Severe Obesity Drops Among US Toddlers in Nutrition Program

Marlene Busko

January 08, 2018

The rate of severe obesity in American 2 to 4 year olds who live in low-income households and are part of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has declined modestly over the most recently studied 4 years, researchers report.

The WIC program provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and nonbreastfeeding postpartum women, and to infants and children up to age 5 years who are found to be at risk of poor nutrition.

The current study reports that among these disadvantaged toddlers in the nutrition program, the prevalence of severe obesity — defined as ≥ 120% of the 95th percentile of body mass index for boys or girls of the same age — was increasing a decade ago, but now seems to be declining slightly.

"Our findings indicate recent progress in reducing the prevalence of severe obesity among young US children enrolled in WIC," Liping Pan, MD, MPH, from the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues report in their article published online January 8 in JAMA Pediatrics. 

However, "severe obesity in early childhood remains a serious public health concern because of its common adverse health and social consequences," they stress.

Further studies are needed to determine if this drop in severe obesity is a blip or part of a continued improvement, and whether it can be traced back to the nutrition-enrichment program.

Nevertheless, according to Dr Pan and colleagues, the findings suggest that "intervention efforts focusing on low-income children and their caregivers may be important for further reducing the prevalence of severe obesity among young children."


Largest Reduction in Severe Obesity Seen in 2 Year Olds

This research is important because children from low-income families are at high risk of becoming obese at a very young age, and tends to persist into adolescence and adulthood.

Childhood obesity is associated with impaired glucose tolerance, respiratory problems, increased health care costs, and premature death, the researchers note, and adult obesity carries an increased risk for stroke, coronary heart disease, diabetes, and many other chronic diseases.

Previous studies have examined trends in severe obesity in preschool-aged children from 1998 to 2010.

To investigate more recent trends, the researchers identified 22.6 million young children enrolled in WIC throughout the United States from 2000 to 2014.

Roughly half the children were boys, and about 40%, 35%, and 25% were 2 year olds, 3 year olds, and 4 year olds, respectively.

In 2014, 46% of the children were Hispanic, 28% were nonHispanic white, 20% were black, 4.3% were Asian/Pacific Islander, and 1.2% were American Indian/Alaska Native. 

Throughout the 14 years, severe obesity was consistently more common in 3 year olds than 2 year olds, and in 4 year olds than 3 year olds.

Girls were slightly more likely to be severely obese than boys, and Hispanic or American Indian/Alaska Native children were more likely to be severely obese than other children.

Overall, 1.8% of toddlers were severely obese in 2000. The prevalence increased to 2.11% in 2004 and stayed at 2.12% in 2010.

However, from 2010 to 2014, the overall prevalence of severe obesity decreased significantly from 2.12% to 1.96%.

The rate of severe obesity dropped among all age, sex, and racial/ethnic groups, but the largest relative decrease was in 2 year olds and Asian/Pacific Islander, Hispanic, and American Indian/Alaska Native children.

The findings are likely because of a complex mix of genetic, behavioral, and environmental factors, Dr Pan and colleagues speculate.

For example, the supplemental nutrition program is now more closely aligned with the latest American dietary guideline recommendations, they note, and food packages promote more fruits, vegetables, and whole wheat products and include more variety and culturally diverse healthy food options.

The researchers acknowledge that the study population is not representative of all American children, and only half of eligible children from low-income homes are enrolled in the program.

Nevertheless, the findings suggest that this supplemental nutrition program may be helping to lower the risk of severe obesity in these very young vulnerable children, they conclude.   

The authors have reported no relevant financial relationships.

JAMA Pediatr. Published online January 8, 2018. Abstract

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