Evidence increasingly identifies higher levels of physical inactivity (watching television and computer screen time),  lower  levels of moderate physical activity (active play), and excessive consumption of sugar sweetened beverages as critical contributors to the ever higher rates of childhood obesity. In infancy, breast feeding appears to provide some protection against later obesity.  In addition, numerous studies indicate clinicians are unable to recognize overweight simply through observation or tracking regular growth charts, while use of age and gender standardized body mass index improves this recognition.

Based on this, NICHQ proposes clinical practices caring for children adopt a 5 point obesity prevention bundle (B-B-2-1-0)

• Breast feeding
• Body mass index
• Fewer than 2 hours of screen time (and no TV in rooms where children sleep)
• Greater than 1 hours of physical activity
• 0 sugar sweetened beverages

This builds on the 5-2-1 message developed by Blue Cross Blue Shield of Massachusetts and the 5-2-1-0 campaign used by the Maine Youth Overweight Collaborative.