For Healthcare Professional use

OVERWEIGHT
AND OBESITY

Learning points
1 The prevalence of obesity in toddlers is increasing.
2 The toddler years are an ideal time for families to make
lifestyle choices to prevent obesity in childhood.
3 Body Mass Index (BMI) is a calculated relationship
between height and weight and plotting BMI on a centile
chart is used to assess overweight and obesity. A BMI over
the 91st centile indicates overweight, and above the 98th
centile is defined as obesity.
7 Medical causes of obesity are rare but toddlers in whom
excess energy intake has been ruled out should be
referred to a paediatrician. Any toddler with a BMI over
the 99.6th centile should also be referred.
8 Parental obesity is a very strong predictor of childhood
obesity.
9 Often parents do not realise their toddlers or children are
overweight.

4 Normally the BMI of toddlers decreases from around their
first birthday onwards as they become slimmer until about
5-6 years when it begins to increase.
5 An early adiposity rebound, the point at which a toddler's
BMI starts to increase again, is associated with a greater
risk of obesity in childhood.
10 Healthy family lifestyles are the key to preventing
childhood obesity and treating obesity in toddlers.
11 Healthcare professionals need an empathetic and non-
judgemental approach to empowering families to make
lifestyle changes.

6 The vast majority of obesity is caused by an imbalance

between energy intake from food and energy expenditure
endorsed by
through activity levels, growth and development.
OVERWEIGHT AND
OBESITY IN TODDLERS
Obesity was once unusual in toddlers but, as in other age groups, it is now
becoming increasingly prevalent. Healthcare professionals can help families with
toddlers to adopt a healthy lifestyle to prevent obesity at this early age and later
in childhood. Healthcare professionals also need the skills to help families of
toddlers who are already obese to make lifestyle changes. In most cases the cause
of the obesity will be multifactorial and a single solution will not suit every family.

PREVALENCE
IN THE UK
Recent national statistics show that around 12 per
cent of English toddlers aged 2-3 years are obese and
a further 15 per cent are overweight1. In Scotland
almost 11 per cent of 2-6 year olds were found to be
obese with a further 15 per cent overweight2
(National statistics define overweight as between the
85th and 95th BMI centiles and obesity as at or above
the 95th BMI centile).
CAUSES OF
OVERWEIGHT AND
OBESITY
The vast majority of overweight and obesity is caused
by an imbalance between energy intake (amount of
calories consumed in food and drinks) and energy
expenditure (amount of energy used in activity).
In toddlers, as in older children, the excessive weight
gain is a result of eating food energy in excess of the
energy requirements for their activity level and their
growth and development. The excess weight gain
accumulates as extra adipose tissue (fat) which
contributes to the physical and metabolic changes
seen in obesity.

Eating patterns, activity levels, ethnicity, genetics and

environment all play a part in the development of
obesity. Evidence is emerging that genetic differences
may make some toddlers more susceptible to obesity
in an obesogenic environment3,4.

Epidemiological research has shown strong

associations between overweight toddlers and
parental obesity. Having one obese parent increases
the risk, and if that parent is the mother the risk is
higher. The highest risk is in toddlers with two obese
parents1,5,6,7,. This could be due to a combination of
genetic, social or environmental factors.

Medical causes of overweight and obesity are rare

but when environmental factors have been excluded,
obese toddlers should be referred to a paediatric
endocrinologist. Medical causes include:

endocrine disorders often signalled by short

stature such as hypothyroidism, Cushing's
syndrome, growth hormone deficiency and leptin
deficiency
chromosomal disorders such as Prader-Willi
syndrome

