Children's health in the United States has improved dramatically over the past century. Vaccines targeting previously common childhood infections—such as measles, polio, diphtheria, tetanus, rubella, and Haemophilus influenza—have nearly eliminated these scourges. Through the widespread availability of potable water, improved sanitation, and antibiotics, diarrheal diseases and infectious diseases such as tuberculosis and pneumonia have diminished in frequency and as primary causes of infant and child deaths in the United States (CDC, 1999). Pervasive food scarcity and essential vitamin and mineral deficiencies have largely disappeared in the U.S. population (IOM, 1991; Kessler, 1995). The net result is that infant mortality has been lowered by over 90 percent, contributing to the substantial increase in life expectancy—more than 30 years—since 1900 (CDC, 1999). Innovations such as seatbelts, child car seats, and bike helmets, meanwhile, have contributed to improved children's safety, and fluo-ridation of municipal drinking water has enhanced child and adolescent dentition (CDC, 1999).
Given this steady trajectory toward a healthier childhood and healthier children, we begin the 21st century with a startling setback—an epidemic1
1The term "epidemic" is used in reference to childhood obesity as there have been an unexpected and excess number of cases on a steady increase in recent decades.
of childhood obesity. This epidemic is occurring in boys and girls in all 50 states, in younger children as well as in adolescents, across all socioeconomic strata, and among all ethnic groups—though specific subgroups, including African Americans, Hispanics, and American Indians, are disproportionately affected (Ogden et al., 2002; Caballero et al., 2003). At a time when we have learned that excess weight has significant and troublesome health consequences, we nevertheless see our population, in general, and our children, in particular, gaining weight to a dangerous degree and at an alarming rate.
The increasing prevalence of childhood obesity throughout the United States has led policy makers to rank it as a critical public health threat for the 21st century (Koplan and Dietz, 1999; Mokdad et al., 1999, 2000; DHHS, 2001). Over the past three decades since the 1970s, the prevalence of childhood obesity (defined in this report as a gender- and age-specific body mass index [BMI] at or above the 95th percentile on the 2000 CDC BMI charts) has more than doubled for preschool children aged 2 to 5 years and adolescents aged 12 to 19 years, and it has more than tripled for children aged 6 to 11 years (see Chapter 2; Ogden et al., 2002). Approximately nine million American children over 6 years of age are already considered obese. These trends mirror a similar profound increase in U.S. adult obesity and co-morbidities over a comparable time frame, as well as a concurrent rise in the prevalence of childhood and adult obesity and related chronic diseases internationally, in developed and developing countries alike (WHO, 2002, 2003; Lobstein et al., 2004).
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