Also Appearing in This Issue of JAMA


Obesity May Be Declining Among Preschool-Aged Children Living in Low-Income Families

“Obesity and extreme obesity in childhood, which are more prevalent among minority and low-income families, have been associated with other cardiovascular risk factors, increased health care costs, and premature death. Obesity and extreme obesity during early childhood are likely to continue into adulthood. Understanding trends in extreme obesity is important because the prevalence of cardiovascular risk factors increases with severity of childhood obesity,” writes Liping Pan, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues. National trends in extreme obesity among young children living in low-income families have not been known.

As reported in a Research Letter, the authors analyzed data from the Pediatric Nutrition Surveillance System (PedNSS), which includes almost 50 percent of children eligible for federally funded maternal and child health and nutrition programs. The analysis for this study included 26.7 million children ages 2 through 4 years from 30 states and the District of Columbia that consistently reported data to PedNSS from 1998 through 2010. One routine clinic visit with demographic information and measured height and weight was randomly selected for each child. Obesity (body mass index [BMI] 95th percentile or greater for age and sex) and extreme obesity (BMI 120 percent or greater of the 95th percentile) were defined according to the 2000 CDC growth charts.

The 2010 study population was slightly younger and had proportionally more Hispanics and fewer non-Hispanic whites and blacks compared with the 1998 population.  The researchers found that the prevalence of obesity increased from 13.05 percent in 1998 to 15.21 percent in 2003. The prevalence of extreme obesity increased from 1.75 percent in 1998 to 2.22 percent in 2003. However, the prevalence of obesity decreased slightly to 14.94 percent in 2010; and the prevalence of extreme obesity decreased to 2.07 percent in 2010.

“To our knowledge, this is the first national study to show that the prevalence of obesity and extreme obesity among young U.S. children may have begun to decline,” the authors write. “The results of this study indicate modest recent progress of obesity prevention among young children. These findings may have important health implications because of the lifelong health risks of obesity and extreme obesity in early childhood.”

(JAMA. 2012;308[24]:2563-2565. Available pre-embargo to the media at


Viewpoints in This Week’s JAMA

Opportunities to Reduce Childhood Hunger and Obesity

David S. Ludwig, M.D., Ph.D., of Boston Children’s Hospital, and colleagues discuss the Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program), and provide recommendations for improving nutritional quality for children in the U.S.

“SNAP is essential for hunger prevention in the United States, but its exclusive focus on food quantity contributes to malnutrition and obesity, and is misaligned with the goal of helping beneficiaries lead healthier lives. The nation’s $75 billion investment in SNAP could provide a major opportunity to reduce the burden of diet-related disease among low-income children and families if policies that promote nutritional quality are instituted.”

(JAMA. 2012;308[24]:2567-2568. Available pre-embargo to the media at


Measure, Promote, and Reward Mobility to Prevent Falls in Older Patients

Samir K. Sinha, M.D., D.Phil., and Allan S. Detsky, M.D., Ph.D., of the University of Toronto, Ontario, Canada, examine the importance of maintaining and improving mobility among older patients to reduce the risk of a fall.

“A focus on maintaining and improving mobility should be encouraged when an older adult becomes acutely ill and particularly vulnerable to permanently losing functional capacity during a hospitalization. More importantly, encouraging routine strength and balance training in community-dwelling older adults should be a priority. This strategy not only could lower the risk of hospitalization due to falls and fractures but also, more importantly and even at advanced ages, could enhance quality and length of life.”

(JAMA. 2012;308[24]:2573-2574. Available pre-embargo to the media at

Editor’s Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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