02
USING BODY MASS INDEX (BMI)
TO DETECT OBESITY
Studies have shown that using clinical judgement to
determine whether a young child is overweight or
obese is unreliable. Overweight and obesity must be
assessed more objectively, using the BMI.
BMI is defined as weight in kilograms divided by the
square of height in metres (BMI=Wt/(Ht)2). Thus a
toddler who weighs 13.2 kg and is 91cm tall has a BMI
of 13.2/0.91x0.91 = 15.9 (a healthy BMI range for
adults of 18.5 - 25 is not applicable to children).
Calculating BMI
To assess if a toddler is overweight or obese, he or
she should be weighed and measured accurately using
calibrated equipment. See Factsheet 3.1 Calculate
the BMI to one decimal place and plot it on a BMI
centile chart for children. There is one for boys and
one for girls (see figures 1 and 2). These charts can be
ordered from www.healthforallchildren.co.uk and all
healthcare professionals should have access to them.
Fig. 1 BMI centile chart with 3 plots of two-and-a-half
year old boys showing: (a) - overweight, (b) - obese, (c)
- over the 99.6th centile, requiring referral

Weight in kilograms
BMI =
(Height in metres)2

For a toddler with a weight of 13.2kg

and a height of 91cm (0.91m)

13.2
BMI = = 15.9
0.91 x 0.91

It is normal for BMI to vary with increasing age and

this variation is different between boys and girls.
BMI should decrease during the toddler years as the
body fat accumulated towards the end of infancy
diminishes when the young toddler begins walking.
With increased mobility the toddler's energy
expenditure rises and body fat is replaced with more
muscle tissue. The average BMI at one year is 17.5,
falling to about 15.5 at five to six years of age. The
BMI of obese toddlers may not decrease or may A child with a BMI between the 91st & 98th centiles
decrease less than expected. is considered overweight (plot (a) in Fig. 1)

A child with a BMI above the 98th centile is

considered obese (plot (b) in Fig. 1)

NHS Trusts and hospitals should have a locally agreed

protocol for treating childhood obesity. Scottish
guidance recommends that toddlers with a BMI over
the 99.6th centile (plot (c) in Fig. 1) should be referred
to a paediatrician for investigation8.

