Early in the Life Course: Time for Obesity Prevention

Abstract

One of the reasons for the intractability of childhood obesity is the underappreciation of the complexity and interconnectedness of contributing factors across the life course. A multilevel approach for obesity prevention takes into account individual risk factors that operate “above water” (family, neighborhood, policies) and the interaction with biology and “underwater” influences (genetics, epigenetics, physiology) and recognizes that these factors also interact across the life course, starting before birth. We organize this chapter to reflect phases of life course health development, prenatally through adolescence, that appear to be most important for the development of obesity and present key examples to illustrate important risk factors, mechanisms, and gaps in research. One of the challenges to understanding influences on obesity risk is the extent to which associations described in observational studies are causal. We present alternative methodological approaches, including sibling-pair design, maternal versus paternal effects, Mendelian randomization, cohorts with different confounding structures, and randomized controlled trials, that can help disentangle causal associations. We conclude with recommendations for future work on methodology, research in emerging areas, and implications for practice and policy based on the current evidence.

Introduction to the Handbook of Life Course Health Development

“…Social epidemiologist Summer Sherburne Hawkins, PhD, MS, collaborated with pediatrician and prenatal nutrition expert Emily Oken, MD, MPH and pediatrician and preventive cardiology expert Matthew W. Gillman, MD, SM, to produce Early in the Life Course: Time for Obesity Prevention. This chapter adopts a multilevel approach in identifying the periods and factors that are the greatest contributors to obesity and explores how innovative research methodologies can be used to demonstrate causality (Hawkins et al 2017 (Drmic et al 2017).…”

Life Course Research Agenda (LCRA), Version 1.0

“…Do certain key factors act as "triggers," setting in motion a cascade of future biological response patterns? Biological conditioning processes can range from the exposure to a specific nutrient like folate and its influence on epigenetic methylation based on availability in indigenous diets (see Herman and Taylor Baer 2017) to the role that different patterns of sleep and sleep duration have on cycling of neuroendocrine hormones that serve to prime other factors related to growth, metabolism, and the biological underpinning of behavioral response systems (see Mummert et al 2017;Hawkins et al 2017).…”

“…Throughout this volume, authors have highlighted the important role of intervention research for better understanding not only how to intervene, but also when. For example, the chapter by Hawkins and colleagues (Hawkins et al 2017) suggests that a key to reducing childhood obesity is finding the right level and time in the life course to intervene for the maximal effectiveness and efficiency of interventions. However, the challenge of mounting programs designed to modify obesogenic health development pathways may be quite complex, involving multiple settings (e.g., medical care, homes, child care, school) (Taveras, Blackburn, et al 2011a;Taveras, Gortmaker, et al 2011b;Taveras et al 2012), or components (e.g., system redesign, individual behavior change strategies including e-technology) (Lubans et al 2010;Taveras et al 2012), and targeting single or multiple factors (Taveras, Gortmaker, et al 2011b;Vesco et al 2012).…”

“…In the past several decades, we have witnessed increased rates of child obesity and child and adolescent mental health disorders. While there have been relatively simple notions about the origins and drivers of the obesity epidemic, the chapter by Hawkins and colleagues in this volume (Hawkins et al 2017) highlights the developmental complexity underlying this major epidemiologic change.…”

The Linked CENTURY Study: linking three decades of clinical and public health data to examine disparities in childhood obesity

“…Life course epidemiology proposes that factors during peri- and post-natal periods may influence the development of obesity from early life through adulthood [ 3 , 4 ]. Observational studies have shown that maternal smoking during pregnancy [ 5 – 7 ], excessive gestational weight gain [ 8 – 10 ], gestational diabetes mellitus (GDM) [ 11 ], and accelerated infant weight gain [ 6 , 12 , 13 ] are associated with higher risk for childhood obesity.…”