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APHA Resolution on Overweight in Childhood
[摘要]

The American Public Health Association,

Recognizing that the prevalence of overweight in childhood is increasing in all sex, age, and racial/ethnic groups in the United States, particularly in Hispanic, African-American, and American Indian Children;1-4 and

Whereas severe overweight in childhood is related to increased stress on weight-bearing joints,5 increased blood pressure and dyslipidemia,6,7 risk of type 2 diabetes,8 and Pickwickian syndrome or breathing difficulties;9 and

Whereas type 2 diabetes due to overweight is the fastest growing childhood disease in the United States;10-12 and

Whereas overweight children are subject to discrimination, social stigmatization, low self-esteem, and depression, as well as reduced earnings and educational achievement in adulthood;13–20 and

Whereas social prejudice and stigmatization also contribute to unhealthy weight loss practices that have negative physical and psychosocial consequences21,22,17

Whereas early childhood overweight is significantly associated with later childhood and adult obesity and related morbidities in adults;23–29 and

Whereas the costs of diseases and conditions related to obesity amounted to $99.2 billion in 1995;30 and

Whereas the health of overweight children is compromised by the lack of treatments known to be consistently effective and safe during periods of growth as well as the limited availability of insurance coverage for family-based treatments;3,31–33 and

Whereas the childhood overweight epidemic is linked to environmental factors such as increased accessibility to calorie dense foods, decreased daily physical activity and increased sedentary behavior;34–38 and

Whereas promising intervention strategies to address childhood overweight include limiting hours of television viewing, increasing physical activity, and consuming lower calorie, nutrient rich diets;39–41 and

Whereas there is a lack of state specific data systems available to monitor the prevalence of overweight in children and youth,

Resolved, to encourage urban designs and other environmental changes in schools and communities to create opportunities for a healthy lifestyle for children of all sizes, including the promotion of alternatives to sedentary activity and increases in access to healthier foods.

To promote increases in the quantity and quality of physical education programs offered in grades K-12 with attention given to culturally appropriate, appealing, non-competitive activities that reflect the diversity of abilities and interests of America’s children.

To support the integration of food and nutrition education into school curricula and to support legislation and policies that increase the accessibility, appeal, and healthy choices available in USDA school breakfast, lunch and after-school snack programs, and that limit the availability of high-calorie, nutrient-poor foods and beverages in school stores, vending machines and a la carte offerings.

To support programs which enable parents to model and support healthy lifestyles for their children.

To encourage the media to reduce or eliminate messages which promote unhealthy eating, sedentary lifestyles and body dissatisfaction.

To encourage food manufacturers to limit marketing of high-calorie, nutrient-poor food products to children.

To support legislation, policies and practices to ensure access to health services for children of all ages and to require insurance coverage for family-based prevention and treatment of childhood overweight.

To encourage prevention efforts that begin in early childhood before habits that promote overweight are established. 

To support funding for large-scale collaborative efforts at the national, state, local and tribal community levels to promote healthful lifestyles for parents and children.

To promote the funding of applied research to identify successful intervention to prevent childhood overweight in the general population of children and youth, as well as within specific ethnic groups, and to support the large-scale application of these interventions.

To support CDC leadership in establishing new data collection systems to allow states to monitor the geographic distribution, secular trends and progress in reducing the prevalence of childhood overweight.

* Overweight in childhood is defined as body mass index over the age and gender-specific 95th percentile.

** Family-based treatment is differentiated from treatments focusing on children without involvement of family members. Family-based treatment has been demonstrated effective for a substantial number of children.42,43

