Obesity is a major public health problem affecting adults and children in the United States. Since 1960, the prevalence of adult obesity in the United States has nearly tripled, from 13% in 1960-1962 to 36% during 2009-2010. Since 1970, the prevalence of obesity has more than tripled among children, from 5% in 1971-1974 to 17% in 2009-2010. Although the prevalence of obesity is high among all U.S. population groups, substantial disparities exist among racial/ethnic minorities and vary on the basis of age, sex, and socioeconomic status.

OBJECTIVE: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups .METHODS: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010-2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length ≥95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age ≥95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile. RESULTS: The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups. CONCLUSIONS: The high incidence underscores the importance of early-life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs.

Food insecurity has detrimental effects on the mental, physical, and behavioral health of developing children. Few studies, however, have sought to determine whether associations exist between food insecurity and intake of vegetables, fresh or canned fruit, candy or cookies, French fries, fast food, water, milk, fruit juices, fruit drinks, soda, and sports drinks. To identify independent associations that exist between maternal food insecurity and food and drink intake among toddlers, population-based data from the 2006-2008 Oregon Pregnancy Risk Assessment Monitoring System follow-back survey (Oregon PRAMS-2) of 1,522 mothers of 2-year-old children were analyzed. Maternal food insecurity was defined as mothers' report of eating less because of lack of money for food. Typical weekly child food and drink intake was examined using polytomous logistic regression: 0-1 days/week, 2-3 days/week, and 4-7 days/week. Maternal food insecurity prevalence was 11.7 %. Compared to toddlers of food secure mothers, toddlers of food insecure mothers consumed vegetables (adjusted odds ratio [AOR] for 4-7 days/week = 0.31; 95 % confidence interval [CI] 0.12, 0.79) and fruit (AOR for 4-7 days/week = 0.25; 95 % CI 0.08, 0.75) fewer days of the week. Toddlers of food insecure mothers consumed soda (AOR for 4-7 days/week = 3.21; 95 % CI 1.12, 9.14) more days of the week. Maternal food insecurity is associated with weekly intake of certain foods and drinks. Among toddlers, consumption of fewer vegetables and fruit, and more soda may help explain the link between food insecurity and poor health.

OBJECTIVE: Overweight and obesity during adolescence are associated with an increased risk for cardiovascular disease (CVD) risk factors. The objective of this study was to examine the recent trends in the prevalence of selected biological CVD risk factors and the prevalence of these risk factors by overweight/obesity status among US adolescents. METHODS: The NHANES is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. The study sample included 3383 participants aged 12 to 19 years from the 1999 through 2008 NHANES. RESULTS: Among the US adolescents aged 12 to 19 years, the overall prevalence was 14% for prehypertension/hypertension, 22% for borderline-high/high low-density lipoprotein cholesterol, 6% for low high-density lipoprotein cholesterol (<35 mg/dL), and 15% for prediabetes/diabetes during the survey period from 1999 to 2008. No significant change in the prevalence of prehypertension/hypertension (17% and 13%) and borderline-high/high low-density lipoprotein cholesterol (23% and 19%) was observed from 1999-2000 to 2007-2008, but the prevalence of prediabetes/diabetes increased from 9% to 23%. A consistent dose-response increase in the prevalence of each of these CVD risk factors was observed by weight categories: the estimated 37%, 49%, and 61% of the overweight, obese, and normal-weight adolescents, respectively, had at least 1 of these CVD risk factors during the 1999 through 2008 study period. CONCLUSIONS: The results of this national study indicate that US adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese.

With obesity affecting approximately 12.5 million American youth, population-level interventions are indicated to help support healthy behaviors. The purpose of this review is to provide a summary of population-level intervention strategies and specific intervention examples that illustrate ways to help prevent and control obesity in children through improving nutrition and physical activity behaviors. Information is summarized within the settings where children live, learn, and play (early care and education, school, community, health care, home). Intervention strategies are activities or changes intended to promote healthful behaviors in children. They were identified from (a) systematic reviews; (b) evidence- and expert consensus-based recommendations, guidelines, or standards from nongovernmental or federal agencies; and finally (c) peer-reviewed synthesis reviews. Intervention examples illustrate how at least one of the strategies was used in a particular setting. To identify interventions examples, we considered (a) peer-reviewed literature as well as (b) additional sources with research-tested and practice-based initiatives. Researchers and practitioners may use this review as they set priorities and promote integration across settings and to find research- and practice-tested intervention examples that can be replicated in their communities for childhood obesity prevention. (Expected final online publication date for the Annual Review of Nutrition Volume 32 is July 17, 2012. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.)

