Early-Life Obesity Prevention: Critique of Intervention Trials During the First One Thousand Days

Abstract

Purpose of ReviewTo critique the evidence from recent and ongoing obesity prevention interventions in the first 1000 days in order to identify evidence gaps and weaknesses, and to make suggestions for more informative future intervention trials.Recent FindingsCompleted and ongoing intervention trials have had fairly modest effects, have been limited largely to high-income countries, and have used relatively short-term interventions and outcomes. Comparison of the evidence from completed prevention trials with the evidence from systematic reviews of behavioral risk factors shows that some life-course stages have been neglected (pre-conception and toddlerhood), and that interventions have neglected to target some important behavioral risk factors (maternal smoking during pregnancy, infant and child sleep). Finally, while obesity prevention interventions aim to modify body composition, few intervention trials have used body composition measures as outcomes, and this has limited their sensitivity to detect intervention effects. The new WHO Healthy Lifestyles Trajectory (HeLTI) initiative should address some of these weaknesses.SummaryFuture early obesity prevention trials should be much more ambitious. They should, ideally: extend their interventions over the first 1000 days; have longer-term (childhood) outcomes, and improved outcome measures (body composition measures in addition to proxies for body composition such as the BMI for age); have greater emphasis on maternal smoking and child sleep; be global.

Preventing childhood obesity: Early‐life messages from epidemiology

“…; Reilly et al . ). The challenges of changing behaviour to achieve a healthy bodyweight before pregnancy may be considerable.…”

“…As data from experimental models suggest that the earliest stages of development are crucial, lifestyle interventions in mid-late pregnancy may be too late to be effective (Catalano & Shankar 2017). Preconception interventions offer huge potential to benefit offspring health but, as highlighted in recent reviews, to date, there has been a lack of trials focusing on the preconception period (Blake-Lamb et al 2016; Reilly et al 2017). The challenges of changing behaviour to achieve a healthy bodyweight before pregnancy may be considerable.…”

Developing a core outcome set for childhood obesity prevention: A systematic review

“…As a result, there is increased research interest in developing and evaluating complementary infant feeding interventions in the first year to prevent childhood obesity (Redsell et al, ). Recent reviews of infant complementary feeding interventions highlight inconsistent or minimal effects on feeding practices, dietary intakes, or weight outcomes (Blake‐Lamb et al, ; Matvienko‐Sikar et al, ; Redsell et al, ; Reilly, Martin, & Hughes, ). One potential reason for inconsistencies across trials may relate to heterogeneity in outcome reporting, definition, and measurement (Matvienko‐Sikar et al, ).…”

What exposures in early life are risk factors for childhood obesity?

“…Recognition of the importance of early exposures has led to several obesity prevention trials starting in early life, with promising results . Many others are currently being undertaken, and two recent systematic reviews and a critique of intervention trials have recently been published …”

“…55 Many others are currently being undertaken, and two recent systematic reviews 56,57 and a critique of intervention trials have recently been published. 58 One of the most important gaps is the translation of evidence generated by randomised trials into practical advice and policies. For example, in children aged 0-5 years, research questions still to be addressed include: What are the most effective intervention components, how do they work, under what circumstances and for whom, what are the costs and how can these findings be translated in different contexts?…”