the environment is clear: Parents provide genes, role models, and food.

Dietary patterns. U.S. dietary patterns have changed significantly over the past few decades. Over nutrition has replaced under nutrition as the largest nutrition-related problem facing both children and adults. Although the percent of calories from total fat have declined over the past 30 years, total calories have increased. Soft drink consumption has also boomed, adding more calories and less nutrients to Americans' diets. Our environment also supports "oversize" through large portion sizes at restaurants. These trends play roles in the increasing rate of obesity, along with lack of physical activity.

Research studies differ on whether obese consume more energy (calories) than non-obese individuals. Some show they do consume more; others show they may consumer fewer calories. The big difference may be in the type of nutrients that they consume, such as fat. For example, Gazzaniga, et al found that the percentage of body fat was positively correlated with total dietary fat. Still, other researchers suggest that the reasons are metabolic in origin and that obese individuals "process" foods differently resulting in an increase in body fat. Although how these factors affect obesity are not fully understood, one thing is clear: Obesity results when energy intake exceeds energy expenditure and is stored as fat.

Parent-child relationships. Ellyn Satter, author of Child of Mine: Feeding with Love and Good Sense, firmly believes in the importance of "the feeding relationship" and its implications for obesity. The feeding relationship is the interaction that takes place between parents and children around food. Obese children need to learn to listen to their internal cues of hunger and appetite. Parents and childcare providers must help them do so. This includes encouraging children to eat according to these cues, while acknowledging the emotional aspect of feeding and eating. A restrictive diet may make the child feel deprived and neglected, and exacerbate the overeating problem.

Television. Children and adolescents who watched the most TV were more obese than peers who watched it less. In general, the more TV they watched, the greater the prevalence of obesity. There are several ways television contributes to childhood obesity:

• Watching TV requires no energy above resting metabolic rates.
• TV reduces the time the child spends in energetic activities, such as running and playing. In other words, it's not what the child is doing but rather what he/she is not doing while watching TV.
• The foods most heavily advertised on TV are high in calories: candy bars, sugared cereals, etc.
• The slim figures of TV stars may indirectly suggest to children that high calorie food and drinks have little effect on weight.
• TV characters are typically snacking, not sitting down for well-balanced meals.

Physical activity. Studies conducted in the last 20 to 30 years show a strong correlation between obesity and lack of physical activity. Nearly half of youths aged 12 to 21 years old are not vigorously active on a regular basis (20 minutes, three times a week).