Childhood obesity is endangering the country's future work force.

"It is a serious health problem that has adverse and long-lasting consequences for businesses," says Laurel Branen, professor of foods and nutrition at the University of Idaho, in Moscow.

According to the Centers for Disease Control and Prevention, 34 percent of adults age 20 years and over are obese.
Employers, who pay for most of the health care expenses for the U.S. work force, are affected by the rising cost of providing health benefits. They're also worried about the potential obstacle obesity poses to employee productivity.

The medical care costs of obesity now total about $147 billion annually, representing nearly 10 percent of all U.S. medical expenses. The CDC notes that direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs include income lost from decreased productivity, restricted activity, absenteeism and sick days, as well as life- and disability-insurance costs.

Branen's long-term vision is helping tackle the issue at the root: early childhood obesity. Until recently, childhood obesity efforts focused largely on school-aged children, with relatively little attention to children younger than the age of 5. However, there is a growing awareness that efforts to prevent childhood obesity must begin before children enter the school system.

"Most people think it's okay to have chubby little children - that the children will grow out of it as they get older," Branen says. "But we are faced with a serious situation that we're certainly not growing out of as time goes by."

More than 20 percent of preschoolers, ages 2 through 5, are overweight. This number has doubled since the 1980s.

"A relationship with food lasts a lifetime," she notes. "It starts from birth and continues into adulthood. Likewise, childhood obesity tends to persist into later life and can increase the risk for obesity-related disease in adulthood."

Branen serves on the National Academies of Science Institute of Medicine's Committee on Early Childhood Obesity Prevention Policies.She's one of only 15 members on the national committee, which recently released its recommendations for early childhood obesity prevention policies.

The recommendations focus on sleep, physical activity, and responsive feeding - eating in response to cues from one's body. They also include potential actions for implementing the recommendations.

"Our policy recommendations are aimed at childcare facilities because they will have such a major impact on children during important developmental years," Branen says.

Millions of children in the U.S. spend time under the care of someone other than their parents; with 57 percent of children ages 3 to 5 years attend day care centers. Many of the children in childcare programs receive one or more meals or snacks per day, including participating in nutrition programs supported by the U.S. Department of Agriculture and Adult Care Food Program.

Branen's work on the committee focused specifically on the food and nutrition element. During her 22 years at the university, she's specialized in nutrition and how it integrates with childhood development. With her research partner, University of Idaho Coeur d'Alene professor Janice Fletcher, she has produced countless tools for child development trainers and nutritionists. Their decades-long research contributed to the policy recommendations.

"A great deal of information in our recommendations relates to teaching and enabling children to self-regulate on food choices," Branen notes. "Providers need to set parameters within the environment so it's not a free-for-all, but also need to make choices available to children that foster appropriate food selection."

For instance, children may turn their noses up at salads with vegetables. But set the same ingredients out buffet style, and children will choose much of the same ingredients.

"They just want and respond better to choices," she says.

Branen's extensive research shows that when given food options, children tend to make appropriate choices. They also tend to select more appropriate portion sizes for themselves than adults serve. In turn, Branen notes, it leads to less food waste.

Children are born with hunger and satiety cues: they know when they're hungry, and they know when they're full. Children can continue identifying those cues as long as adults don't interfere by forcing, coercing, or restricting their intake. However, providers should carefully set parameters, such as noting that more food is available if the child is still hungry after finishing an initial, self-selected portion.

This responsive feeding - or self-selecting portions - will go a long way toward fighting the obesity epidemic. One of the proposed recommendations calls for state child care regulatory agencies to require that child care providers and early childhood educators to use responsive feeding.

Sleep and physical activity

Sleep and physical activity are the two other major areas of emphasis in the committee's recommendations.

Evidence suggests that a decrease in sleep duration in infancy and childhood has occurred during the past 20 years, with the most pronounced decreases seen among children less than 3 years of age.

"Sleep ties into eating, too," Branen says. "Children will tend to overeat if they do not have enough sleep."

She admits what most parents know: Children don't want to go to sleep. But Branen says the key is in the routine.

"Children are more comfortable with routines," she says. "Have a routine that includes an environment conducive to sleep, such as a darkened room with no televisions and minimal disturbances. Allow a choice - such as a quiet time to be alone with their thoughts. Kids may not fall asleep, but it provides an environment supportive of rest and rejuvenation."

The policy recommendations call for child care regulatory agencies to require child care providers and early childhood educators to provide infants, toddlers and preschool children with opportunities to be physically active throughout the day.

Despite sounding obvious, policies aren't developed because people are already doing those things.

"Unfortunately, it's not the case that providers encourage such activity," says Branen. "But what we've found is that when adults make things available, such as structure and unstructured physical activity, young children naturally make the right choices."

It's over time that bad habits form. Establishing healthy behaviors in early childhood will lead to a healthier nation - physically and economically. In turn, businesses will have a better bottom line.