Childhood Obesity: Solutions to a Growing Problem

  • Jason P. SchaubEmail author
Part of the Nutrition and Health book series (NH)


Common knowledge to healthcare professionals and laymen alike, obesity has reached epidemic proportions in both the adult and juvenile populations. While each constitutes serious implications for health, childhood obesity is of particular significance due to the relatively fragile state of children’s physical and psychological development. Intense research in this field has identified numerous causative factors; however, the incidence of childhood obesity continues to rise, further endangering the health of future generations. In the following chapter key risks associated with childhood obesity are discussed, accompanied with an overview of the obesogenic environment contributing to weight gain in America. The interplay between various factors associated with childhood obesity is investigated, augmented by the development of a global childhood obesity correlation model. With a cohesive understanding of the current state of childhood obesity, established recommendations and future directions, centered on weight loss-specific dietary and exercise regimens pertinent to healthcare professionals, are further discussed.


Childhood obesity Physical education Health education School lunch Health literacy Obesogenic Weight loss Glycemic index Glycemic load High-intensity interval training 



American Alliance for Health Physical Education, Recreation, and Dance


Body mass index


Centers for Disease Control and Prevention


Community supported agriculture


Cardiovascular disease


Dietary guidelines for Americans


Fitness integrated with teaching


Glycemic index


Glycemic load


High-intensity interval training




Healthy Hunger-Free Kids Act


Institute of Medicine


Nonalcoholic fatty liver disease


National School Lunch Program


Physical education


Physical Education Program


School Health Policies and Programs Study


Total energy expenditure


United States Department of Agriculture


Youth Risk Behavior Survey


  1. 1.
    Jamie Oliver’s Food Revolution. Why we need a food revolution [Internet]. California: Jamie Oliver Food Foundation; 2011 [updated 2012 Oct; cited 2012 Oct 1].
  2. 2.
    Learn The Facts, Let’s Move! [Internet]. Washington, DC: Let’s Move! Initiative; 2009 [updated 2012 June; cited 2012 Oct 1].
  3. 3.
    Health Policy Snapshot. Declining childhood obesity rates—where are we seeing the most progress? [Internet]. New Jersey: Robert Wood Johnson Foundation; 2012 [updated 2012 Sep; cited 2012 Oct 1].
  4. 4.
    A patchwork of progress, changes in overweight and obesity among California 5th, 7th, and 9th graders, 2005-2010 [Internet]. California: UCLA Center for Health Policy Research and California Center for Public Health Advocacy; 2011 [updated 2011 Nov; cited 2012 Oct 1].
  5. 5.
    Heitmann BL, Koplan J, Lissner L. Childhood obesity: successes and failures of preventive interventions. Nutr Rev. 2009;67 Suppl 1:S89–93.CrossRefPubMedGoogle Scholar
  6. 6.
    What is obesity [Internet]. Maryland: The Obesity Society; 2010 [updated 2010; cited 2012 Oct 1].
  7. 7.
    CDC Online Newsroom-Press Briefing Transcript: May 7, 2012 [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2012 [cited 2012 Oct 3].
  8. 8.
    Fryar CD, Carrol MD, Ogden CL. NCHS Health E-Stat, prevalence of obesity among children and adolescents: United States, trends 1963-1965 through 2009-2010 [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2010 [updated 2012 Sep 13, cited 2012 Oct 1].
  9. 9.
    Understanding childhood obesity [Internet]. Texas: American Heart Association, American Stroke Association; 2011 [updated 2011; cited 2012 Oct 1].
  10. 10.
    Obesity and overweight for professionals: Childhood-DNPAO-CDC [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; [updated 2012 June 7; cited 2012 Oct 1].
  11. 11.
    Daniels SR. The consequences of childhood overweight and obesity. Future Child. 2006;16(1):47–67.CrossRefPubMedGoogle Scholar
  12. 12.
    CDC-DHDSP-Heart Disease Facts [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; [updated 2012 Mar 23; cited 2012 Oct 1].
  13. 13.
    Berenson GS. Cardiovascular risk begins in childhood: a time for action. Am J Prev Med. 2009;37(1S):S1–2.CrossRefPubMedGoogle Scholar
  14. 14.