03

TODDLERS WHO
RISK DEVELOPING
OBESITY IN
CHILDHOOD
Adiposity rebound is the term given to the time
when BMI begins to increase after falling to a low
point at around four to five years. The Avon
Longitudinal Study of Parents and Children (ALSPAC),
also known as Children of the 90s, showed that
toddlers who have an early adiposity rebound at three
to four years of age are at risk of becoming obese in
childhood7.
Fig. 2 Girls BMI chart showing early adiposity
rebound7.
ALSPAC also identified the following risk factors for
childhood obesity at seven years irrespective of
whether the child was overweight as a toddler7:
parental obesity of one or both parents
high birth weight
rapid weight gain in the first year
catch-up growth between birth and two
years
sedentary behaviour: more than eight
hours watching TV per week at three years
less than ten hours sleep per day at three
years
04
Breastfeeding
Whether breastfeeding in early infancy plays a role in
preventing obesity in childhood, remains
controversial. Formula-fed infants lose less weight in
the first few days after birth and their growth rate and
pattern is different to that of exclusively breastfed
babies. This is one reason why the World Health
Organisation has created growth charts based on the
measurement of healthy breast-fed babies9. However
there are many confounding lifestyle factors
throughout the toddler years and early childhood, in
addition to the mode of milk feeding during infancy,
that may contribute to the development of obesity6,10.
Exclusive breastfeeding remains the ideal way of
feeding an infant until weaning for many other health
reasons.
CONSEQUENCES
OF OVERWEIGHT
AND OBESITY
Obese toddlers who remain obese into childhood
will be at risk of:
lower levels of fitness
increased severity of asthma and other
respiratory disease
social discrimination that can lead to:
low self-esteem
lower quality of life
lower academic achievement
increased risk of insulin resistance and type II
diabetes
higher incidence of atherosclerosis
increased risk of cardiovascular disease
An overweight child has a 40-70 per cent chance
of becoming an obese adult11.
Picture reproduced with the permission of MEND
LIFESTYLE IDEALS TO PREVENT OBESITY
Because preschool children are dependent on parents
and carers for their food and opportunities for physical
activity, it is parents and carers who must take
responsibility for a healthy family lifestyle.
However providing food is an emotional issue for
parents and many are more concerned about their
toddlers being underweight than overweight12.
Initiatives to improve lifestyles in families at risk of
obesity need to be undertaken sensitively and should
involve support for parents to improve their parenting
skills. Home visits by healthcare professionals during
pregnancy and infancy may be a time when parents
are receptive to advice on healthy eating for young
children13.
Encouraging physical activity
Toddlers should have plenty of opportunities and be
encouraged to take part in active play every day, to
promote development of co-ordination and skills that
will allow them to enjoy sport as they get older. Most
toddlers do not need encouragement to play and will
enjoy active play particularly with their parents. Parents
can encourage active play by praising their toddlers
when they are active.
There is little evidence-based guidance regarding the
optimum daily amount of exercise but the Department
of Health now recommend that under fives are
physically active for at least three hours each day14.
This can be made up of short episodes spread over the
whole day. Any active play inside or outside as well as
walking up stairs, bouncing on a trampoline, dancing,
running, walking to nursery, and other similar activities
all count.
Picture reproduced with the permission of MEND
Limiting sedentary behaviour
Many toddlers spend a lot of time being babysat by a
TV/DVD/video. There are no evidence based
guidelines for this in the UK, but in the USA and
elsewhere watching television is not recommended
for the under-two's. For those three and over the
American Academy of Pediatrics recommends no
more than two hours per day of sedentary behaviours
such as TV viewing15. The ALSPAC study showed that
three year olds who watched TV for more than eight
hours a week (which is over one hour per day) were at
a higher risk of becoming obese at seven years old
than those who watched less7. Parents may need help
exploring physical activities that can be substituted
for sedentary behaviour watching TV or DVDs.
Getting enough sleep
Toddlers normally sleep about 12 hours in each 24
and this is important for growth. The ALSPAC study
also found that three year olds who were sleeping for
less than 10 hours per day were found to be at greater
risk of being obese at seven years7.
Encouraging healthy eating
Toddlers learn by copying so parents need to adopt
healthy eating patterns themselves. Changing eating
habits is usually difficult, but particularly so for
parents and families who:
do not understand the principles of healthy eating
do not have the cooking skills necessary to prepare
simple home-cooked food and instead rely on
convenience foods, which are usually higher in
energy, fat, sugar and salt
do not have set mealtimes, either as a family or for
their toddlers, and consequently frequent snacking
forms part of their eating pattern
05
Healthcare professionals report that running cook-
and-eat sessions for parents improves their cooking
skills and their knowledge of healthy eating, and
empowers parents to provide healthier family meals.
A balanced diet based on a combination of foods
from five groups is outlined in detail in Factsheet 1.2
By eating the number of servings recommended in
Table 1 toddlers will be assured of getting all the
nutrients they need to grow and develop. Foods in
the fifth food group are high in fat and sugar. Small
amounts of these foods are acceptable in a toddler
diet but many toddlers eat these foods to excess16
- particularly sweetened drinks and high-fat snack
foods such as crisps. Restricting these foods in today's
environment requires discipline, as preschool children
naturally prefer energy dense foods17. Healthcare
professionals could help parents to plan more
nutritious meals and snacks that they can then
substitute for the high-fat and high-sugar foods that
they may normally offer.
Family meals
Toddlers need encouragement to learn to eat a
variety of foods and they learn by copying others
See Factsheets 1.1 and 2.2 This is best achieved
during meals where the family all eat nutritious food
together in a calm, relaxed atmosphere with the TV
switched off and no other distractions. Toddlers
should be allowed to stop eating when they signal
they have had enough - they should not be pressured
to finish all the food on their plate. Toddlers will also
benefit from a routine of meals and planned
nutritious snacks that fit around their sleeping pattern
so that the nutritious meals and snacks are given
when they will accept them willingly. Toddlers who
are over-tired or over-hungry at a meal time may
refuse to eat.
06
NICE guidance published in 2006 recommends that18:
All nurseries and childcare facilities should:
minimise sedentary activities during play time, and
provide regular opportunities for enjoyable active
play and structured physical activity sessions
implement Department for Education and Skills,
Food Standards Agency and Caroline Walker Trust19
guidance on food procurement and healthy
catering
ensure that children eat regular, healthy meals in a
pleasant, sociable environment free from other
distractions (such as television). Children should be
supervised at mealtimes and, if possible, staff should
eat with children
Any programme to prevent obesity in preschool or
childcare settings should incorporate a range of
components (rather than focusing on parental
education alone).
diet: interactive cookery demonstrations, videos
and group discussions on practical issues such as
meal planning and shopping for food and drink
physical activity: interactive demonstrations, videos
and group discussions on practical issues including:
- ideas for activities
- encouraging more walking instead of always
using the car or pushing toddlers around in a
pushchair
- opportunities for active play
- concern for safety
- availability of local facilities
To comply with this guidance it is good practice for
healthcare professionals to have local knowledge of
facilities where toddlers can enjoy opportunities for
physical activity. Where facilities and opportunities are
poor practitioners could lobby their local authority to
provide affordable activities for families of young
children through Children's Centres. For example, this
may include a regular weekly subsidised
parent/toddler swim or an organised parent/toddler
health walk or active play group.
Table 1 Healthy eating recommendations for toddlers

