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Two- to five-year-olds who participated in the programme adopted a healthier diet than those that did not. They ate less junk food, more fresh fruits and vegetables and drank less juice and more low-fat milk and water. And almost all of the "intervention" children who started out at a normal weight stayed at a normal weight while those who were at risk for obesity lost a little weight.

The results were presented earlier this month at the American Heart Association's Conference on Nutrition, Physical Activity and Metabolism.

Intervention must start as soon as possible
"Nobody would dispute that we are experiencing an epidemic of obesity in this country," Dr. Ruby Natale at the University of Miami, Miller School of Medicine, who was involved in the research, said in a statement. "Children as young as 7 years old are experiencing health consequences of being overweight, suggesting that intervention must occur as early as possible and involve the entire family."

Offering children healthy alternatives
At six "intervention" childcare centers, teachers made menu modifications such as promoting water as the primary beverage; offering only skim or 1 percent milk; limiting juices and other sweetened beverages; and serving fruits and vegetables at snack time. They also educated the children on how to eat healthy.

"Teachers actually have a really big influence on what children eat - I hate to say it but even more so than the parents at this young age -- especially if they are in school from 7 am to 6 pm," Natale noted in an AHA podcast from the meeting.

At home, parents of intervention children reinforced what the children learned at childcare. Monthly parent dinners and newsletters educated parents on portion sizes and how to make healthy food choices. The two-tiered preschool- and home-based obesity prevention programme was a success, the researchers report. While roughly 68 percent of children were at normal weight at the start of the study, this increased to 73 percent at the 6-month check-up. And the percentage of children who were at risk for overweight decreased from 16 percent at the outset to 12 percent at 6 months.

Helping the whole family
Dietary recall reports showed that, on average, chip consumption decreased from daily to no consumption in the intervention groups and cookie consumption decreased by 50 percent. Fresh fruit and vegetable consumption increased 25 percent and juice consumption decreased 50 percent and was replaced with a 20 percent increase in water consumption. One percent milk consumption increased 20 percent. Intervention children not only ate healthier in school, but at home too, with parents reporting that they served their children more fruits and vegetables at meal time and that while food shopping their children actually asked for the fruits and vegetables that they were exposed to at school.

Study may impact future policy
In sharp contrast, at the two control sites, where there was no intervention, cake and cookie consumption actually increased, while the average fresh fruit and water consumption decreased. Dr. Sarah E. Messiah, from University of Miami, who led the research team, said she is hopeful that this study "will impact policy around the country leading to healthier standards for meals served at childcare centers." "If we are successful in improving attitudes toward nutrition and physical activity in early childhood, we can potentially influence adult behavior and begin to hope that the public health epidemic of obesity can be ended," Messiah said.

2008-03-28 By Megan Rauscher (Reuters Health)

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