    Mauras N, DelGiorno C, Kollman C, Bird K, Morgan M, Sweeten S, et al. Obesity without established comorbidities of the metabolic syndrome is associated with a proinflammatory and prothrombotic state, even before the onset of puberty in children. J Clin Endocrinol Metab. 2010;95(3):1060–8.CrossRefPubMedGoogle Scholar
  15. 15.
    McGill Jr HC, McMahan CA, Zieske AW, Malcom GT, Tracy RE, Strong JP. Effects of nonlipid risk factors on atherosclerosis in youth with a favorable lipoprotein profile. Circulation. 2001;103:1546–50.CrossRefPubMedGoogle Scholar
  16. 16.
    Berenson GS, Srinivasan SR, Bao W, Newman III WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998;338(23):1650–6.CrossRefPubMedGoogle Scholar
  17. 17.
    McGill HC Jr, McMahan CA, Malcom GT, Oalmann MC, Strong JP, and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Relation of glycohemoglobin and adiposity in atherosclerosis in youth. Arterioscler Thromb Vasc Biol. 1995;15(4):431–40.Google Scholar
  18. 18.
    Insulin Resistance and Prediabetes-National Diabetes Information Clearinghouse [Internet]. Maryland: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 2008 [updated 2011 Dec 6; cited 2012 Oct 1].
  19. 19.
    Diabetes Statistics-American Diabetes Association [Internet]. Reston, VA: American Diabetes Association; 1995-2012 [updated 2012; cited 2012 Oct 1].
  20. 20.
    National Diabetes Fact Sheet, 2011 [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2011 [updated 2011, cited 2012 Oct 1].
  21. 21.
    Metabolic Syndrome-PubMed Health [Internet]. Maryland: National Center for Biotechnology Information, U.S. National Library of Medicine; [updated 2012 June 2, cited 2012 Oct 1].
  22. 22.
    Steinberger J, Moran A, Hong CP, Jacobs Jr DR, Sinaiko AR. Adiposity in childhood predicts obesity and insulin resistance in young adulthood. J Pediatr. 2001;138(4):469–73.CrossRefPubMedGoogle Scholar
  23. 23.
    Howard BV, Best LG, Galloway JM, Howard WJ, Jones K, Lee ET, et al. Coronary heart disease risk equivalence in diabetes depends on concomitant risk factors. Diabetes Care. 2006;29(2):391–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Duncan GE, Li SM, Zhou X. Prevalence and trends of a metabolic syndrome phenotype among U.S. adolescents, 1999-2000. Diabetes Care. 2004;27(10):2438–43.CrossRefPubMedGoogle Scholar
  25. 25.
    American Liver Foundation-Non-Alcoholic Fatty Liver Disease [Internet]. New York: American Liver Foundation; [updated 2011 Oct 4; cited 2012 Oct 1].
  26. 26.
    Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012;54(5):700–13.CrossRefPubMedGoogle Scholar
  27. 27.
    Adams LA, Angulo P. Treatment of non-alcoholic fatty liver disease. Postgrad Med J. 2006;82:315–22.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    D’Adamo E, Cali AM, Weiss R, Santoro N, Pierrpont B, Northrup V, et al. Central role of fatty liver in the pathogenesis of insulin resistance in obese adolescents. Diabetes Care. 2010;33(8):1817–22.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Wieckowska A, Carey WD. Nonalcoholic fatty liver disease [Internet]. Ohio: Cleveland Clinic, Center for Continuing Education; 2011-2012 [cited 2012 Oct 4].
  30. 30.
    Childhood obesity [Internet]. Texas: American Heart Association; [updated 2012 Apr 12; cited 2012 Oct 1].
  31. 31.
    Cornette R. The emotional impact of obesity on children. Worldviews Evid Based Nurs. 2008;5(3):136–41.CrossRefPubMedGoogle Scholar
  32. 32.
    Park CM, Kim MD, Hong SC, Kim Y, Hyun MY, Kwak YS, et al. Effects of obesity and obesity-induced stress on depressive symptoms in Korean elementary school children. Int J Soc Psychiatry. 2009;55(4):322–35.CrossRefPubMedGoogle Scholar
  33. 33.
    Sanchez-Villegas A, Field AE, O’Reilly EJ, Fava M, Gortmaker S, Kawachi I, et al. Perceived and actual obesity in childhood and adolescence and risk of adult depression. J Epidemiol Community Health. 2013;67(1):81–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Reeves GM, Postolache TT, Snitker S. Childhood obesity and depression: connection between these growing problems in growing children. Int J Child Health Hum Dev. 2008;1(2):103–14.PubMedCentralPubMedGoogle Scholar
  35. 35.