Food Group Foods included Main nutrients supplied Recommendations for toddlers

1. Bread, cereals and Bread, chapatti, Carbohydrate Serve at each meal and some snacks
potatoes breakfast cereals, B vitamins
rice, couscous, Fibre
pasta, millet, Some iron, zinc and
potatoes, yam, and calcium
foods made with
flour such as pizza
bases, buns,
pancakes

2. Fruit and vegetables Fresh, frozen, Vitamin C Serve at each meal and some snacks.
tinned and dried Phytochemicals The more variety the better, although
fruits and Fibre this may be difficult to achieve with
vegetables Also Carotenes fussy eaters
pure fruit juices

3. Milk, cheese and Breast milk, infant Calcium Three servings a day
yogurt formula milks, Protein One serving is
follow-on and Iodine about 100-120ml/3-4oz milk in a
growing up milks, Riboflavin beaker or cup
cows' milk, yogurts, one pot yogurt or fromage frais
cheese, calcium a serving of cheese in a sandwich
enriched soya or on a pizza
milks, tofu a milk based pudding
a serving of tofu

4. Meat, fish and Meat, fish eggs, Iron Two servings a day
vegetarian pulses, dahl, nuts Protein Three for vegetarians
alternatives Zinc
Magnesium Fish should be offered twice per
B vitamins week and oily fish at least once per
Vitamin A week but no more than four servings
Omega 3 long chain per week for boys and two servings
fatty acids: EPA and per week for girls
DHA from oily fish

5. Foods high in fat Cream, butter, Oils such as olive, soya, Small amounts in addition to but not
and / or sugar margarines, walnut and rapeseed instead of the other food groups.
cooking and salad give a good balance of Too much of them increases the risk
oils, mayonnaise, omega 3 & 6 fatty acids of obesity
chocolate,
confectionery,
sweetened drinks,
jam, syrup, crisps
and other high fat
savoury snacks

See Factsheets 1.1 and 1.2 for further information about healthy eating.

