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Obesity prevention starts prenatally.

Childbirth educators are in a unique position to teach to a receptive, ready and willing to learn audience; new parents. They are excited to be good parents and want to learn as much as possible. This is an opportunity to teach them to role model good behaviors and practice obesity prevention. Childbirth educators should teach parents that it is their responsibility to be proactive in obesity prevention and to educate their children in healthy habits (CDC, 2013a). Some tools can serve as guidelines to promote healthy outcomes, such as nutrition and portion control, exercise implementation, and supportive environment information.

The following is information to share with families that can influence them to make the right choices to decrease the obesity crisis in the US and worldwide. While this may not currently be a priority in most educators' curricula, it is the childbirth educators' responsibility to teach parents about healthy lifestyle choices in the prenatal period.


Over the last 30 years, obesity rates in the US have risen to an epidemic level. Data from 2003-2004 and 2005-2006 indicates that two thirds of US adults and one fifth of US children are either obese or overweight (CDC, 2009). This is especially concerning as obesity for adults doubled during 1980-2004 (CDC, 2009). Even more alarming is that since 1980, the prevalence of obesity among children and adolescents has almost tripled (CDC, 2013b). In 2009-2010, the National Health and Nutrition Examination Survey reported that in the US, 35.7% of US adults and 16.9% of children age 2-19 years were obese (Ogden, Carroll, Kit, & Flegal, 2012). Obesity is now considered by the Center for Disease Control (CDC) to be "common, serious, and costly" (CDC. 2013A, p.1).

There are also significant disparities among racial and ethnic groups (CDC, 2013b). In the US, Hispanic boys 2-19 years are more likely to be obese than non-Hispanic white boys and non-Hispanic black girls were more like to be obese than non-Hispanic white girls (CDC, 2013b). In adults, non-Hispanic blacks have the highest age-adjusted rates of obesity (49.5%) and all Hispanics have a rate of 39.1% compared to non-Hispanic whites who were 34.4% obese (CDC, 2013a). Socioeconomically, adult non-Hispanic and Mexican-American men with high incomes are more likely to be obese than lower income members of the same group (CDC, 2013a). Sadly, in low-income preschool children one in seven are obese. The only good news is that obesity and extreme obesity among US low-income pre-school children for the first time in recent years slightly decreased, and decreased among all racial groups except American Indians/ Alaska Natives (CDC, 2013b)

Overweight and obesity involves eating too many calories and not expending enough energy to balance the energy intake (CDC, 2013a). Obesity is defined for adults as a body mass index (BMI) of greater than or equal to ([greater than or equal to]) 30. Overweight is considered for adults to be BMI of 25-29.9. For children overweight is defined as being at or above the 95% percentile of the sex-specific BMI for age-growth CDC charts. (Ogden, Carroll, Kit, & Flegal, 2012). To get a better picture, please refer to the table 1 indicating the obesity rates by state.


The obesity epidemic is not only in the US, but it is also a global problem. Worldwide estimates identify 18 million children as obese (Ebbelung, Pawlak, & Ludwig, 2002). European children are estimated at approximately 10-30% overweight or obese (Lobstein & Frelut, 2003). Alarmingly, Italy's rates are 36% of children 7-11 years (WHO, 2005). Even in countries where obesity was not a problem in the past, there has been an increasing trend (Ben-Sefer, Ben-Natan & Ehrenfeld, 2009). For example for ages 11-14 years, the percentage of overweight/obese children in Hungary is 20% and in Poland is 18% (previously 8%). In Australia and New Zealand for ages 6-13 years 30% are overweight/obese (Ben-Sefer, et al., 2009; WHO, 2005). Even in countries where there are food shortages, surprisingly, obesity among children is a concern; the World Health Organization found that 14.9% of children in Swaziland are overweight (WHO, 2005; Ben-Sefer, et al., 2009). These numbers are shocking: the obesity problem is a global issue that could be considered a threat to worldwide health. Childbirth educators must be aware of these trends to teach parents the importance of obesity prevention in their own lives and in the lives of their children.

