half of that occurring in a daycare setting.

“Childhood obesity is a multidimensional problem requiring a multidimensional solution,” the report concludes. It urges policy makers to be innovative in tackling the issue and flexible in adopting solutions.


Cite this as: BMJ 2011;342:d4074