1

Premature or delayed weaning increases risk of elevated adiposity in childhood through

excessive energy intakes














Sarah Leahy
May 2, 2014
Diet 3231W



2
According to the 2007-2008 National Health and Nutrition Examination Survey
(NHANES), almost 17% of children between the ages of two to nine years old throughout the
United States are obese.
1
Childhood obesity is a major concern because of the immediate and
long-term health and psychological side effects associated with this disease. The rate of
childhood obesity has been on a continual incline for the past decade, until new 2011-12
NHANES data, was released from the Centers for Disease Control.
2
This data shows
significant decline in the rate of childhood obesity for the youngest group of children ages two to
five years old, however, the overall rates of childhood obesity remain unchanged. When a child
is overweight or obese they have an increased risk of being overweight as an adult and
behavioral patterns, which are developed as a child, are likely to continue into adulthood.
3

Obesity occurs when there is an imbalance between dietary intake and physical activity.
4

The development of this disparity may begin during early childhood, influenced by a multitude
of factors including parental weight, dietary and lifestyle patterns. Inadequate nutritional intake
as early as infancy begins with the timing and variety of foods introduced during the weaning
transition. This paper will explore the thesis that the introduction of complementary food, along
with premature or delayed weaning, may increase the risk for inappropriate food intake
unsuitable for developmental age and may lead to rapid weight gain throughout childhood. The
initiation of solid food into an infants diet is influenced by the timing and variety of foods
offered throughout the first year of life. Factors associated with inappropriate weaning age
include mothers of low socio-economic status, who are overweight or obese themselves and
single parent families. Interventions that provide support and education for mothers and families
on weaning age and technique promote optimal nutrition and prevention of excessive weight
gain throughout early childhood. To address this hypothesis, the paper will review of the
3
guidelines for infant weaning set by the American Academy of Pediatrics and the consequences
of premature and delayed weaning. This paper will also focus on early infant feeding methods,
including timing and type of complementary food introduced during infancy, examine existing
interventions in this field and additional multidisciplinary interventions that should be taken into
additional consideration

American Academy of Pediatrics Guidelines for Weaning Age
Weaning is the process of introducing food into an infants diet when they have
previously been exclusively breastfed or formula fed.
5
The American Academy of Pediatrics
(AAP) recommends exclusive formula or breastfeeding until an infant is at least six months old.
6

Weaning an infant should be done in partnership between mother and child, and begin when the
infant is developmentally ready. The goal for weaning is to slowly introduce complementary
food into the infants diet. Optimal weaning provides a smooth transition from exclusive feeding
to the infant consuming solid foods to provide additional nutrition in their diet.
The AAP advocates for combination feeding of breast milk or formula and solid food
until the infant is twelve months of age to ensure the infant is still receiving complete and ideal
nutrition.
6
There is no recommendation involving when to discontinue breastfeeding, it is
usually a gradual process that is determined by mother and child together. Breast or formula
feeding usually stops once the child is completely weaned onto solid food and is able to receive
full nutrition without additional supplementation. Complete weaning may be difficult for many
infants because of the security associated with receiving a bottle or being breastfed by mother.
5

Complete weaning from a bottle should be brought to an end by the time the infant is eighteen
months to prevent tooth decay, and potentially excessive calorie consumption.
6
Complete
breastfeeding weaning age has not been established; according to the World Health Organization
4
children should not be completely weaned until the child is two years old.
7
Weaning is an
important process that takes place in every childs life, and can have a lasting affect on an
infants long-term health.
Several variables important to consider throughout the weaning process include the
timing of food introduction, the type, variety, and amount of food presented to the child at each
feeding. If a child is not weaned properly, they may be at risk for excessive weight gain due to
excessive calorie consumption and development of unhealthy feeding behaviors.