    Shomaker LB, Tanofsky-Kraff M, Stern EA, Miller R, Zocca J, Field SE, et al. Longitudinal study of depressive symptoms and progression of insulin resistance in youth at risk for adult obesity. Diabetes Care. 2011;34:2458–63.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Rofey DL, Kolko RP, Losif A-M, Silk JS, Bost JE, Feng W, et al. A longitudinal study of childhood depression and anxiety in relation to weight gain. Child Psychiatry Hum Dev. 2009;40(4):517–26.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Decaluwe V, Braet C. Prevalence of binge-eating disorder in obese children and adolescents seeking weight-loss treatment. Int J Obes Relat Metab Disord. 2003;27:404–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Goldfield G, Moore C, Henderson K, Buchholz A, Obeid N, Flament M. The relation between weight-based teasing and psychological adjustment in adolescents. Paediatr Child Health. 2010;15(5):283–8.PubMedCentralPubMedGoogle Scholar
  39. 39.
    Storch EA, Milsom VA, DeBraganza N, Lewin A, Geffken GR, Silverstein JH. Peer victimization, psychosocial adjustment, and physical activity in overweight and at-risk-for-overweight youth. J Pediatr Psychol. 2007;32(1):80–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Eisenberg ME, Neumark-Sztainer D, Story M. Associations of weight-based teasing and emotional well-being among adolescents. Arch Pediatr Adolesc Med. 2003;157(8):733–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Krukowski RA, West DS, Siddiqui NJ, Bursac Z, Phillips MM, Raczynski JM. No change in weight-based teasing when school-based obesity policies are implemented. Arch Pediatr Adolesc Med. 2008;162(10):936–42.CrossRefPubMedGoogle Scholar
  42. 42.
    Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res. 1998;6(2):97–106.CrossRefPubMedGoogle Scholar
  43. 43.
    Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822–31.CrossRefGoogle Scholar
  44. 44.
    Shape of the Nation Report, Status of Physical Education in the USA, 2010 [Internet]. Reston, VA: National Association for Sport and Physical Education; 2010 [cited 2012 Oct 1].
  45. 45.
    Bradt S. Obesity rate will reach at least 42 %, projections suggest obesity among U.S. adults may not plateau until 2050. Harvard Gazette [Internet]. 2010 [cited 2012 October 1].
  46. 46.
    Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al.; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–e220.Google Scholar
  47. 47.
    Generation M2, Media in the Lives of 8- to 18-Year-Olds, a Kaiser Family Foundation Study [Internet]. California: The Henry J. Kaiser Family Foundation; 2010 [cited 2012 Oct 2].
  48. 48.
    Charts from the American Time Use Survey [Internet]. Washington, DC: Bureau of Labor Statistics, United States Department of Labor; [updated 2011 Dec 2; cited 2012 Oct 2].
  49. 49.
    Gomez LF, Parra DC, Lobelo F, Samper B, Moreno J, Jacoby E, et al. Television viewing and its association with overweight in Colombian children: results from the 2005 National Nutrition Survey: a cross sectional study. Int J Behav Nutr Phys Act. 2007;4:41. doi: 10.1186/1479-5868-4-41.CrossRefPubMedCentralPubMedGoogle Scholar
  50. 50.
    Harris JL, Bargh JA. The relationship between television viewing and unhealthy eating: implications for children and media interventions. Health Commun. 2009;24(7):660–73.CrossRefPubMedCentralPubMedGoogle Scholar
  51. 51.
    Harrison K, Marske AL. Nutritional content of foods advertised during the television programs children watch most. Am J Public Health. 2005;95(9):1568–74.CrossRefPubMedCentralPubMedGoogle Scholar
  52. 52.
    Story M, French S. Food advertising and marketing directed at children and adolescents in the US. Int J Behav Nutr Phys Act. 2004;1:3. doi: 10.1186/1479-5868-1-3.CrossRefPubMedCentralPubMedGoogle Scholar
  53. 53.
    Bock R, Miller MG. Children’s physical activity drops from age 9 to 15, NIH Study indicates [Internet]. Maryland: NIH News, National Institutes of Health, U.S. Department of Health and Human Services. 2008 [cited 2012 Oct 2].
  54. 54.
    CDC-Nutrition-Facts-Adolescent and School Health [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; [updated 2012 Jan 20; cited 2012 Oct 2].
  55. 55.
    Profiling Food Consumption in America, 2001-2002 Agriculture Fact Book, Chapter 2 [Internet]. Washington, DC: United States Department of Agriculture; 2002 [cited 2012 Oct 2].
  56. 56.
    Do increased portion sizes affect how much we eat? [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; Research to Practice Series, 2006 No. 2 [cited 2012 Oct 2].
  57. 57.