Obesity is a global problem and can be considered a threat to worldwide health

Issues Associated with Obesity

For Adults, overweight and obesity increases the risks for the following conditions:

* Coronary heart disease

* Type 2 diabetes

* Cancers (endometrial, breast, and colon)

* Hypertension (high blood pressure)

* Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)

* Stroke

* Liver and Gallbladder disease

* Sleep apnea and respiratory problems

* Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)

* Gynecological problems (abnormal menses, infertility)

(CDC, 2013a)

Health Consequences

For children, multiple health risks are linked to overweight and obesity. Atherosclerotic plaque has been found in children as young as 3 years. Another health concern is the increase of insulin resistant type 2 diabetes in children (Ben-Sefer, et al., 2009). Other documented problems include hypertension, asthma, musculoskeletal discomfort, shortness of breath, obstructive sleep apnea, bone disorders, abnormal growth patterns, breast cancer, colon cancer, and kidney cancer (Ben-Sefer, et al., 2009). Previously the most common cause of cirrhosis of the liver was alcohol; however now obesity is a direct result of liver overloaded with fat (Ben-Sefer, et al., 2009). This information is valuable information for the childbirth educator to share with parents to illustrate the seriousness health hazards associated with obesity.

Economic Consequences

The health problems associated with overweight and obesity significantly affect the US health care system both directly and indirectly (CDC, 2013a). Indirect costs refer to decreased productivity, absenteeism, restricted activity, and sick days. Premature death results in a future income loss. Direct costs are related to healthcare services needed to treat problems related to obesity (CDC, 2013a). In 2008, the estimated cost for obesity was $147 billion (Finkelstein, Trogdon, Cohen, & Dietz, 2009).

Factors that Contribute to the Obesity Problem

Psychological and Social Factors

Studies have shown that if parents overeat, then their children will probably overeat as well. Furthermore, when a child has one or two obese parents then they have a 40% or 80% respectively likelihood of being obese (Broedsgaard, 2006). Psychologically obese children have been found to have lower self-esteem that could result in depression (Ben-Sefer, et al., 2009). Long-term implications of childhood obesity could result in poor academics and social attainment (Ben-Sefer, et al., 2009).


In some cases, science has shown that genetics or inherited metabolism plays a role in obesity (CDC, 2013a). Although genes may increase one's susceptibility for obesity there are outside factors such as a learned behavior, food supply, or physical activity that play a role as well. Ultimately, genes may not predict one's future health; instead it is usually both behavior and genes that cause obesity (CDC, 2013a).

Exercise and Energy Expenditure

Sedentary lifestyle contributes to obesity. Children spend an average of 7.5 hours a day using entertainment media (television, computers, video games, cell phones, and movies), with about 4.5 hours dedicated to television viewing (CDC, 2013b). Television viewing takes away time children would spend on physical activities. The 2008 Physical Activity Guidelines for Americans recommends at least 60 minutes of aerobic physical activity each day (CDC, 2013b). Only 18% of students in grades 9-12 met this recommendation in 2007. Childbirth educators should encourage parents to role model daily exercise routines and promote physical activity for parents and their children.

Food Portions and Parental Knowledge

Food portions have increased in size especially in less healthy foods and beverages. This is not only at fast food restaurants but can also be found in grocery stores and vending machines (CDC, 2013b). Adults and children may eat more without realizing they have consumed a lot of extra calories. Learning how to read labels and practicing reading labels on food products and in restaurants will help parents realize the high calorie content of food for themselves and their children.

Many Americans have difficulty accessing stores and markets that offer healthy, affordable food such as fruits and vegetables, notably in rural, minority and lower-income neighborhoods (CDC, 2013a). Snack shops, vending machines, and lower priced restaurants may serve food that is often higher in calories and fat than food made at home (CDC, 2013a). Often it is cheaper and easier to purchase less healthy foods and beverages. This has resulted in too much sugar in our diet. Students have access to drinks and less healthy snacks at school from vending machines, school cafeterias, and fund raisers where parents cannot monitor their intake.

Children will follow their parents' lead and over half of adults drink at least one sugary drink per day (CDC, 2013a). Lack of knowledge concerning nutritional values of food and the inability to read product labels can contribute to bad food choices. For example, many parents give their children juice instead of soda, not realizing that more than 12 ounces of juice a day can contribute to overweight; but also create a preference for sweetened drinks, which could lead to a lifetime habit (Ben-Sefer, et al., 2009).