References

  1. Mei Z, Scanlon KS, Grummer-Strawn LM, Freedman DS, Yip R, Trowbridge FL. Increasing prevalence of overweight among U.S. preschool children: The Center for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983-1995. Pediatrics, 1998; 101:1-6.
  2. Troiano RP, Flegal KM, Kuezmarski RH, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents. Arch Pediatr Adolesc Med, 1995;149:1085-91.
  3. Troiano RP, Flegal KM. Overweight children and adolescents: Description, epidemiology and demographics. Pediatrics. 1998;101:497-503.
  4. Crawford PB, Story M, Wang MC, Ritchie LD, Sabry ZI Ethnic issues in the epidemiology of childhood obesity. Ped Clin North Am. In Press.
  5. Bray GA. Complications of obesity. Ann Int Med. 1985;103:1052-62.
  6. Morrison JA, Barton BA, Biro FM, Daniels SR, Sprecher DL. Overweight, fat patterning, and cardiovascular disease risk factors in black and white boys. J Pediatr. 1999;135:451-7. 
  7. Morrison JA, Sprecher DL, Barton BA, Waclawiw MA, Daniels SR. Overweight, fat patterning, and cardiovascular disease risk factors in black and white girls: The National Heart, Lung, and Blood Institute Growth and health Study. J Pediatr. 1999;135:458-64.
  8. Gower BA, Nagy TR, Trowbridge CA, Dezenberg C, Goran MI. Fat distribution and insulin response in prepubertal African American and white children. Am J Postgrad Med. 1990;87:123-33.
  9. Leung AK, Lane W, Robson M. Childhood obesity. Postgrad Med. 1990; 87:123-33.
  10. Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999;22:345-54.
  11. Dabelea D, Pettitt DJ, Jones KL, Arslanian SA. Type 2 diabetes mellitus in minority children and adolescents. An emerging problem. Endocrinol Metab Clin North Am. 1999,28:709-29.
  12. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. 2000;23:381-9.
  13. Strauss RS. Childhood obesity and self-esteem. 2000; 105(1). URL http:/www.pediatrics.org/cgi/content/full/105/1/e15. 14. Neumark-Sztainer D, Story M, Faibisch L. Perceived stigmatization among overweight African and Caucasian adolescent girls. J Adolesc Med. 1998;23:264-70. 
  14. Hill AJ, Silver EK. Fat, friendless and unhealthy: 9-year old children’s perception of body shape stereotypes. Int J Obesity. 1995;19:423-30.
  15. French SA, Story M, Perry CL. Self-Esteem and obesity in children and adolescents: a literature review. Obes Res. 1995;3:479-80. 
  16. Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med. 1993;329:1008-12.
  17. Sobal J, Nicolopoulos V, Lee J. Attitudes about overweight and dating among secondary school students. Int J Obesity. 1995;19:376-81.
  18. Pesa JA, Syre TR, Jones E. Psychosocial differences associated with body weight among female adolescents: the importance of body image. J Adolesc Med. 2000;26:330-7
  19. Sargent JD, Blanchflower DG. Obesity and stature in adolescence and earnings in young adulthood. Arch Pediatr Adolesc Med. 1994;148:681-7.
  20. Johnston FE. Health implications of childhood obesity. An Int Med. 1985;103:1068-72.
  21. Melbin T, Vullie JC. Rapidly developing overweight in school children as an indicator of pychosocial stress. Acta Pediatr Scand. 1989;78:568-75.
  22. Charney E, Goodman HC, McBride M, Lyon B, Pratt R. Childhood antecedents of adult obesity. Do chubby infants become obese adults? New Eng J Med. 1976;295:6-9.24. 
  23. Durnin JV, McKillop FM. The relationship between body build in infancy and percentage body fat in adolescence: A 14-year follow-up on 102 infants. Proc Nutr Soc Engl. 1978;37:81. 
  24. Mumford P, Morgan JB. A longitudinal study of nutrition and growth of infants initially on the upper and lower centile for weight and age. Int J Obes. 1982;6: 335-41. 
  25. Shapiro L, Crawford PB, Clark MJ, Pearson DL, Raz J, Huenemann RL. Obesity prognosis: A longitudinal study of children from the age of 6 months to 9 years. Am J Public Health. 1984;74:968-72.
  26. Hulman S, Kushner H, Katz S, Falkber B. Can cardiovascular risk be predicted by newborn, childhood, and adolescent body size? An examination of longitudinal data in urban African Americans. J Pediatr. 1998;132:90-7.
  27. Dietz WH. Childhood weight affects adult morbidity and mortality. J Nutr. 1998;128:411S-4S.
  28. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523-9.
  29. Wolfe AM and Colditz GA, Current Estimates of the economic costs of obesity in the United States. Obes Res. 1998;6:97-106.
  30. Tershakovec AM, Watson MH, Wenner WJ, Marx AL. Insurance reimbursement for the treatment of obesity in children. J Pediatr. 1999;134:576-8.
  31. Dietz WH, Nelson A. Barriers to the treatment of childhood obesity: A call to action. J Pediatr. 1999; 134:535-6.
  32. National Institutes of Health. NIH Technology Assessment Conference on Methods for Voluntary Weight Loss and Control. Ann Intern Med. 1992;116:942-9.
  33. Waxman M, Stunkard AJ. Caloric intake and expenditure of obese boys. J Pediat. 1980;96:187-93.
  34. Sallis JF, Patterson TL, Buono MJ, Nader PR. Relation of cardiovascular fitness and physical activity to cardiovascular disease risk factors in children and adults. Am J Epidemiol. 1988;127:933-41.
  35. Obarzanek E, Schreiber G, Crawford P, Goldman S, Barrier P, Frederick M. Energy intake and physical activity in relation to indices of body fat. Am J Clin Nutr. 1994;60:15-22.
  36. Harsha DW. The benefits of physical activity in childhood. Am J Med Sci. 1995;310:S109-13.
  37. Moore LL, Nguyen USDT, Rothman KJ, Cupples LA, Ellisun RC. Preschool physical activity level and change in body fatness in young children. Am J Epidemiol. 1995;142:982-8.
  38. Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990.
  39. Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, Laird N. Reducing obesity via a school basedinterdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999;153: 409-18.
  40. Robinson TN. Reducing children’s television viewingto prevent obesity. A randomized controlled trial. JAMA. 1999;282:1561-7.
  41. Epstein LH, Valoskmi A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology. 1994;13: 373-83.
  42. Mellin LM, Slinkard LA, Irwin Jr, CE. Adolescentobesity intervention: validation of the SHAPEDOWN program. JADA. 1987;87:333-8.

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[发布日期] 2001-01-01 [发布机构] 
[效力级别]  [学科分类] 医学（综合）
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