    Diliberti N, Bordi PL, Conklin MT, Roe LS, Rolls BJ. Increased portion size leads to increased energy intake in a restaurant meal. Obes Res. 2004;12(3):562–8.CrossRefPubMedGoogle Scholar
  58. 58.
    Rolls BJ, Roe LS, Meengs JS. Larger portion sizes lead to a sustained increase in energy intake over 2 days. J Am Diet Assoc. 2006;106(4):543–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Rolls BJ, Roe LS, Kral TV, Meengs JS, Wall DE. Increasing the portion size of a packaged snack increases energy intake in men and women. Appetite. 2004;42(1):63–9.CrossRefPubMedGoogle Scholar
  60. 60.
    Ledikwe JH, Ello-Martin J, Rolls BJ. Portion sizes and the obesity epidemic. J Nutr. 2005;135(4):905–9.PubMedGoogle Scholar
  61. 61.
    Schaub J, Marian M. Reading, writing, and obesity: America’s failing grade in school nutrition and physical education. Nutr Clin Pract. 2011;26(5):553–64.CrossRefPubMedGoogle Scholar
  62. 62.
    Davis CL, Tomporowski PD, McDowell JE, Austin BP, Miller PH, Yanasak NE, et al. Exercise improves executive function and achievement and alters brain activation in overweight children: a randomized controlled trial. Health Psychol. 2011;30(1):91–8. doi: 10.1037/a0021766.CrossRefPubMedCentralPubMedGoogle Scholar
  63. 63.
    Hollar D, Messiah SE, Lopez-Mitnik G, Hollar LT, Almon M, Agatston AS. Effect of a two-year obesity prevention intervention on percentile changes in body mass index and academic performance in low-income elementary school children. Am J Public Health. 2010;100(4):646–53.CrossRefPubMedCentralPubMedGoogle Scholar
  64. 64.
    Carlson SA, Fulton JE, Lee SM, Maynard LM, Brown DR, Kohl III HW, et al. Physical education and academic achievement in elementary school: data from the early childhood longitudinal study. Am J Public Health. 2008;98(4):721–7.CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    Telford RD, Cunningham RB, Fitzgerald R, Olive LS, Prosser L, Jiang X, et al. Physical education, obesity, and academic achievement: a 2-year longitudinal investigation of Australian elementary school children. Am J Public Health. 2012;102(2):368–74.CrossRefPubMedCentralPubMedGoogle Scholar
  66. 66.
    Study shows overwhelming parent support for healthier schools-Robert Wood Johnson Foundation [Internet]. New Jersey: Robert Wood Johnson Foundation; 2009 [cited 2012 Oct 2].
  67. 67.
    CDC-Youth Online-High School YRBS: Home Page [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 1991-2011 [cited 2011 Jan 18].
  68. 68.
    SHPPS 2006, School Health Policies and Programs Study [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2006 [cited 2012 Oct 2].
  69. 69.
    The obesity epidemic and United States students [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2011 [cited 2012 Oct 2].
  70. 70.
    Trends in the prevalence of physical activity and sedentary behaviors, National YRBS: 1991-2011. Atlanta, GA: Centers for Disease Control and Prevention; 2011 [cited 2012 Oct 2].
  71. 71.
    Dwyer T, Magnussen CG, Schmidt MD, Okoumunne OC, Ponsonby AL, Raitakari OT, et al. Decline in physical fitness from childhood to adulthood associated with increased obesity and insulin resistance in adults. Diabetes Care. 2009;32(4):683–7. doi: 10.2337/dc08-1638.CrossRefPubMedCentralPubMedGoogle Scholar
  72. 72.
    Villaire T. Decline of physical activity [Internet]. Reston, VA: National PTA; 2000-2012 [cited 2012 Oct 6].
  73. 73.
    VP Programs [Internet]. Reston, VA; American Alliance for Health, Physical Education, Recreation, and Dance; 2012 [cited 2012 Oct 6].
  74. 74.
    Physical education is an academic subject [Internet]. Reston, VA: National Association for Sport and Physical Education; 2010 [cited 2012 Oct 2].
  75. 75.
    Carol M. White Physical Education Program (PEP) [Internet]. Reston, VA: National Association for Sport and Physical Education; 2012 [cited 2012 Oct 2].
  76. 76.
    Carol M. White Physical Education Program [Internet]. Washington, DC: U.S. Department of Education [updated 2011 Nov 2; cited 2012 Oct 2].
  77. 77.
    PEP Program Safe for FY2014 [Internet]. Virginia: American Alliance for Health, Physical Education, Recreation, and Dance; 2014 [cited 2014 Feb 20].
  78. 78.
    Funding Status—Carol M. White Physical Education Program [Internet]. Washington, DC: U.S. Department of Education [updated 2011 Nov 2, cited 2012 Oct 2].
  79. 79.
    Hackensmith CW. History of physical education. New York: Harper & Row; 1966.Google Scholar
