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A Study of Nearly 400 Children Asked How Many Followed Guidelines to Prevent Obesity. The Answer? Just One


According to the CDC, 8.9% of children aged 2 to 5 are obese and more than 20% of youth are obese by the time they are 12 to 19 years old.

Despite efforts to fight childhood obesity, slightly more than 1 in 5 youth aged 12 to 19 is obese, according to CDC. The problem starts early, with data showing that 8.9% of children aged 2 to 5 already meet the criteria for obesity.

A new study published in Preventive Medicine Reports sheds light on just how hard it will be to combat obesity. When researchers from Cincinnati Children’s Hospital tried to find out if children in area day care centers followed basic nutrition and activity guidelines, the results were stark: out of nearly 400 children, just 1 met all 4 standards.

The American Academy of Pediatrics has been sharing the guidelines, known as 5-2-1-0, for several years with caregivers and schools. The numbers call for 5 servings a day of fruits and vegetables, no more than 2 hours a day of screen time, at least 1 hour a day of physical activity, and 0 sugar-sweetened beverages.

Amrik Singh Khalsa, MD, a fellow in general and community pediatrics at Cincinnati Children’s and the study’s lead author, said the results show “there is ample room for improvement.”

The study was a 24-hour observation of 398 children in 30 centers; their average age was 4.3 years. The researchers obtained information on dietary intake, screen time, and body mass index (BMI) from the day care staff and from parents and used accelerometers to measure physical activity. They found the following:

  • 1 of every 4 children already had a BMI that put them in the obese range (30 kg/m2).
  • 17% had at least 5 servings of fruits and vegetables
  • Half the children consumed a sugar-sweetened beverage
  • 81% had less than 2 hours of screen time
  • Less than 1% met the activity recommendation

Researchers searched for demographic predictors, given the fact that the children came from a range of income levels and ethnic backgrounds. Children in households with incomes between $25,000 and $50,000 ate more fruits and vegetables than those in households with incomes below $25,000; those in households with incomes above $100,000 were less likely to consume sugar-sweetened beverages than those in households with incomes below $25,000. African American children had higher levels of any activity, but not necessarily higher levels of moderate to vigorous levels of activity. The study found that increased screen time was associated with a modest increase in BMI.

The Cincinnati results are part of the Preschool Eating and Activity Study, led by Kristen Copeland, MD.

“Preschool children who are overweight or obese have a 4-fold odds of being overweight or obese as adults,” said Khalsa. “Preventing obesity is critical to averting obesity-associated diseases, such as metabolic syndrome, type 2 diabetes, hypertension and cardiovascular abnormalities.”


Khalsa AS, Kharofa R, Ollberding NJ, Bishop L, Copeland KA. Attainment of ‘5-2-1-0’ obesity recommendations in preschoolaged children [published online August 14, 2017]. Preven Med Reports 2017; doi: 10.1016/j.pmedr.2017.08.003.

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