Preventing obesity in American Indian children: when to begin

Obesity risk factors in American Indians and Alaska Natives: a systematic review

OBJECTIVES

We systematically reviewed the literature on risk factors for obesity in American Indians (AIs) and Alaska Natives (ANs) of all ages.

STUDY DESIGN

We searched titles and abstracts in PubMed with combinations of the following terms: obesity, body mass index (BMI), American Indian, Alaska Native, and Native American.

METHODS

We limited our review to articles that provided an empirically testable claim about a variable associated with obesity, measured obesity as a dependent variable, and provided data specific to AI/ANs.

RESULTS

Our final sample included 31 articles; 20 examined AI/AN youth (<18 years), and 11 examined AI/AN adults (≥18 years). Risk factors for obesity varied by age. In infants, low birth weight, early termination of breastfeeding, and high maternal BMI, and maternal diabetes increased the risk of childhood obesity. In children and adolescents, parental obesity, sedentary behaviors, and limited access to fruits and vegetables were associated with obesity. In adulthood, sedentary behaviors, diets high in fats and carbohydrates, stress, verbal abuse in childhood, and the belief that health cannot be controlled were associated with obesity.

CONCLUSIONS

Extant studies have three limitations: they do not apply a life course perspective, they lack nationally representative data and have limited knowledge of the resilience, resistance and resourcefulness of AI/ANs. Future studies that avoid these shortcomings are needed to inform interventions to reduce the prevalence of obesity in AI/ANs across the life course.

Undernutrition and obesity in indigenous children: epidemiology, prevention, and treatment

Over the past 50 years there has been a shift in nutritional problems amongst Indigenous children in developed countries from under-nutrition and growth faltering to overweight and obesity; the major exception is small numbers of Indigenous children predominately living in remote areas of Northern Australia. Nutritional problems reflect social disadvantage and occur with disproportionately high incidence in all disadvantaged subgroups. There is limited evidence of benefit from any strategies to prevent or treat undernutrition and obesity; there are a limited number of individual studies with generalizable high grade evidence of benefit. Potential solutions require a whole of society approach.

Prevention of overweight and obesity in children under the age of 6 years

Although obesity was rarely observed among children 30 years ago, it is now evident among Canadian children of all ages. Currently, 15.2% of 2- to 5-year-old children are overweight, whereas 6.3% are obese. Limited data suggest that poor dietary and physical activity patterns are increasing obesity risk among these young children. Body weight and lifestyle behaviours are known to track from childhood to adulthood, thereby increasing the risk for obesity and other chronic diseases later in life. Intrauterine life, infancy, and the preschool years may all include critical periods that program the long-term regulation of energy balance, and therefore obesity-prevention strategies should be initiated in utero and continue throughout childhood and adolescence. Although single-strategy obesity-prevention initiatives have had limited success, programs that target multiple behaviours may help reduce body weight and body fat among young children. Parental involvement is key to the success of obesity-prevention programs at a young age, as parents have primary control over their children's food and activity environments. Accordingly, parental obesity is the best predictor of childhood obesity. Parents should be encouraged to teach and role model healthy lifestyle behaviours for their young children. Health professionals can also be involved in obesity prevention, as they are ideally placed to identify young children at risk for obesity. By calculating and plotting the body mass index for all children, and initiating obesity-prevention strategies in utero, health professionals can help curb the rise in overweight and obesity among young children.

Nutritional concerns in aboriginal children are similar to those in non-aboriginal children in Prince Edward Island, Canada

OBJECTIVE

To assess food consumption among aboriginal children living on Mi'kmaq reserves in Prince Edward Island, Canada.

DESIGN

Data were collected as part of a larger study of health perceptions and behaviors in Mi'kmaq children and youth ages 1 to 18 years. Food consumption was assessed using a self-administered food frequency questionnaire during an in-home interview.

SUBJECTS/SETTING

Fifty-five children living on a reserve (53% of total population) ages 9 to 18 years.

STATISTICAL ANALYSES PERFORMED

The number of servings of milk products, vegetables and fruit, and snack foods/beverages was calculated by adding the responses to the frequency of consumption of foods assessed in each group. chi(2) analysis was used to assess differences in food consumption according to sex and age.

RESULTS

Only one child reported consuming the recommended minimum of five vegetables and fruit daily (Canada's Food Guide to Healthy Eating, 1992) (mean [+/-standard deviation]=2.8+/-1.1 servings). Twenty-five (49%) of the children consumed three or more servings of milk products daily (mean=2.6+/-1.3 servings). Approximately half of the children had three or more snack foods/beverages daily (mean=3.1+/-2.2 servings). Younger children (grades 4 to 6) consumed more cereal, peanut butter, and yogurt than older children. There were no significant differences in food consumption between boys and girls.

CONCLUSIONS

Our findings are consistent with past reports in aboriginal children. However, except for higher consumption of french fries, results are similar to recent surveys of other Prince Edward Island school children, suggesting a province-wide rather than cultural health issue.

Perceptions of children's body sizes among mothers living on the Texas-Mexico border (La Frontera)

OBJECTIVES

The objectives of this study were to quantify mothers' perceptions of their children's sizes and explore mothers' views of child growth, diet, activity, and health. Photographs of children from the Berkeley Longitudinal Growth Study (on Centers for Disease Control and Prevention [CDC] Web site) were used to stimulate discussion with mothers about child sizes.

DESIGN

A descriptive, cross-sectional study examined mothers' perceptions of their children's size and their beliefs about child size, growth, and health.

SAMPLE

The convenience sample included 25 mother-child dyads of 3-year-old children at two Head Start Centers in a county on the Texas-Mexico border. All mothers self-identified as Hispanic.

MEASUREMENT

Photographs of children were shown to elicit mothers' perceptions of children's body sizes. The children and mothers were weighed and measured and their body mass indices (BMIs) were computed. The mothers were interviewed about their beliefs on child health, growth, and feeding.

RESULTS

No congruence was found between mothers' perceptions of child sizes in the pictures and their children's sizes.

CONCLUSIONS

Using CDC photographs does not appear to be a useful way to educate mothers about child body sizes. A child who is happy, active, and can accomplish normal childhood activities is not considered by mothers as overweight, regardless of the child's BMI.

Feeding Patterns and Weight Among First Nations Children

Purpose: Little information is available on the growth and feeding patterns of First Nations children. Our goal was to assess the anthropometric status, feeding practices, and dietary intake of children born in 1994 or 1995 (n=102) and living in Walpole Island First Nation.

Methods: Information on demographic characteristics and infant feeding practices was obtained through parent interviews conducted between 1994 and 1999. Parents also completed a 24-hour dietary recall for their children when they were 48 months old. Head circumference was measured at three and 18 months, and weight and length/height at three, 18, 33, and 48 months.

Results: Most infants (75%) were breastfed at birth; however, by the time infants were three months old, 39.7% of the mothers had stopped breastfeeding. Over half (57.1%) of the infants were fed solids before age three months, 11.6% were given whole milk before age nine months, and 59.4% had low fat milk before age two years. Body mass index (kg/m2) (BMI) was above the 85th percentile for 27.8% at the 48-month interview, and was associated with a maternal BMI above 25 (OR=7.8, CI=1.1-41.9).

Conclusions: Mothers need to be encouraged to follow current infant feeding recommendations. Strategies should be developed to reduce the prevalence of overweight among adults and children in First Nations communities.