Childhood Obesity Risk and Prevention: Shining a Lens on the First 1000 Days.

Abstract

[Author Affiliation]Elsie M. Taveras. 1 Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA. 2 Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.Address correspondence to: Elsie M. Taveras, MD, MPH, Chief, Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, E-mail: elsie.taveras@mgh.harvard.eduThe first 1000 days--the period from conception to age 2 years--is increasingly recognized as an important period for the development, and thus prevention, of obesity and its adverse consequences. In recent years, the National Academies of Sciences, Engineering, and Medicine1 and the NIH2 have convened multidisciplinary workshops to examine the state of the science and promising solutions to reduce the risk of childhood obesity beginning in early life. Additionally, The World Health Organization's Report of the Commission on Ending Childhood Obesity3 emphasized the important role of the preconception, antenatal, and early childhood periods in prevention of childhood obesity, and the Robert Wood Johnson Foundation recently published an issue brief on the impact of the first 1000 days on childhood obesity.4 Yet, substantial knowledge gaps remain in the understanding of etiology and plausible behavioral and biological mechanisms of obesity development in early life, and few interventions have been conducted to demonstrate the extent to which prevention in early life has a beneficial effect on infant growth status and obesity-related behaviors.For this theme issue of Childhood Obesity, we asked investigators from a range of disciplines to submit articles that advanced the science of early life obesity risk factors and prevention. Taken together, the articles in this issue begin to narrow the evidence gaps and present emerging and promising methods and approaches to further inform obesity prevention beginning in early life.Claesson and colleagues,5 Fuemmeler and colleagues,6 and Gregory and colleagues7 examined risk factors and interventions in pregnancy. Fuemmeler and colleagues examined associations of maternal prepregnancy obesity and gestational weight gain with infant weight trajectories in the first 24 months of life using the SuperImposition by Translation and Rotation (SITAR) method, which provides estimates of infant size, timing to peak velocity, and growth velocity. Both prepregnancy obesity and greater-than-adequate gestational weight gain were independently associated with risk for greater early postnatal weight growth. These findings suggest that maternal obesity and excessive gestational weight gain may be targets for interventions to prevent child obesity risk. Yet, in two follow-up studies of infants whose mothers participated in interventions to prevent excessive weight gain during pregnancy, Claesson and colleagues and Gregory and colleagues did not find a protective effect of reduced gestational weight gain on offspring BMI. Neither intervention continued to work with the parent-infant dyad in infancy. Previous observational studies that followed offspring of mothers who were participants in interventions targeting gestational weight gain or gestational diabetes, and in which the interventions ceased after birth, have similarly found no spillover effect on childhood obesity.8,9 The studies by Claesson and Gregory suggest the need for risk-reducing interventions to be continued or maintained in infancy once they have begun in the prenatal period in order to influence child obesity risk.Several of the studies in this issue examine risk factors for greater weight-for-length increases in the first year of life10 and at age 6 years11 and with increasing leptin levels from 6 months to 8 years of age. …