  80. 80.
    Physical education trends in our nation’s schools, a survey of practicing K-12 physical education teachers [Internet]. New York: Roslow Research Group, Prepared For: Polar Electro Inc., National Association for Sport and Physical Education (NASPE); 2009 [cited 2012 Oct 2].
  81. 81.
    SHPPS 2006, School Health Policies and Programs Study, Physical Education [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2007 [cited 2012 Oct 2].
  82. 82.
    Barnett LM, Morgan PJ, van Beurden E, Beard JR. Perceived sports competence mediates the relationship between childhood motor skill proficiency and adolescent physical activity and fitness: a longitudinal assessment. Int J Behav Nutr Phys Act. 2008;5:40. doi: 10.1186/1479-5868-5-40.CrossRefPubMedCentralPubMedGoogle Scholar
  83. 83.
    Schmalz DL, Kerstetter DL, Anderson DM. Stigma consciousness as a predictor of children’s participation in recreational vs. competitive sports. J Sport Behav. 2008;31(3):276–97.Google Scholar
  84. 84.
    Fitness Integrated with Teaching Kids Act (FIT Kids Act) [Internet]. Reston, VA: National Association for Sport and Physical Education 2011 [cited 2012 Oct 2].
  85. 85.
    H.R. 1057, 112th Congress 1st Session [Internet]. Washington, DC: House of Representatives 2011 [cited 2012 Oct 2].
  86. 86.
    American Heart Association Federal Priorities, 112th Congress [Internet]. Washington, DC: American Heart Association; 2011 [cited 2012 Oct 2].
  87. 87.
    Fit Kids Act (H.R. 2178) [Internet]. Washington, DC:, a project of Civic Impulse LLC; 2009 [cited 2014 Feb 20].
  88. 88.
    Levine S. School lunch politics: the surprising history of America’s favorite welfare program. Princeton, NJ: Princeton University Press; 2008.Google Scholar
  89. 89.
    Gunderson G. The National School Lunch Program background and development [Internet]. Washington, DC: U.S. Department of Agriculture, Food and Nutrition Service 2009 [cited 2011 Feb 16].
  90. 90.
    PL 396, 79th congress, June 4 1946, 60 Stat. 231.Google Scholar
  91. 91.
    National School Lunch Program: Fact Sheet [Internet]. Washington, DC: U.S. Department of Agriculture, Food and Nutrition Service. 2012 [cited 2012 Oct 2].
  92. 92.
    Tray Talk-Get the Facts [Internet]. Bethesda, MD: Tray Talk, Communities for Healthy School Meals, School Nutrition Association 2012 [cited 2012 Oct 2].
  93. 93.
    Robinson-O’Brien R, Burgess-Champoux T, Haines J, Hannan PJ, Neumark-Sztainer D. Associations between school meals offered through the National School Lunch Program and the School Breakfast Program and fruit and vegetable intake among ethnically diverse, low-income children. J Sch Health. 2010;80(10):487–92. doi: 10.1111/k.1746-1561.2010.000532.x.CrossRefPubMedCentralPubMedGoogle Scholar
  94. 94.
    Crepinsek MK, Gordon AR, McKinney PM, Condon EM, Wilson A. Meals offered and served in the US public schools: do they meet nutrient standards? J Am Diet Assoc. 2009;109(2 Suppl):S31–43.CrossRefPubMedGoogle Scholar
  95. 95.
    Clark MA, Fox MK. Nutritional quality of the diets of US public school children and the role of the school meal programs. J Am Diet Assoc. 2009;109(2 Suppl):S44–56.CrossRefPubMedGoogle Scholar
  96. 96.
    Cullen KW, Watson KB, Dave JM. Middle-school students’ school lunch consumption does not meet the new Institute of Medicine’s National School Lunch Program recommendations. Public Health Nutr. 2011;14(10):1876–81.CrossRefPubMedGoogle Scholar
  97. 97.
    SHPPS 2006 School health policies and programs study, foods and beverages sold outside of the school meals programs [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2007 [cited 2012 October 2].
  98. 98.
    Lipsett A. Stress driving pupils to suicide, says union. The Guardian [Internet]. 2008 [cited 2012 Oct 2].
  99. 99.
    Smith T. What’s new in high school? Stress reduction 101. National public radio [Internet]. 2011 [cited 2012 Oct 2].
  100. 100.
    Pope DC. Doing school: how we are creating a generation of stressed out, materialistic, and miseducated students. New Haven, CT: The Yale University Press; 2001.Google Scholar
  101. 101.
    Tucker J. Stressful AP courses—a push for a cap. 2012 Jan 9. San Francisco Chronicle [Internet].
  102. 102.
    Number of AP examinations per student [Internet]. New York: College Board; 2008 [cited 2012 Oct 2].
  103. 103.
