Childhood obesity: recommendations

Culled from Marion Nestle's blog, who mentioned the publication of the December 126-page supplement to the journal Pediatrics.
Here is a summary of recommendations for pediatricians to help prevent or treat childhood obesity:

Prevention through healthy habits:
1. limiting consumption of sugar-sweetened beverages
2. encouraging consumption of diets with recommended
quantities of fruits and vegetables; the current
recommendations from the US Department of
Agriculture (USDA) (www.mypyramid.gov) are for 9
servings per day, with serving sizes varying with age
3. limiting television and other screen time (the American
Academy of Pediatrics recommends no television
viewing before 2 years of age and thereafter no
more than 2 hours of television viewing per day), by
allowing a maximum of 2 hours of screen time per
day and removing televisions and other screens
from children’s primary sleeping area (although
a relationship between obesity and screen time other
than television viewing, such as computer games, has
not been established, limitation of all screen time may
promote more calorie expenditure);
4. eating breakfast daily;
5. limiting eating out at restaurants, particularly fast
food restaurants (frequent patronage of fast food
restaurants may be a risk factor for obesity in children,
and families should also limit meals at other
kinds of restaurants that serve large portions of energy-
dense foods);
6. encouraging family meals in which parents and children
eat together (family meals are associated
with a higher-quality diet and with lower obesity
prevalence, as well as with other psychosocial benefits);
and
7. limiting portion size (the USDA provides recommendations
about portions, which may differ
from serving sizes on nutrition labels, and a product
package may contain several serving sizes).
In addition:
1. eating a diet rich in calcium
2. eating a diet high in fiber;
3. eating a diet with balanced macronutrients
4. encouraging exclusive breastfeeding to 6 months of
age and maintenance of breastfeeding after introduction
of solid food to 12 months of age and beyond,
5. promoting moderate to vigorous physical activity for
at least 60 minutes each day
6. limiting consumption of energy-dense foods.

Staged treatment:
1. consume at least 5 servings of fruits and vegetables every
day . Families may subsequently increase to 9
servings per day, as recommended by the USDA.
The USDA Web site (www.mypyramid.gov) recommends
the number of cups of fruits and vegetables
per day according to age, ranging from 2 cups per
day for 2-year-old children to 4.5 cups per day for
17- and 18-year-old youths;
according to age, ranging from 2 cups per
day for 2-year-old children to 4.5 cups per day for
17- and 18-year-old youths;
2. minimize sugar-sweetened beverages such as soda,
sports drinks, and punches . Ideally, these beverages
will be eliminated from a child’s diet, although
children who consume large amounts will
benefit from reduction to 1 serving per day;
3. decrease television viewing (and other forms of
screen time) to less than 2 hours per day . If the child is
less than 2 years of age, then no television viewing should
be the goal. To assist with this change, the television
should be removed from the room where the child sleeps;
4. be physically active at least 1 hour each day . Unstructured
play is most appropriate for young children.
Older children should find physical activities
that they enjoy, which may include sports, dance,
martial arts, bike riding, and walking. Activity can be
structured, such as a dance class, or unstructured,
such as dancing to music at home, and children can
perform several shorter periods of activity over the
day;
5. prepare more meals at home rather than purchasing
restaurant food ;
6. eat at the table as a family at least 5 or 6 times per
week ;
7. consume a healthy breakfast every day ;
8. involve the whole family in lifestyle changes ;
9. allow the child to self-regulate his or her meals and
avoid overly restrictive feeding behaviors
10. help families tailor behavior recommendations to
their cultural values