07
Treating OVERWEIGHT AND obesity
NICE guidelines recommend that18:

a supportive environment should be created that helps overweight or obese children and their families to make
lifestyle changes
decisions on the approach to management of a child's overweight or obesity should be made in partnership
with the child and family and be tailored to the needs and preferences of both
weight management interventions should include behaviour change strategies to increase physical activity
levels or decrease inactivity, improve eating behaviour and the quality of the diet and reduce energy intake
dietary changes should be individualised, tailored to food preference and allow for flexible approaches to
reducing calorie intake

Most parents do not recognise that their toddlers
are overweight or obese, so healthcare professionals
need to be sensitive when discussing the issue.
Parents could be asked how they feel about their
child's weight as a way of beginning a discussion.
Measurement of the toddler's weight and
height/length could then be offered. Showing
parents how the BMI of their overweight/obese
toddler relates to the normal range, by using the BMI
centile chart, is a good way to continue the discussion.
Unless parents acknowledge that there is a problem
and are ready to change their lifestyle there is little
that can be achieved for an overweight or obese
toddler.
There is usually no need for overweight toddlers and
young children to actively lose weight, but weight
gain should be slowed or stopped temporarily
through healthy eating and physical activity so that
BMI declines as the child grows taller.
The aim of treatment is to improve the energy
imbalance and this will be achieved by a combination
of any of the following:
decreasing the energy content of food and drinks
eaten by limiting high calorie foods and drinks
increasing physical activity
decreasing sedentary behaviour
ensuring adequate sleep for growth
The barriers to making these changes may be
considerable for some families because of:
the family lifestyle
lack of knowledge of what a healthy balanced diet is
lack of cooking skills to prepare lower energy foods
housing and immediate local environment
limited finances

Picture reproduced with the permission of MEND

08
SUPPORTING PARENTS TO MAKE
LIFESTYLE CHANGES
The whole family will need to make lifestyle changes
that become a normal part of their family life so that
they are maintained long-term.

At the outset healthcare professionals should initiate

a sensitive discussion with parents to determine
which factors in their lifestyle are contributing to
obesity. These may be complex, and will need a
structured assessment of need. Parents are likely to be
aware of factors but they may involve emotional
issues making change seem more difficult12.

Once contributing factors have been identified,

healthcare professionals should help parents explore
which of these factors they feel they may be able to
change. There will be pros and cons and solutions
may not always be clear cut.

For instance, excess sedentary behaviour and lack of

physical activity could be a major factor for a family
living in a cramped flat in a high-rise building with no
access to a playground or garden. Taking a toddler to
play outside would impact on the time a busy mother
might have to prepare ideal foods. A carefully
structured assessment of need will enable healthcare
professionals to support parents in balancing needs
and priorities.

It is important to encourage families to set small

achievable goals. Up to three could be tackled at one
time. If there are financial concerns or if both parents
need to work and have limited free time, parents may
be encouraged to share a care plan with staff in the
child's day care setting.

With time, when these changes have been made and

sustained, the family can be encouraged to consider
another set of lifestyle changes.
Support for parents who are not
ready to make lifestyle changes
Parents need help to understand that obesity is a
clinical condition with health implications rather than
just a question of how someone looks18. Discuss the
benefits of making changes to physical activity and
eating patterns and give them details of someone
they can contact when they are ready to consider
making changes.

09
Lifestyle changes may benefit from:
Goal setting. Begin by agreeing simple goals for
behaviour change and what benefits they will
achieve. Make sure the goals will not lead to conflict
between family members and limit the number of
goals to three or less. Make the goals SMART (Table 2).
Keep records of the goals and the achievements
so that they can be reviewed when necessary. When
goals are not achieved, make it an opportunity to
re-evaluate motivation and the complexity or effort
required to achieve that goal.
Reward systems. Toddlers are more willing to
repeat behaviours which are rewarded with parental
attention and praise. Parents should be encouraged to
praise their toddlers for good behaviour and never to
use food or drinks as rewards. More suitable rewards
are, for example, playing indoor games with them,
reading books to them, taking them on a swimming
trip or playing with them in the park.
Removing inconsistencies in the family
environment. Parents should limit the availability
of foods and triggers that lead to overeating. Ideally
they should, for example:
not bring high calorie, low nutrient foods into the
house at all
buy an individual packet rather than multi packs
of snack foods or biscuits that must be stored
somewhere in the house
not go to 'all you can eat for x' style restaurants
have set mealtimes, preferably with all the
family eating together
have readily available healthy snacks to use in
between meals
resist spontaneous snack rewards or incentives in
and outside the home