    Ginsburg KR, and the Committee on Communications, and the Committee on Psychosocial Aspects of Child and Family Health. The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics. 2007;119(1):182–91. doi: 10.1542/peds.2006-2697
  104. 104.
    Teen suicide is preventable [Internet]. Washington, DC: American Psychological Association; 2012 [cited 2012 Oct 2].
  105. 105.
    Youth risk behavior surveillance-United States, 2011 [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; Morbidity and Mortality Weekly Report, Surveillance Summaries Vol.61 No.4; 2012 [cited 2012 Oct 2].
  106. 106.
    Mai A. How many is too many (AP classes)? BTHSnews [Internet]. 2010.
  107. 107.
    Rachel G. AP classes: worth it?—College Article-Teen Ink. Teen Ink [Internet].
  108. 108.
    Hopkins K. Weight the benefits, stress of AP courses for your student. US News [Internet]. 2012 [cited 2012 Oct 2].
  109. 109.
    Pervanidou P, Chrousos GP. Metabolic consequences of stress during childhood and adolescence. Metabolism. 2012;61:611–9. doi: 10.1016/j.metabol.2011.10.005.CrossRefPubMedGoogle Scholar
  110. 110.
    Weingarten HP, Elston D. Food cravings in a college population. Appetite. 1991;17(3):167–75.CrossRefPubMedGoogle Scholar
  111. 111.
    Gilhooly CH, Das SK, Golden JK, McCrory MA, Dallal GE, Saltzman E, et al. Food cravings and energy regulation: the characteristics of craved foods and their relationship with eating behaviors and weight change during 6 months of dietary energy restriction. Int J Obes (Lond). 2007;31(12):1849–58.CrossRefGoogle Scholar
  112. 112.
    Lowry R, Eaton DK, Foti K, McKnight-Eily L, Perry G, Galuska DA. Association of sleep duration with obesity among US high school students. J Obes. 2012. doi: 10.1155/2012/476914
  113. 113.
    Al-Hazzaa HM, Musaiger AO, Abahussain NA, Al-Sobayel HI, Qahwaji DM. Prevalence of short sleep duration and its association with obesity among adolescents 15- to 19-year olds: a cross-sectional study from three major cities in Saudi Arabia. Ann Thorac Med. 2012;7(3):133–39.CrossRefPubMedCentralPubMedGoogle Scholar
  114. 114.
    Chen MY, Wang EK, Jeng YJ. Adequate sleep among adolescents is positively associated with health status and health-related behaviors. BMC Public Health. 2006;6:59. doi: 10.1186/1471-2458-6-59.CrossRefPubMedCentralPubMedGoogle Scholar
  115. 115.
    Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62.CrossRefPubMedCentralPubMedGoogle Scholar
  116. 116.
    Sekine M, Yamagami T, Handa K, Saito T, Nanri S, Kawaminami K, et al. A dose-response relationship between short sleeping hours and childhood obesity: results of the Toyama Birth Cohort Study. Child Care Health Dev. 2002;28(2):163–70.CrossRefPubMedGoogle Scholar
  117. 117.
    USDA unveils historic improvements to meals served in America’s schools, new standards will improve the health and wellbeing of 32 million kids nationwide [Internet]. Washington, DC: United States Department of Agriculture; 2012 [cited 2012 Oct 2].
  118. 118.
    Bill summary & status-111th Congress (2009-2010)-S.3307-Major congressional actions-THOMAS (Library of Congress) [Internet]. Washington, DC: The Library of Congress; 2010 [updated 2010 Dec 13; cited 2012 Oct 2].
  119. 119.
    Federal Register, Department of Agriculture, Food and Nutrition Service, 7 CFR Parts 210 and 220, Nutrition Standards in the National School Lunch and School Breakfast Programs; Final Rule [Internet]. Washington, DC: National Archives and Records Administration; 2012;77(17) Part II.
  120. 120.
    USDA announces historic school nutrition improvements as children return to school [Internet]. Washington, DC: United States Department of Agriculture, Food and Nutrition Service, Release No. 0359.11; 2011 [updated 2012 Feb 16; cited 2012 Oct 2].
  121. 121.
    Federal Register, Department of Agriculture, Food and Nutrition Service, 7CFR Parts 210 and 220, National School Lunch Program and School Breakfast Program: Nutrition Standards for All Foods Sold in School as Required by the Healthy, Hunger-Free Kids Act of 2010; Interim Final Rule [Internet]. Washington DC: United States National Archives and Records Administration; 2013 Jun 28;78(125) Part II. Available from:
  122. 122.
    Galvez MP, Hong L, Choi E, Liao L, Godbold J, Brenner B. Childhood obesity and neighborhood food-store availability in an inner-city community. Acad Pediatr. 2009;9(5):339–43.CrossRefPubMedCentralPubMedGoogle Scholar