Consequences of Premature Weaning
Early weaning is categorized as introducing solid food into an infants diet before the
recommended age of six months.
6
Most studies examined for this review considered early
weaning to be introduction of solid food before four months, and proper weaning age to be
between four and six months. Systematic reviews have been conducted to determine the
association between early weaning, introductory foods and types of complementary food
appropriate during infancy.
8
Research examined for this paper provides various levels of
scientific evidence evaluate the general consensus involving the appropriateness of current
weaning guidelines and the influence of premature weaning on excessive adiposity development
during childhood. Cohort and case controlled studies are examined in this section of the paper to
provide evidence and correlation. Cohort studies provide a higher level of scientific evidence
because it follows a population of individuals over a period of time and tracts frequency and
prevalence of a child becoming overweight or obese. While case-controlled studies compare two
groups, one with the disorder and one without, this does not provide as strong of scientific
evidence because of inability to match populations and provide accurate validity.
5
Early weaning, defined as exclusive breastfeeding for less than four months, increases
risk of obesity in preschoolers according to a case-controlled study of 366 children between ages
two and six.
9
The intervention group consisted of children with a BMI greater than the 85
th

percentile and the control group was made up of students from the same school, with a BMI less
than the 85
th
percentile. Additional risk factors controlled for the analysis of this trial included
the weight of the child at birth, mothers weight, and dietary and physical activity patterns of the
child. From the analysis, 36.2% of the children who were breastfed for less than four months
were at risk for being obese or overweight, but not after controlling the other risk factors.
Breastfeeding exclusively for greater than four months allows for child-led weaning, infant-
regulated feeding and a plays a protective role against a child being overweight later in life.
Additional significant factors for increased child weight included low fruit and vegetable intake
and excessive caloric intake of high soft drinks. There was an association between weaning too
early and excessive caloric consumption and overall poor diet quality. There appears to be a
correlation between weaning of an infant prematurely and increased risk for that child to be
overweight or obese during childhood, however this risk may not be an isolated association. The
implications of this study supports the current American Academy of Pediatrics guidelines, for
exclusive breastfeed or formula feeding until the child is six months of age.
6
Introduction of
solid food too early may lead to increased risk of being overweight or obese, however continued
research needs to be completed to account other influential variables.
A cohort study identified infants who were never breastfed or infants who were exposed
to solid food before four months have increase risk of being overweight by the age of three.
10

The study consisted of 847 eligible child-mother pairs followed from gestational period through
infant delivery, and then followed-up when the infant was six months, three and six years old.
6
The children were broken into two groups based on exclusivity and length of breastfeedingless
than four months or greater than four months, or if they were exclusively formula fed. At each
visit, the childs adiposity was assessed through BMI and skin fold measures. The age in which
the child was introduced to solid food was adjusted based on breastfeeding status. The study
sample recruited was homogeneous; the individuals enrolled had similar levels of education and
income. This increased the internal validity of the study to increase the ability to associate the
differences in weaning age with childs weight. However, this also causes a decrease in external
validity of the study and prevents the generalizability of the results, outside of the examined
population and in populations with lower rated of breastfeeding initiation. From the analysis and
accounting for breastfeeding status, infants introduced to solid food before four-six months and
were never breastfed, had six-fold higher rates of being obese by the age of three. This study did
not account for rapid growth during infancy or early infancy weight to length/height ratio.
Researchers speculated infants exclusively formula-fed appear to have higher rates of obesity
and increased weight gain because feeding self-regulation was not developed and excessive
energy intake was not taken into consideration.
An alternative cohort study was completed within a different population, and examined
the association between breastfed vs. formula fed infants, while taking into consideration rates of
rapid weight gain and growth. A cohort study was completed in the UK, it examined 10,533
three-year old children, and analyzed early infant feeding practices and current weight trends.
11