Table 2: Examples of good and poor SMART Goals

Aspect of goal Good examples Poor examples

Specific Have water or diluted fruit juice in place Choose healthy drinks
of sweetened squashes and fizzy drinks.
Dilute fruit juice using one part juice to
6-10 parts water

Measurable Limit crisps for everyone to 4-6 crisps Eat fewer crisps
at one meal each week

Achievable 1. Toddlers can walk the last 200 metres 1. Walk all the way to nursery
to nursery rather than being pushed in (which might be over a mile and
the buggy or driven in the car too far for a toddler to walk)

2. Use the stairs rather than escalators 2. Only use stairs, never escalators
or lifts in the shopping centre - (the family may live at the top of a tall
particularly when not encumbered with tower block)
heavy shopping or pushchairs

Relevant Include fruit with each meal Eat more pomegranates

Time limited Go swimming on Saturday Go swimming more often this year

afternoons this month

10
 Page suitable for photocopying for healthcare professionals to give to parents
OVERWEIGHT AND OBESITY
GUIDANCE & TIPS FOR PARENTS
Obesity in children is becoming more
common and obese children tend to
remain obese as they grow up and
become adults.
Obese children have a weight that is too
great for their height. The excess weight is
stored as fat which affects their health.
Medical causes of obesity are very rare and
most children become obese because of
their lifestyle.
Children who are obese are more likely to
get health problems such as asthma, high
blood pressure, heart disease and
diabetes. They are also more likely to be
bullied.
There are no medicines to treat young
children who are obese. The only way to
help toddlers and children overcome
obesity is to increase activity and change
the type of foods that the whole family eats.
Toddlers learn by copying you and others
around them. The whole family making
changes towards a healthy family lifestyle
while your child is a toddler will help to
prevent them becoming overweight or
obese as they get older. In this way
toddlers learn and develop healthy habits.
You may need to make lifestyle changes
such as:
increasing the time when you are all
physically active - walking, playing
together e.g. ball games, dancing,
swimming
decreasing the time you spend in
sedentary pursuits - such as sitting
watching TV or playing computer
games
Practical help and information
on nutrition and development
Supported by an educational grant from Danone UK
eating a healthy diet and limiting foods
high in fat or sugar such as crisps,
sweets, and fizzy drinks to once a week
or less
It is best to make small gradual changes to
family behaviour. Make a list of changes
you think will be possible for your family
to make. Choose up to three of them.
Discuss them in your family and decide
when you will start each change.
Talk to your extended family, such as
grandparents, aunts and uncles, about the
changes you are making so that they will
not undermine them when they see your
toddler. Also tell any other people who
come to your home, such as baby sitters
and friends.
When the changes are successful choose
up to three more to change.
Praise your children when they make these
changes. They are more likely to follow them
again as they like praise from parents.
Praise your children when they are active.
For example: 'You are good at running and
you run so fast now.'
When choosing rewards for your children,
choose things other than food. Do not give
sweets or high-fat foods such as crisps as
rewards.
If toddlers are overweight or obese they
do not have to lose weight. By staying the
same weight they will get slimmer as they
grow taller.
11
 References
1. Health Survey for England 2010. Chapter 11 Children's BMI overweight and obesity.
2. The Scottish Health Survey. Vol 1: Main Report. Table 7.4 Proportion of children with BMI outwith the healthy range, and
prevalence of overweight and obesity in children, 1998, 2003, 2008, 2009, 2010, by age and sex.
3. Lagou V, Manios Y, Moran CN, Bailey ME, Grammatikaki E, Oikonomou E et al. Developmental changes in adiposity in toddlers
and preschoolers in the GENESIS study and associations with the ACE I/D polymorphism, 2007.
4. Oswal A, Yeo GS. The leptin melanocortin pathway and the control of body weight: lessons from human and murine
genetics. Obes Rev 2007 Jul; 8(4): 293-306.
5. Dorosty AR, Emmett PM, Cowin IS, Reilly JJ. ALSPAC Study Team. Factors associated with early adiposity rebound. Pediatrics
2000;105:1115-1118.
6. Hediger ML, Overpeck MD, Kuczmarski RJ, Ruan WJ. Association between infant breastfeeding and overweight in young
children. JAMA 2001;285:2453-2460.
7. Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I et al. Early life risk factors for obesity in childhood: cohort
study. BMJ 2005;330:1357-1359.
8. Scottish Intercollegiate Guidelines Network (SIGN). Obesity in children and young people: a national clinical guideline SIGN
69 (www.sign.ac.uk).
9. www.who.int/childgrowth/standards
10. Clifford TJ. Breastfeeding and Obesity. BMJ 2003;327:879-880.
11. National Audit Office (NAO). Tackling Child Obesity - First Steps. London: The Stationery Office, 2006.
12. Pagnini DL, Wilkenfeld RL, King LA, Booth ML, Booth SL. Mothers of pre-school children talk about overweight and obesity:
The Weight of Opinion study,Journal of Paediatrics and Child Health 2007 (in press).
13. Bull J, McCormick G, Swann C, Mulvihill C. Ante-and post-natal home-visitng programmes: a review of reviews: Evidence
Briefing Health Development Agency 2004.
14. Department of Health 2011 Start active, stay active: a report on physical activity from the four home countries Chief Medical
Officers. DH, London.
15. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gillman MW, Lichtenstein AH et al. American Heart Association Dietary
recommendations for children and adolescents: a guide for practitioners. Pediatrics 2006 117(2):544-59.
16. Gregory JR, Collins DL, Davies PSW, Hughes JM, Clarke PC. National Diet and Nutrition Survey: children aged 11/2 to 41/2 years.
Volume 1: Report of the diet and nutrition survey. Ministry of Agriculture, Fisheries and Food and Department of Health.
1995. London: HMSO.
17. Cooke L. The development and modification of children's eating habits. Nutrition Bulletin 2004;29:31-35.
18. NICE. Clincial Guideline 43. Obesity. 2006.
19. The Caroline Walker Trust (2005) http://www.cwt.org.uk