  123. 123.
    Gebauer H, Laska MN. Convenience stores surrounding urban schools: an assessment of health food availability, advertising, and product placement. J Urban Health. 2011;88(4):616–22.CrossRefPubMedCentralPubMedGoogle Scholar
  124. 124.
    McLaughlin J. Students strike against new federal school lunch rules. JS Online [Internet]. 2012 [cited 2012 Oct 2].
  125. 125.
    Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS. A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med. 2003;157(8):773–9.CrossRefPubMedGoogle Scholar
  126. 126.
    Spieth LE, Harnish JD, Lenders CM, Raezer LB, Pereira MA, Hangen SJ, et al. A low-glycemic index diet in the treatment of pediatric obesity. Arch Pediatr Adolesc Med. 2000;154(9):947–51.CrossRefPubMedGoogle Scholar
  127. 127.
    Thomas DE, Elliot EJ, Baur L. Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database Syst Rev. 2007;3, CD005105.PubMedGoogle Scholar
  128. 128.
    Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010;363(22):2102–13.CrossRefPubMedCentralPubMedGoogle Scholar
  129. 129.
    Papadaki A, Linardakis M, Larsen TM, van Baak MA, Lindroos AK, Pfeiffer AF, et al. The effect of protein and glycemic index on children’s body composition: the DioGenes randomized study. Pediatrics. 2010;126(5):e1143–52.CrossRefPubMedGoogle Scholar
  130. 130.
    Chang KT, Lampe JW, Schwarz Y, Breymeyer KL, Noar KA, Song X, et al. Low glycemic load experimental diet more satiating than high glycemic load diet. Nutr Cancer. 2012;64(5):666–73.CrossRefPubMedCentralPubMedGoogle Scholar
  131. 131.
    Pereira MA, Swain J, Goldfine AB, Rifai N, Ludwig DS. Effects of a low-glycemic load diet on resting energy expenditure and heart disease risk factors during weight loss. JAMA. 2004;292(20):2482–90.CrossRefPubMedGoogle Scholar
  132. 132.
    Kraschnewski JL, Boan J, Esposito J, Sherwood NE, Lehman EB, Kephart DK, et al. Long-term weight loss maintenance in the United States. Int J Obes (Lond). 2010;34(11):1644–54.CrossRefGoogle Scholar
  133. 133.
    Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA. 2012;307(24):2627–34.CrossRefPubMedCentralPubMedGoogle Scholar
  134. 134.
    Abete I, Parra D, Martinez JA. Energy-restricted diets based on a distinct food selection affecting the glycemic index induce different weight loss and oxidative response. Clin Nutr. 2008;27(4):545–51.CrossRefPubMedGoogle Scholar
  135. 135.
    Weickert MO. What dietary modification best improves insulin sensitivity and why? Clin Endocrinol (Oxf). 2012;77(4):508–12. doi: 10.1111/j.1365-2265.2012.04450.x.CrossRefGoogle Scholar
  136. 136.
    Solomon TP, Haus JM, Kelly KR, Cook MD, Filion J, Rocco M, et al. A low-glycemic index diet combined with exercise reduces insulin resistance, postprandial hyperinsulinemia, and glucose-dependent insulinotropic polypeptide responses in obese, prediabetic humans. Am J Clin Nutr. 2010;92(6):1359–68.CrossRefPubMedCentralPubMedGoogle Scholar
  137. 137.
    Riccardi G, Rivellese AA. Dietary treatment of the metabolic syndrome—the optimal diet. Br J Nutr. 2000;83 Suppl 1:S143–8. doi: 10.1017/S0007114500001082.PubMedGoogle Scholar
  138. 138.
    Finley CE, Barlow CE, Halton TL, Haskell WL. Glycemic index, glycemic load, and prevalence of the metabolic syndrome in the cooper center longitudinal study. J Am Diet Assoc. 2010;110(12):1820–9.CrossRefPubMedGoogle Scholar
  139. 139.
    Gilbertson HR, Thorburn AW, Brand-Miller JC, Chondros P, Werther GA. Effect of low-glycemic-index dietary advice on dietary quality and food choice in children with type 1 diabetes. Am J Clin Nutr. 2003;77(1):83–90.PubMedGoogle Scholar
  140. 140.
    Du H, van der A DL, van Bakel MM, van der Kallen CJ, Blaak EE, van Greevenbroek MM, et al. Glycemic index and glycemic load in relation to food and nutrient intake and metabolic risk factors in a Dutch population. Am J Clin Nutr. 2008;87(3):655–61.Google Scholar
  141. 141.
    Louie JC, Buyken AE, Brand-Miller JC, Flood VM. The link between glycemic index and nutrient adequacy. Am J Clin Nutr. 2012;95(3):694–702.CrossRefPubMedGoogle Scholar
  142. 142.
    Heydari M, Freund J, Boutcher SH. The effect of high-intensity intermittent exercise on body composition of overweight young males. J Obes. 2012. doi: 10.1155/2012/480467
  143. 143.
