John Presley is a playful 4-year-old from Marshfield, Mass., who loves the beach and video games. But, at 86 pounds, John weighs as much as a typical 11-year-old, which raises real health concerns.
"It made me feel worried and sad because you want him to fit in and not be discriminated against," said his mother, Theresa Presley.
John falls into a category that doctors have labeled "super obese;" part of a new epidemic of children as young as 2 and 3 years old who are extremely overweight.
"It's hard as a mother. I feel like I was footing the blame for a lot of it, even though I honestly felt like I was doing the right thing for him," Presley said.
When John was 3, Presley enrolled him in a weight-management program in Boston, where she learned about making healthier choices for her son, like trading French toast for melon and juice, or soda for water. Program directors said they have never seen so many young, obese children before.
"Kids are just getting overweight at a much younger age. We're noticing that infants are off the chart for height and weight," said Maryanne Lewis, nurse practitioner at the Children's Hospital Boston's Optimal Weight Life Program. "Toddlers are having … difficulty on normal equipment that they have outside in nursery school because they are just so overweight. It is a drastic change from what we've seen in the last 25 years, and it's affecting younger and younger children."
Obesity rates among children younger then 5 have doubled over the last two decades, according to the Centers for Disease Control and Prevention. The prevalence of childhood obesity has prompted pediatricians to encourage parents to start monitoring their children's weight.
"This is not something, 'Oh, my kid looks cute at 2 or 3. They're a little bit heavy, but they just look cute,'" said Carolyn Landis, assistant professor of pediatrics at Case Western Reserve University and a licensed clinical psychologist in Cleveland. "People don't realize it, but even preschool age kids can have high blood pressure, they can have type 2 diabetes."
Conditions like high cholesterol and high blood pressure, which were once seen as only affecting adults, have reached a much younger age group.
In response, some hospitals around the country have launched weight-management programs specifically designed to deal with obesity in 2- to 5-year-olds. The Rainbow Babies and Children's Hospital in Cleveland teaches creative ways to exercise and methods to get children to eat healthier food.
By promoting healthy eating at early ages, dietitians hope to prevent obesity from continuing in adulthood.
"You don't put little kids on diets for the most part," Landis said. "You don't want necessarily little kids to lose weight. You want them to grow into the weight they already have. So you're basically slowing down how quickly they're gaining weight."
If children are overweight before they are 8 years old, obesity is likely to be more severe in adulthood, according to the CDC.
But despite health concerns, some experts warn that the supporting research for some of these programs' effectiveness is limited, and that restricting toddlers' diets can have dangerous health implications.
"This is very worrisome," said dietitian Stacey Schulman. "Talking to kids about weight too early can lead to eating disorders later in life."
To lessen feelings of guilt and shame, some dietitians, like Landis are careful not to discuss "weight" or "obesity."
Theresa Presley feeds the entire family healthier food, so John doesn't feel singled out.
While there is some skepticism about putting 4-year-olds on diets, Presley said that her priority is to save her son from developing serious health complications later in life.
"I think we're doing everything we can for him now that we know what to do, and it's definitely making a difference," she said.