Environmental factors can contribute to the obesity epidemic. It is important to create environments that make it easier to participate in physical activities. For example, if a person lives in an area without sidewalks, it would be more difficult to walk to nearby areas in the community. For children, decreased physical activity may be because there are no safe areas to play or there are limited safe routes to parks. Half of the children in the US do not have a park or sidewalk in their neighborhood (CDC, 2013b).

Another aspect of the environment is the exposure to advertising on television. Many commercials target children with flashy and exciting visual and auditory stimuli that encourage consumption of sugary and fatty foods (Ben-Sefer, et al., 2009). As a childbirth educator, you can encourage parents to consider their environment and plan for safe physical activates outdoors and being careful to monitor television viewing.

Strategies and Solutions


Only 75% of mothers start out breastfeeding, and after 6 months only 13% of babies are exclusively breastfed. Childbirth educators should know and teach that breastfeeding protects against childhood overweight and obesity (CDC, 2013b). The success rate can be improved by suggesting that families, friends, employers, communities, and policymakers support the choice to breastfeed (CDC, 2013b)

Public Policy

Policymakers across all systems should aim to ensure that obesity is addressed. Policies should promote obesity prevention to help citizens choose healthy behaviors and reinforce healthy eating and physical activity (Ben-Sefer, et al., 2009). Supporting healthy environments should include safe areas in which to exercise; and further should impose limits on advertising unhealthy food and expand programs that bring local fruits and vegetables to schools. Childbirth educators can be involved in public policy to support these types of initiatives.

Supportive Environment

Encourage parents to provide a home environment where a healthy lifestyle is role modeled. Some suggestions to make changes would be to serve water instead of sugary drinks, serve fruits and vegetables and limit fats and sugar. Making routines that include a daily physical activity will support this environment. Refer parents to the American Academy of Pediatrics (n.d.) as a resource for recommendations on many environmental concerns such as television time (no more that 1-2 hours of quality programming a day) and healthy choices.


Healthy eating and exercise must become part of an overall lifestyle change for parents (Ben-Sefer, et al., 2009). Childbirth educators can emphasize this important component of obesity prevention during pre-natal classes. Opening a parent's eyes to this very real epidemic should reinforce their desire to protect their children from obesity. Offering education and resources in obesity prevention prenatally will help parents be responsible to themselves as role models and to their children as they practice a healthy lifestyle.



American Academy of Pediatrics (n.d.). Dedicated to the health of children. Retrieved from

Ben-Sefer, E., Ben-Natan, M, & Ehrenfeld, M. (2009). Childhood obesity: current literature, policy and implications for practice. International Nursing Review 56, 166-173.

Broedsgaard, A. (2006). Obese mothers experiences and assessment of their own obesity and their children's risk of developing overweight-a qualitative phenomenological study. Present at Western European Nurses' Research Meeting, Copenhagen, October 12, 2006.

Centers for Disease Control and Prevention. ([CDC], 2009). Recommended Community Strategies and Measurements to Prevent Obesity in the United States. MMWR 2009; 58(No. RR--7), pp.1-29.

Centers for Disease Control and Prevention ([CDC], 2013a). Adult obesity facts. Retrieved from

Centers for Disease Control and Prevention ([CDC], 2013b). Childhood obesity facts. Retrieved from

Ebbelung, C. B., Pawlak, D. B., & Ludwig, D. S. (2002). Childhood obesity: public-health crisis, common sense cure. Lancet 360(9331), 473-82.

Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs, 28(5), 822-831.

Lobstein, T. & Frelut, M. L. (2003). Prevalence of overweight among children in Europe. Obesity Reviews 4(4), 195-200.

World Health Organization ([WHO], 2005). Fact sheet Copenhagen 2005, the challenge of obesity in the WHO European Region. Retrieved from

Dr. Sullivan is an Assistant Professor at Middle Tennessee State University School of Nursing where she currently teaches graduate and undergraduate nursing students. She was the 2010/11 National League of Nursing, Healthcare Informatics and Technology Scholar (HITS) and currently is a Fellow for the Tennessee Simulation Alliance. Currently she is working with childbirth educators to build simulated scenarios. She has published in international and national nursing journals and presented at many local, state, and national nursing conferences.

Debra Henline Sullivan, PhD MSN RN CNE COI
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Author:Sullivan, Debra Henline
Publication:International Journal of Childbirth Education
Geographic Code:1USA
Date:Apr 1, 2014
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