The results of this data suggest that formula fed infants or infants that were breastfed for less
than four months had increased weight and growth rates by the age of three years old, compared
to infants that were breastfed exclusively for a longer period of time. Infant birth weight and
feeding patterns were compared to weight and height ratio and growth rate at age three. The data
7
presented increased weight and growth rates among children formula-fed, but did not indicate the
children where overweight or obese, they only had a greater growth rate. Infants that were
breastfed exclusively for an extended period of time had slower rates of growth and did not have
increased weight gain by the age of three. There was no relationship observed between timing of
introduction of solid or complementary foods and an effect on rapid or excessive weight gain.
The findings of this study must be evaluated within the limitations that all information gathered
was based on parental recall, including information gathers about duration of breastfeeding,
bottle-feeding, and introduction of complementary foods.
Although the studies may present conflicting information one point is evident. If a child
is exclusively fed the risk of rapid weight gain is less likely to occur because the child is able to
self regulate food intake for a longer period of time. Weaning age of a child appears to play a
role in influencing weight gain during childhood. Development of dietary and food preference
patterns during childhood and infancy could influence an individual through adulthood to have a
lasting consequence.

Consequences of Delayed Weaning
Various research and systematic reviews have explored the effects of early weaning and
potential risk for childhood obesity; however, the research determining the consequences of
delayed weaning was not as abundant. Many different search strategies were completed to find
scientific evidence that supported, or disproved the present paper thesis. The first search was
delayed weaning of infants resulting in 157 entries recovered, most them focused on the
benefits of extended breastfeeding, weaning HIV-infected infants or weaning related to the
prevention of allergies. The next search was delayed complementary feeding, which studies
involving delayed weaning during infancy and the correlation they have on weight gain. There
8
was research from the National Health and Nutrition Examination Survey (NHANES) on effects
of late bottle weaning and increase risks of childhood obesity.
12

A child weaned too late from bottle-feeding has a greater probability of being overweight
or obese BMI according to analysis of the NHANES. The nationally represented data was cross-
sectional of extended bottle-feeding in relation to the childs body weight.
12
The 3,021 surveyed
children, ages 3-5 years, were weighed, and parents identified bottle weaning age of the child.
The average weaning age was 18.75 months, which is almost four months greater then the
recommended bottle weaning age of 15 months.
13
At the age of two, 21.5% of the children were
still being bottle-fed. At the age of three, 9% were still on a bottle and by the age four there were
still 2.3% on a bottle.
There was a positive association between the childs BMI and mean age for bottle
weaning. Children with a BMI greater than the 85
th
percentile had a mean weaning age of 18.25,
while children with a BMI greater than 95% had a mean bottle weaning age of 22.34 months. A
few limitations to the NHANES data were that neither the number of bottles given to the child
each day nor what was given to the child in the bottle was collected. Despite the limitations
excessive bottle feeding seems to be the main concern addressed in this study and when talking
about a childs risk for being overweight. The additional caloric intake throughout the day can
cause the child to be in a positive energy balance and therefore at risk for an overweight or obese
BMI.
This first study focused on the effects of late weaning from bottle-feeding, and the risk
for increase calorie consumption resulting excessive infant weight gain. A cohort study
examined effects of delayed weaning from breastfeeding and late introduction to solid food on
BMI of the child into adulthood.
14
The Copenhagen Perinatal cohort study was completed in
9
1959 to 1961 to observe 9,125 mothers and gather information about their newborn infants.
Mothers who decided to participate in the study provided self-reported information and
anthropometric about their children at ages 1, 3, and 6 years old. These children were then
followed into adulthood and answered questions at age 20-34 and 41-43 year old, with a 54%
retention rate of the participants over the 43-year study.
This study tracked the duration of breast-feeding, the age of weaning and timing for
introduction of complementary feedings, and compared it to the participants weight progression
from infancy to adulthood. According to analysis of the data, individuals who were breastfed
longer had a reduced weight during infancy, but did not appear to have significant effect on
weight during childhood or beyond. However, the timing of complementary food introduction
did appear to be significant with the weight during adulthood. If participants were introduced to
solid food later, they had a lower BMI and weight during adulthood. It is important to consider
the different environmental and genetic variables that can contribute to an individuals weight
throughout their life. This study examines the fact that delayed transition to solid foods may
benefit the child in keeping their weight within normal range during adulthood.
The two studies examined above were completed differently, providing various levels of
scientific evidence to support the association between delayed weaning and risk for increased
adiposity gains during childhood. The first study completed by NHANES was a cross-sectional
study gathering information from individuals across the country, through a one-time survey. The
level of scientific evidence presented by the study is generalizable to the public because it was
collected and represents a large population. The second study examined was a longitudinal
analysis, which provides stronger evidence to support this association due to lapse of time.
Change over time allows for discovering long-term outcomes of studies and correlation can be
10
observed in the subjects. This evidence supports delayed introduction to solid food may also
have potential beneficial effects to prevent obesity during adulthood. Children weaned from a
bottle later are less likely to have a nutrient dense diet, however, there is not enough evidence to
determine a cause or effect. Potential for additional research in this field could examine the
association between delayed weaning and altered taste of food due to of lack of exposure, affects
on inadequate diet, and excessive calories consumption.