Further Reading
1. Matyka K. Managing obesity in children. Obesity In Practice 2002: 4 (2) 2-8.
2. Taheri S. The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis
Child 2006: 91: 881-884.
3. Zaninotto P, Wardle H, Stamatakis E, Mindell J and Head J. Forecasting Obesity to 2010. Prepared by the Joint Health Surveys
Unit for the Department of Health. 2006.
4. The Information Centre. Statistics on Obesity, Physical Activity and Diet: England, January 2008. Government Statistical
Centre. 2008. www.ic.nhs.uk/pubs/opadjan08

Glossary
Cushing's syndrome: caused by excessive levels of the hormone cortisol which causes rapid weight gain, particularly of the trunk and face
endocrine disorders: abnormalities of hormone secretion or action
growth hormone: a hormone secreted by the pituitary gland which stimulates growth and cell reproduction. It controls the growth in
toddlers and young children
hypothyroidism: insufficient production of thyroid hormone by the thyroid gland
leptin: a hormone secreted by adipose tissue, that plays a key role in regulating energy intake and energy expenditure, including the
regulation of appetite and metabolism
Prader-Willi syndrome: a condition due to a chromosomal abnormality. Babies are floppy at birth and go on to develop obesity due
to an excessive appetite and overeating. Other characteristics are small hands and feet, mental retardation, poor emotional and social
development and immature development of sexual organs and other sexual characteristics

Additional copies of this Factsheet can be downloaded from www.infantandtoddlerforum.org

The information contained within this Factsheet represents the independent views of the members of the Forum and copyright rests with the Forum members.
BMI charts reproduced with the permission of the Child Growth Foundation. Supplies and further information from www.healthforallchildren.co.uk

ITF129 - March 2008

Revised - April 2012