    Ross R, Dagnone D, Jones PJ, Smith H, Paddags A, Hudson R, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med. 2000;133(2):92–103.CrossRefPubMedGoogle Scholar
  144. 144.
    Boutcher SH. High-intensity intermittent exercise and fat loss. J Obes. 2011. doi: 10.1155/2011/868305
  145. 145.
    Trapp EG, Chisholm DJ, Freund J, Boutcher SH. The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women. Int J Obes (Lond). 2008;32(4):684–91.CrossRefGoogle Scholar
  146. 146.
    Stiegler P, Cunliffe A. The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss. Sports Med. 2006;36(3):239–62.CrossRefPubMedGoogle Scholar
  147. 147.
    Cocks M, Shaw CS, Shepherd SO, Fisher JP, Ranasinghe AM, Barker TA, et al. Sprint interval and endurance training are equally effective in increasing muscle microvascular density and eNOS content in sedentary males. J Physiol. 2013;591(3):641–56.Google Scholar
  148. 148.
    Rognmo O, Hetland E, Helgerud J, Hoff J, Slordahl SA. High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil. 2004;11(3):216–22.CrossRefPubMedGoogle Scholar
  149. 149.
    Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801.CrossRefPubMedGoogle Scholar
  150. 150.
    Schunemann HJ, Dorn J, Grant BJ, Winkelstein Jr W, Trevisan M. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest. 2000;118(3):656–64.CrossRefPubMedGoogle Scholar
  151. 151.
    Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest. 2005;127(6):1952–9.CrossRefPubMedGoogle Scholar
  152. 152.
    America’s Health Literacy: why we need accessible health information [Internet]. Washington, DC: US Department of Health & Human Services, Office of Disease Prevention and Health Promotion; 2008 [cited 2012 Oct 2].
  153. 153.
    Sharif I, Blank AE. Relationship between child health literacy and body mass index in overweight children. Patient Educ Couns. 2010;79(1):43–8.CrossRefPubMedCentralPubMedGoogle Scholar
  154. 154.
    Vice Admiral Richard H. Carmona. Health Literacy in America: the role of health care professionals [Internet]. Washington, DC: US Department of Health and Human Services; 2003 [updated 2007 Jan 9, cited 2012 Oct 2].
  155. 155.
    DeWalt DA, Hink A. Health literacy and child health outcomes: a systematic review of the literature. Pediatrics. 2009;124:S265. doi: 10.1542/peds.2009-1162B.CrossRefPubMedGoogle Scholar
  156. 156.
    Tsang R. The college student’s perception of healthful eating. Undergraduate Research Community. 2011;10.
  157. 157.
    Downs M. Why do we keep falling for fad diets? [Internet]. New York: WebMD; 2012 [cited 2012 Oct 3].
  158. 158.
    Weber J. Confusing food labels can hide diet hazards. NBC News [Internet]. 2011 [cited 2012 Oct 3].
  159. 159.
    Borzekowski DLG. Considering children and health literacy: a theoretical approach. Pediatrics. 2009;124:S282. doi: 10.1542/peds.2009-1162D.CrossRefPubMedGoogle Scholar
  160. 160.
    The Center for Mindful Eating [Internet]. New Hampshire: The Center for Mindful Eating; 2012 [cited 2012 Oct 11].
  161. 161.
    Ikerd J. The new American food culture. Field Notes [Internet]. 2005 [cited 2012 Oct 2].
  162. 162.
    What is sustainable agriculture?—ASI [Internet]. California: Sustainable Agriculture Research and Education Program, Agricultural Sustainability Institute at UCDavis. 2012 [cited 2012 Oct 2].
  163. 163.
    Chefs collaborative-about [Internet]. Boston, MA: Chefs Collaborative; 2007 [cited 2012 Oct 2].
  164. 164.
    DeMuth S. Defining community supported agriculture [Internet]. Washington, DC: United States Department of Agriculture, National Agriculture Library; 1993 [updated 2009, May 28, cited 2012 Oct 2].
  165. 165.
    How our CSA works [Internet]. California: eating with the seasons; 2011 [cited 2012 Oct 2].
  166. 166.
    Full farm list: FairShare CSA Coalition [Internet]. Wisconsin: FairShare CSA Coalition; 2012 [cited 2012 Oct 11].
  167. 167.
    Organics for New York’s underprivileged. Organic connections [Internet]. 2012 [cited 2012 Oct 2].
  168. 168.
    Sutton E. Obesity, poverty, and the case for community supported agriculture in New York state. New York: Hunger Action Network of NYS; 2005 [cited 2012 Oct 2].
  169. 169.
    McNulty TJ. 50 Years later, many claim Fdr Mantle-Clinton, Gingrich Both Honor achievements. Chicago Tribune [Internet]. 1995 [cited 2012 Oct 3].

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.SaratogaUSA
  2. 2.University of ArizonaTucsonUSA

Personalised recommendations