High intake of fruits and vegetables (FV) is associated with a decreased risk for many chronic diseases and may assist in weight management, but few children and adolescents consume the recommended amounts of FV. The pediatric practitioner can positively influence FV consumption of children through patient-level interventions (eg, counseling, connecting families to community resources), community-level interventions (eg, advocacy, community involvement), and health care facility-level interventions (eg, creating a healthy food environment in the clinical setting). This article reviews the importance of FV consumption, recommended intakes for children, and strategies by which pediatric practitioners can influence FV consumption of children.

In 2007-2008, the prevalence of obesity was 10% among 2- to 5-year-old US children (1). Even in early childhood, significant racial/ethnic differences were apparent. Approximately 9% of non-Hispanic white, 11% non-Hispanic black, and 14% of Hispanic 2- to 5-year-old children were obese. Sex differences within racial/ethnic groups were also present. Obesity was least prevalent among non-Hispanic white (7%) and most prevalent among 2- to 5-year-old Hispanic boys (18%), whereas only modest differences were observed among non-Hispanic white, non-Hispanic black, and Hispanic 2- to 5-year-old girls (1). An elevated body mass index early in life is positively associated with adult adiposity (2). Although the causes of obesity are complex and multifaceted, at the most basic level, obesity is the result of an imbalance in energy intake and energy expenditure. Energy intake, specifically food consumption, is perhaps the most widely studied contributor to obesity. | This supplement to the Journal of the American Dietetic Association contains two articles (3, 4) that use data from the Feeding Infants and Toddlers Study (FITS) 2008 to describe food consumption of infants and toddlers and provide insights into the potential foods that may contribute to excess energy intake. FITS 2008 is a cross-sectional, national follow-up survey to FITS 2002. The survey methodology is described in this issue (5), but in short was composed of recruitment interviews and a 24-hour telephone dietary recall completed by parents or primary caregivers of infants and toddlers aged 0 to 48 months. Respondents completed questionnaires regarding family demographic characteristics, child development, and knowledge and attitudes about infant feeding. A random subsample of respondents provided an additional 24-hour dietary recall to estimate usual food intake. The FITS data presented in this issue of the Journal include the dietary intake data of 3,273 children: 382 infants aged 0 to 5.9 months, 505 infants aged 6 to 11.9 months, 925 toddlers aged 12 to 23.9 months, and 1,461 children aged 2 to 3 years (3, 4). This commentary highlights those studies and demonstrates their importance within the broader context of obesity prevention among young children. Children's eating patterns and food preferences are well established early in life (6). Therefore, the dietary behaviors that young children adopt during these critical periods of development may affect growth and health outcomes throughout the lifespan. Until recently, the frequency of food consumption among an adequate sample size of young children, especially those younger than age 2 years, was not well established. FITS was developed to address this gap by describing infant and toddler food consumption patterns (7).

We investigate sex and race/ethnic differences in adolescents' perceptions of the same objectively measured weight in a nationally representative US sample. At the same BMI z-score, girls perceive themselves as heavier than boys. Regardless of sex and relative to Whites, African-Americans perceive the same BMI z-score as leaner and Native Americans are more likely to perceive objectively heavier weights as 'about the right weight'. Asian boys consider a narrower weight range to be 'about the right weight' relative to White boys, and Asian girls are less likely than White girls to perceive objectively lower weights as 'about the right weight'.

PURPOSE: Inaccurate weight perceptions may lead to unhealthy weight control practices among normal weight adolescents and to a greater risk of adult obesity and related morbidities for overweight adolescents. To examine which U.S. adolescents are at risk of these outcomes, we examine gender and racial/ethnic differences in weight perception inaccuracy. This is the first study of weight perception inaccuracy to include Latino/a and Asian American adolescents. METHODS: Among the 12,789 Wave II participants of the National Longitudinal Study of Adolescent Health, we estimate multivariate models that reveal how gender, race/ethnicity, and clinical weight categories predict weight perception inaccuracy. RESULTS: Relative to boys, girls have lower odds of underestimating their weight and greater odds of overestimating their weight. In particular, among overweight and obese adolescents, girls are more accurate than boys, but among normal weight adolescents, boys are more accurate. Compared with Whites, African Americans are more likely to underestimate their weight, particularly among overweight girls and obese boys. Overall and particularly among girls and normal weight adolescents, African Americans are less likely to overestimate their weight than their White counterparts. Finally, Asian American girls are more likely to underestimate their weight than White girls. CONCLUSION: These findings have important implications for identifying and intervening with adolescents at the greatest risk of long-term weight problems, weight-related morbidity, and unhealthy weight control practices.