It’s no secret why the United States is facing an obesity epidemic—poor diet and exercise habits—but UNC researcher Peggy Bentley says childhood obesity can sometimes take root in infancy, long before kids eat junk food or play their first video game.

In 2003, her team of UNC researchers began studying what happens in the lives of children before they become overweight. They recruited 217 low-income mothers between 18 and 35 to study how they fed and cared for their babies through the first 18 months of life. Turns out, about half of the mothers fed their babies in front of the television, something pediatricians caution against.

“It’s easier to miss an infant’s cues when a baby or mother is watching television,” says UNC anthropologist Amanda Thompson, who is part of Bentley’s team.

Click to read photo caption. Photo by Mark Derewicz

When babies are distracted by TV, they sometimes push away food, clamp down their mouths, or squirm to get away from the food—typical things babies do to tell parents they’re not hungry, Thompson says. And television isn’t limited to mealtime. Thompson also found that:

• Infants as young as three months were exposed to an average of 2.6 hours of television or videos a day.

• 40 percent of one-year-olds were exposed to more than three hours of television a day.

• At 3 months, 14 percent of babies had televisions in their rooms. By 18 months, it’s 30 percent.

• Fussier or more agitated babies were more likely to watch at least an hour of TV a day.

The upshot, Thompson says, is that many parents are using television to distract or calm their babies. But the American Academy of Pediatrics recommends no TV for kids under two years old. Pediatricians and researchers suggest that parents allow babies and toddlers to explore their environment, play with age-appropriate toys, and read books with caregivers.

Early exposure to television might set kids up for a more sedentary life or delay motor skill development, but it’s just one precursor to childhood obesity that Bentley’s team has studied. Diet is another; its effect on weight is likely much more direct than television’s.

Maternal health experts recommend that babies don’t eat or drink anything other than breast milk for at least their first six months of life.

Click to read photo caption.

That’s no longer a common practice in the United States. Using the same data from surveys and observations of 217 mothers, Bentley’s team found that 75 percent of three-month-olds were fed complementary foods along with breast milk or formula. Twenty-five percent were fed juice, which is full of empty calories. Just 6 percent were fed breast milk exclusively.

Also, Bentley’s team found that mothers who thought their infants were fussy or agitated were much more likely to feed their babies food and juice at three months old.

The findings suggest that babies are getting too many calories at a young age, which likely plays a role in childhood obesity.

Bentley’s team is now studying how to reverse these trends. Her team is recruiting hundreds of expectant mothers, caregivers, and family members to provide guidance on the benefits of breastfeeding, proper diet, and engaged play with babies and toddlers, as well as on the potential detriment of watching too much television. Mothers in the control group, meanwhile, will receive interventions about child safety.

“We think these are important teachable moments,” Bentley says. “Moms want their babies to be healthy and on track to reach developmental milestones.” And they want to soothe their babies. But some mothers don’t know the best strategies to calm an infant down. So during the study, Bentley’s team will help mothers develop more parenting skills.

“There are ways to soothe a baby without using food or television,” she says. It’s just easier to distract a baby with a bottle or television.

But Bentley’s team has shown that the easier parenting methods can lead to some hard consequences. They found one more thing: overweight infants face a higher risk of delayed motor skill development, which can lead to reduced physical activity.

Childhood obesity, turns out, can be a vicious cycle that begins shortly after baby’s first breath.

Peggy Bentley is the Carla Smith Chamblee Distinguished Professor of Global Nutrition in the Gillings School of Global Public Health, where she also serves as associate dean. Amanda Thompson is an assistant professor of anthropology in the College of Arts and Sciences. Both are faculty fellows at the Carolina Population Center. They received funding from the National Institutes of Health. Their most recent paper on television exposure was published in the journal Pediatrics.