Infant Feeding Practices: timing and types of complementary food introduced to infants
The Infant Feeding Practice Study II was a nationally conducted longitudinal study to
gather comprehensive information about mother-infant feeding patterns.
15
Information was
obtained by sending questionnaires to pregnant women based on completion of a consumer
opinion survey. A participating sample of 4,900 women responded to at least one initial survey, a
total of 2,000 mothers received questionnaires, telephone interviews, and nutritional assessments
that lasted until the child was 12 months old. This survey observed different infant feeding
methods, along with types foods fed to an infant, maternal nutrition and employment status and
additional factors affecting maternal and infant health.
16
This study has provided baseline data
for a multitude of different studies, and utilized the results of this study to determine the effects
of infant feeding through out the United States.
An analysis of the Infant Feeding Practices Study II revealed that mothers education
level had an association with the infant-feeding practice, specifically focusing on the timing and
type of complementary food introduction.
17
Almost 21% of mothers fed their infants solid food
before 4 months. Mothers with a high school education or less were more likely to give their
infants solid food prior to 4 months and the quality of the foods initially introduced to infants did
not meet the recommendations of the AAP. Over 15% of mothers fed their 9 to 12 month old
11
infants less than one fruit or vegetable per day. Mothers did not appear to feed their infants an
adequate diet; lack of proper nutrition at a young age could lead to problems with growth and
development.
3
This study provides a snapshot into the feeding practices taken place through out
the country, and how mothers from every socioeconomic status chose to feed their infants. As a
study limitation, the sample was not representative of the diversity of race/ethnicity and
educational levels U.S. population. The surveys also lacked specific information about the type
or amount of food being provided to the infants.
Early dietary patterns of infants play a role in determining lifelong nutrition and risk of
being overweight or obese according to the national recognized Feeding Infants and Toddlers
Study (FITS).
18
Typical dietary intake survey provided an examination of different components
of infant feeding patterns and how it may contribute to rapid and excessive weight gain This
study consisted of 3,273 randomized households through out the United States, with a child aged
from newborn to four years old (47 months old). The information was collected through a series
of phone interviews to gather information regarding general demographic information and
multiple dietary interviews. One major finding, which may play an influential role on childhood
obesity, was that 10-27% of children in every age category, from zero months to forty-seven
months, received excessive energy and increased daily caloric intake. The average energy intake
of infants younger than six months was 14% in excess of calories per day, and the percentage of
excessive calories consumers per day increased with the age of the child.
A second contributing factor to increase weight gain identified by the FITS study was the
lack of consumption of fruits and vegetable in the first year of life. The types of food being
consumed were lower in nutrient density and starchier. The average 18 months old infant only
12
consumed 10% of diet from fruits and vegetables. Increased fruit and vegetable intake is
associated with decreased calorie consumption and decreased body weight.
11

