Food behaviors and other strategies to prevent and treat pediatric overweight.

OBJECTIVE: To summarize the evidence for the following six strategies to prevent or treat overweight among children: promoting breastfeeding, promoting physical activity, reducing TV/video viewing, increasing fruit and vegetable consumption, reducing sugar-sweetened drink consumption, and reducing portion sizes. METHODS: Summarization of the relevant literature including review articles, relevant newly published work, the Institute of Medicine’s Report on Preventing Childhood Obesity and the Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, 2001. This is not a comprehensive review. RESULTS: Evidence for the association between each strategy and overweight varies. For breastfeeding, physical activity, and TV viewing, there are large review studies. Breastfed children may have a small reduction in risk for overweight. Participation in physical activity may reduce the risk of overweight among school-aged children and adolescents. For preschool- and school-aged children, reducing TV viewing time may reduce their risk of overweight, but most studies report small significant associations. Evidence for an association between each dietary factor and overweight is limited and inconclusive. The biggest gaps in evidence are for the effectiveness of interventions using these strategies. The reviewed interventions based on increasing physical activity (n=7) were effective. Two randomized trials suggest that reducing TV viewing reduces overweight. No intervention studies were found that examined the effectiveness of changing fruit and vegetable consumption, sugar-sweetened drink consumption, or portion sizes. Further clarification of the effect of breastfeeding on obesity is needed. CONCLUSIONS: These six strategies are reasonable ways to attempt prevention or treatment of overweight in children. Strength of the evidence varies by strategy. The key finding is that more applied research is needed to determine the effectiveness of these and other strategies.