During the last 10 years, much attention has been devoted to monitoring the growing epidemic of childhood obesity in the U.S.1–3
and around the world.4
Obesity among children can lead to poor health-related quality of life, and can also increase the risk of hyperlipidemia, prediabetes, and hypertension.5–7
Furthermore, overweight and obese children are also significantly more likely to become overweight adults,5
thus increasing their lifetime risk of various chronic diseases, including sleep apnea, diabetes, cardiovascular disease, and cerebrovascular disease.
The burden of childhood obesity is higher among some low-income and minority children.8–14
The relationship between socioeconomic status and obesity among children varies by race/ethnicity and age.9,14
Among 2- to 5-year-old Mexican American children, obesity is inversely related to family income, while obesity prevalence rises with income level among black and white children, then declines at income levels above approximately twice the federal poverty level (FPL).14
Explanations for the excess prevalence of obesity in various populations include lack of opportunities for physical activity; higher availability and consumption of affordable, high-calorie, high-fat convenience foods; and lower access to healthy foods, including fruit and vegetables.15,16
While there is widespread acknowledgement that the etiology of childhood obesity includes a complex interaction of many biological and social factors,15,17
there is awareness that strategies that can significantly control the childhood obesity epidemic should emphasize changing children's eating and physical activity environments.13,18,19
The need to change the eating and physical activity environments of low-income and other at-risk children was highlighted by the 2005 Institute of Medicine report,20
which recommended changes to the food packages provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The WIC program was established in 1972 by the U.S. Department of Agriculture to address hunger and malnutrition among low-income children and pregnant and postpartum women. While food insecurity remains a major concern, the emergence of the childhood obesity epidemic in the ensuing decades has challenged the WIC program to ensure adequate nutrition for low-income, nutritionally at-risk infants, children, and pregnant and postpartum women, while simultaneously promoting healthy eating to minimize the risk of overweight and obesity among participants.
In New York State (NYS), public health officials have worked in partnership with federal, state, and local agencies to make obesity a priority public health issue for all age groups, including preschool-aged children (e.g., children aged 0–5 years).21,22
The state's premier childhood obesity prevention initiative, the Eat Well Play Hard program, promotes healthy eating and physical activity across all nutrition assistance programs, including WIC, the Hunger Prevention and Nutrition Assistance Program, and Child and Adult Care Food Program. In addition to launching population-based strategies to promote healthy eating and physical activity among young children and their families, the NYS Department of Health (DOH) has also enlisted the help of educators and clinicians in statewide efforts to ensure that parents, caregivers, and health-care providers take an active role in the prevention and control of childhood overweight and obesity. The measures taken by the NYS DOH were largely prompted by evidence showing that childhood obesity was steadily increasing among preschool-aged children participating in the NYS WIC program.23
For example, analyses of trends in obesity prevalence from 1989 to 2003 showed an overall obesity prevalence increase from 12% in 1989 to 16% in 2003;23
in comparison, the national prevalence estimate among U.S. children aged 2 to 5 years in 2002 was slightly more than 10%.24
We assessed trends in prevalence of childhood obesity from 2002 to 2007 among preschool-aged children (2 to <5 years of age) enrolled in the NYS WIC program. We also reported on trends in prevalence of overweight during the study period.