The FITS study verified the need to improve early infant feeding practices by altering the
amount of food being fed to infants and the types of food introduced during the first year of life.
The first two years of an infants life sets the stages for dietary behaviors for life. Limitations to
the FITS study include the interviews took place over the phone and not in person; this could
influence the response of the subjects, altering their answers to certain questions. This study did
not track participates over a period of time, it only identifies current weight and dietary habits; it
does not look at the long-term effects of weaning diet. The diet of infants plays an influential role
on weight gain through out the lifespan of a child by influencing excessive weight gain, dietary
patterns and behaviors.
The FITS study was an extensive survey study completed to examine patterns of national
infant feeding practices; other research has been conducted to measure the direct effect of infant
feeding methods on infant anthropometric data. A cohort study was completed to analyze the
timing of introduction of solid foods in infants in relation to weight gain during the first two
years of life.
19
This study examined the feeding behaviors of 828 children who were exclusively
formula fed. Data were collected from parental report in three-month intervals for the first
twenty-four months of the infants life. Parents reported feeding behaviors including first
introduction of solid foods and the amount and type of food introduced to their infant. The
infants were broken into groups based on the age (in weeks) they were introduced to solid food;
the mean infant was introduced to solid food at 19 weeks old. The four groups included
introduction of solid food before thirteen weeks, fourteen to seventeen weeks old, eighteen to
twenty-one weeks and after twenty-two weeks old.
13
According to the results of the study, time of introduction of solid food did not appear to
be significantly associated with the anthropometric data collected at 24 months. Although weight
and BMI for age appears to have significant results, the data appears to be skewed by outlier
infants who were improperly weaned. The recalls and information gathered in this study were
based of parent self-report, and 24hr recall competed through a limited nutritional database.
Further investigation is needed on the timing of solid food introduction and the types of foods
introduced during infancy.
The variety of early infant feeding practices, methods and the long-term effects may still
be unknown; nevertheless, there appears to be an association with childhood weight gain. There
are different factors to take into consideration such as the foods fed during infancy, along with
the amount and variety presented during early infancy and childhood that develop preference and
dietary habits for life. Rapid weight gain at a young age can be contributed by excessive calorie,
inadequate fruit and vegetable intake, and introduction of solid food at too young of an age.

Infant Feeding Interventions
Infant feeding practices are determined based on a feeding schedule that is consistent
with the AAP guidelines and meet the needs of the infant. An investigation of existing infant
feeding practices and interventions was completed, by searching PubMed for infant feeding
practices, looking specifically at randomized control trails. Interventions that were discovered
appear to focus on current implementation of the AAP guidelines, providing education to parents
about recommendations and reducing the gap between knowledge and current feeding practices.
Risk factors associated with inconsistent patterns of infant feeding include if the infant is a first
born child, socioeconomic status of the family, maternal weight and weight gain during
pregnancy along with development of proper nutritional habits.
13

14
The NOURISH trial was a parent-based community intervention to promote appropriate
infant feeding practices, and examine the correlation with increased rates of childhood obesity.
20

