Preventing childhood obesity: Early‐life messages from epidemiology

Abstract

The high rates of overweight and obesity, currently seen in young children, underline the urgent need for preventive strategies in early life, before excess weight is gained. However, alongside such practical considerations, a body of epidemiological evidence now links experience in fetal and early postnatal life to an individual's later risk of obesity -pointing to the importance and role of 'developmental influences', such as maternal obesity, excess gestational weight gain and short duration of breastfeeding, in the aetiology of childhood obesity. Differences in early experience are linked to lifelong differences in predisposition to gain weight and, as the associated differences in obesity risk are large, real benefits could be achieved by early intervention. Such messages, regarding the need for efforts to address these early influences to prevent obesity, are now embedded in national and international health policy. Whilst successful prevention initiatives are needed early in life, the most effective strategies may need to be focused even earlier in the life course, in the period before conception. Although the challenges of changing behaviour are considerable, such changes have the potential to impact both on the health of future mothers and future generations.Keywords: childhood obesity, early life, life course, preconception, programming Childhood obesityThe rapid increases in the prevalence of overweight and obesity, seen worldwide in recent decades, have made this a public health priority (Butland et al. 2007). In the UK, although there is some evidence to suggest a slowing rate of increase, rates remain very high. For example, the Health Survey for England (2015) showed that the majority of adults studied were overweight (41% of men, 31% of women) or obese (affecting a further 27% of men and women).These are some of the highest levels of overweight and obesity seen in Western Europe (FAO 2013). These changes are not confined to adults; recent (2015/2016) data from the National Child Measurement Programme (NCMP) show that more than one in five children in England are now overweight or obese by the time they start primary school, with rates increasing to one in three by the end of Year 6. To put these statistics in context, using data from 1974, soon after the establishment of the British Nutrition Foundation (BNF), the National Study of Health and Growth found that less than 10% of English children aged 4-6 years were overweight and fewer than 2% were obese (Chinn & Rona 2001). As body composition 'tracks', such that children who Correspondence: Professor Sian Robinson,

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“…). It is now well‐established that rapid weight gain in the early years predicts children's later risk of obesity (BNF ; Robinson ), with this recent advance in knowledge juxtaposed with population statistics showing that overweight and obesity prevalence in preschool children is at 29%, and little progress is being made in reducing this problem (NHS Digital ). The government's recent publication Childhood obesity: a plan for action (DH ) highlights the preschool years as an important time to prevent the development of childhood overweight and obesity.…”