This intervention was a randomized control trial to promote infant feeding practices and took
place in Australia with 698 new mothers. The purpose of this intervention was to encourage
maternal and infant feeding habits and determine if providing education influences healthy food
and dietary intake among during infancy and early childhood.
21
The study was composed of a
control group that received usual self directed care from a physician and an intervention group
that received two, six-week group education sessions. Each session included parent education
classes, peer support groups meetings, and check-ins to determine maternal efficacy involving
proper feeding techniques. Anthropometric data was taken of the infants at 6 months, 20 months
and 24 months, however the results did not appear significant in relation to the childs weight,
height or BMI. There was a 4.1% decrease in the overall rates of overweight or obese children in
the control population, however it was not a significant reduction. There was an increase among
the control group of mothers involving food acceptance, child-led weaning and promotion of
overall healthy eating patterns.
This study was one of the first of its kind to address feeding habits during infancy,
beginning before the age of 12 months, and potential the influence on childhood obesity. This
study concluded infant feeding interventions may lead to an increase in child led feeding, and
additional exposure to a variety of foods during infancy, and overall feeding behaviors. The
NOURISH intervention was not effective in reducing rate of childhood obesity by the age of
two. The outcome of this study may not be able to observed until adolescence or beyond. The
effects of promoting adequate nutrition at an early age may be long-term and not been to be
observed within the two year window provided.
15
The Healthy Beginnings Trial, influential in development of the NOURISH Trial
mentioned above, is randomized control trial completed by Wen et al. to observe the effects of
home based intervention and the potential influence of feeding practices and BMI during
infancy.
22
This Australian study recruited 667 first time expecting mothers of low
socioeconomic status; they were split into a control group that received routine health care and
the intervention group. The intervention group received routine care and in addition received
eight, two hour, at home visits, during major developmental milestones in the first two years of
the infants life. The intervention promoted breastfeeding, and the timing of introduction of
complementary food. It also endorsed increased fruit and vegetable consumption, along with
focusing on maternal nutritional health, and additional factors that may influence infant BMI.
This study compared the BMI of the infants within the intervention and control group, along with
eating habits of the infants and maternal nutritional and lifestyle choices. There appeared to be a
2.9% reduction in the number of infants that were obese at the age of two in the intervention
group. There also appeared to be an increase in the consumption of vegetables for both mother
and child due to the education provided through out this trial. This study supports early
childhood intervention support the development of healthy eating patterns and lifestyle. The
long-term effects of this intervention have not yet been observed, and it is uncertain if these early
interventions will have an effect on the childs BMI beyond two years of age.
The Infant Feeding Series (IFS) was a randomized control trail, pilot intervention, that
focused on maternal education and behavior change interventions to increase knowledge about
infant feeding practices
23
. This six-week intervention had six at home lessons to 31 expecting
and new mothers of low socioeconomic status. All mothers were recipients of federally, funded
supplemental nutrition programs and enrolled in a previously existing nutrition education series.
16
This study utilized two different behavior change models; the transtheoretical model of change
and the theory of planned behavior. This intervention provided education about the AAP infant
feeding recommendations, promoted healthy infant feeding practices following introduction of
solid foods, and aimed to increase new mothers confidence and self-efficacy to assist in
behavior change. From pre and post-test intervention, the mothers increased recognition of infant
readiness for solid food, increased their reported self-efficacy to follow AAP recommendations,
and self-efficacy on options about infant feeding practice. This pilot intervention provides
evidence that supports. The concept of mothers receiving education about infant feeding
practices, they may be more likely to take part in a behavior change and follow current
guidelines. This study is limited because it does not provide a follow up with the mothers to
determine the utilization of the knowledge learned and it does not test the effectiveness of
knowledge gained in relationship to prevalence of child obesity. Further implications of this
study include further development of this IFS education program and utilization of behavior
change theories along with education to provide mothers with proper education about infant
feeding.
A secondary search on PubMed was completed; this search was for early feeding
practices which provided additional interventions focused on infant nutrition and the potential
effects of child becoming overweight or obese. Different types of interventions have been
conducted to focus on potential risk factors, such as early feeding, composition of infant diet,
influence of parental diet and weight, to name a few of the associations examined to determine
the influence of excessive weight gain during childhood.
24

The Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) program was a
longitudinal, randomized control trial, completed to determine the effectiveness of community
17
and parent-based intervention to provide obesity prevention education to new and expecting
parents. Campbell and colleagues completed one analysis of this study to determine the success
of the providing parents with education and instruction at a personal level and in a group setting
(s).
25
This study recruited 542 new parents to take part in six, two-hour education sessions over
a 15-month period of time. This intervention measured the impact these sessions had on child
feeding patterns; BMI, physical activity levels and time spend in front of a screen. The
intervention focused on providing education to parents about healthy infant feeding behaviors
and emphasized the effect parent modeling impacts child life-long development. The Melbourne
InFANT intervention appeared to present a significant reduction in infant consumption of sugary
beverages, sweet snacks, and reduced amount of screen time per day. There was no correlation
seen involving infant BMI or fruit or vegetable by the age of two years old. However, the
success seen among parents has led to an additional follow-up to be completed to determine the
long-term effects of childhood obesity intervention.
24
The follow-up is being completed by
Hesketh and Campbell et al. is still being completed and will follow up with participants of this
study when they are three and five years old. This continuation intervention will address
potential reduction in obesogenic behaviors and environmental influence during infancy and
through out early childhood.
The interventions examined may have produced results that were unclear or in need of
additional research. Further investigation involving parental interventions and education of
proper infant feeding practices should be examined to determine the associated risk of reducing
childhood obesity. Additional studies should be completed to investigate the longitudinal results
of the studies that have been completed and determine the long-term impact of intervening at a
18
young age. Ongoing education to parents and care providers will help to address influential
factors related to childhood obesity.

MULTIDISCIPLINARY INTERVENTIONS
Childhood obesity is a multidimensional public health issue effecting the youth of the
United States. The continual increase in the rates of childhood obesity is not solely caused by
one contributing factor and will not be eliminated through one measure. Additional fields needs
to be studied in conjugation with early infant feeding practices such as; dietary behaviors,
development of food preferences, portion size and the effect of parental influence. Obesity
prevention programs and interventions that are child and parent focused provide education about
different topics and factors to reduce rates of obesity. Different research investigates topics or
hypothesis; however, the end goal for each of these studies is to eliminate risk of gaining
excessive adiposity during childhood and later in life. Several multidisciplinary interventions
were investigated; such as promotion of healthy maternal and child weight gain pre and post
pregnancy, introduction of a diverse diet, and promotion of food preferences during infancy and
the association with a reduction in childhood obesity.
Consumption of vegetables in very a low among American adults, less than 50% of the
population meets daily serving requirements for vegetable consumption.
26
If less than 50% of
adults are meeting the recommendation of three or more vegetable serving per day, it can be
guaranteed that children are also not consuming the proper amount of vegetables in their diets
daily. Research suggests that low rates of vegetable consumption may be associated with strong
and bitter flavor of vegetables resulting in decreased personal preference and poor daily
consumptions.
27
A study completed by Mennella and colleagues suggests that predisposition and
expanded vegetable consumption by the mother during pregnancy and while breastfeeding can
19
influence flavor preferences once solid food is introduced into the infants diet.
28
Increased
exposure and flavor learning during in-utero and from breastfeeding may lead to increased
vegetable consumption throughout childhood, which leads to decreased risk of excessive weight
gain.
Parental influence on development of child behaviors and lifestyle choices can have a
powerful impression on lifelong health and weight. Maternal weight gain, dietary habits, and
physical activity level can influence child development and risk of becoming overweight.
Excessive maternal weight gain during pregnancy can lead to risk of delivering a macrosomic
baby. Baby that are born at a heavier weight have an increased risk of being overweight or obese
because of excessive weight and growth rates.
29,30

Childhood obesity is a complex problem, and in order to develop an intervention to
reduce current rates, it must be observed from all dimensions. It is of vital importance to consider
that this paper addresses one facet of the problem that is excessive energy and inadequate dietary
intake. A secondary consideration for this epidemic is the reduction in physical activity seen
among all children in the United States.
4


CONCLUSION AND ADDITIONAL RESEARCH

Interventions are needed to address and prevent excessive weight gain during early
childhood. The timing of food introduction and the variety of foods provided are critical during
the first year after birth. By providing childhood obesity prevention and education, the risk for
childhood obesity may be decreased, as well as promote an increase in healthy and active
lifestyles. Future research should incorporate the social-ecological model, which is a multi-level
design that incorporates community, policy, family, and individual level interventions. It is
essential for these to work concurrently to reduce childhood obesity in future generations
20

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