Childhood Obesity: Early Intervention is Key

Part Two of a three-part series: Researchers work to prevent crisis prenatally 

To read part 1 of this series, “Health in the Balance,” click here

Photo by Jessica Dimmock, courtesy of HBOTo read part 1 of this series, “Health in the Balance,” click here

Part Two: In Utero Intervention                                                       

With childhood obesity now affecting some 17 percent of American children, U.S. government and health officials agree that serious action is required and a new focus involves intervention even earlier than previously considered.

 In 2010, President Barack Obama established the first-ever Task Force on Childhood Obesity, aimed at reducing the rate of childhood obesity to just 5 percent by 2030. Although many of the plan’s 70 recommendations focus on approaches such as improving access to healthy, affordable foods; increasing physical activity; and empowering parents to make smart nutrition choices, a large chapter of the report is dedicated to reducing the risk of childhood obesity early in life. In fact, since the president released the task force's call to action, two Institute of Medicine (IOM) reports have emphasized the need for early interventions to prevent obesity.

That’s welcome news to researchers like Matthew Gillman, Elsie Taveras (a member of the IOM Committee on Early Childhood Obesity Prevention Policies), and their colleagues at Project Viva, a longitudinal research study that examines a woman’s lifestyle and other factors during pregnancy and after birth, as well as the effects on her health and the health of her child.

Since 1998, the project has studied thousands of expectant moms and their children, including more than 1,110 in-person visits with 7-year-olds. Thanks in large part to Project Viva’s findings, a growing body of evidence indicates that childhood obesity begins in utero—and early interventions can go a long way to quelling the problem.

There’s good reason to start preventing childhood obesity as soon as possible. It’s well established that more than half of obese children are already overweight by age 2, and approximately one in five children will be overweight or obese by age 6.

In addition, many of the racial and ethnic differences in risk factors for childhood obesity appear to occur early in life. One large Project Viva study, published in the April 2010 issue of Pediatrics, found that black and Hispanic children were more likely than white children to have gained weight rapidly during infancy. What’s more, they spent less time breast-feeding, were introduced to solid foods sooner, consumed more fast foods and sugar-sweetened beverages, slept less and had television sets in their bedrooms during the first three years of life—all risk factors for childhood obesity. Black and Hispanic mothers were also more likely to begin their pregnancies overweight or obese, to have depressive symptoms during pregnancy, and (Hispanic only) to develop gestational diabetes.

Although the exact reasons for such disparities are still largely unclear, researchers continue to find associations of these and other risk factors with childhood obesity, including:

Maternal habits. What’s good for a pregnant mother is good for her child—and the inverse holds true, as well. One 2007 study by Gillman, Taveras and their colleagues found that children of mothers who had gained more weight in pregnancy had about four times the risk of being overweight by age 3. Other Project Viva findings suggest that children whose mothers smoked while pregnant have twice the risk of being overweight by age 3 than those whose mothers did not smoke.

C-sections. A 2012 study by Project Viva researchers found that 3-year-olds who had been born by Caesarean section were twice as likely to be obese as those who had been delivered vaginally. That may be because babies born by C-section have different bacteria in the gut than those born vaginally, and some emerging data suggest that this microbiome could be important for energy balance.

Breast-feeding. Studies suggest that children who are breast-fed have a lower risk of obesity, possibly because breast-fed children may learn to self-regulate how much they eat—and mothers may learn to control how much they feed their children—by responding to hunger rather than other cues. A study by Gillman and colleagues in the March 2011 issue of Pediatrics sheds light on formula-fed infants, too: Those who were introduced to solid food before 4 months old had a six-fold increase in their odds of being obese at age 3, compared to those whose parents waited at least 4 to 6 six months to introduce solids.

Infant sleep. Research by Taveras suggests that adequate sleep during infancy is just as important to babies as it is to their weary parents. Her 2008 Project Viva study, published in the Archives of Pediatrics and Adolescent Medicine was the first to examine the effects of sleep during infancy. She found that babies who slept less than 12 hours a day were twice as likely to be obese by age 3 than those who got more shut-eye, possibly because sleep is crucial for a proper balance of the hormones that regulate appetite.

Starting the Fight Early

Findings like these are helping physicians, public health advocates and others make recommendations to parents even before a child is born.

“It’s becoming obvious that early prevention is a big part of the answer to childhood obesity,” said Gillman.

But the goal, he stresses, isn’t to blame parents.

“We’re focusing on expectant and new mothers, because most women are especially receptive to making positive changes for their child’s health during and right after pregnancy,” Gillman said. 

Early interventions may have impressive effects on children’s behavior. In a study published in the November 2011 issue of the Journal of Maternal and Child Health, Taveras and her colleagues assigned new mothers and their babies (age 0 to 6 months) to two groups. One group received an intervention that included conversations with pediatricians, motivational counseling by a health educator and group parenting workshops. The other group received usual pediatric care.

After six months, they found that infants in the intervention group breast-fed longer and were less likely to be introduced to solid foods, watched less TV than their peers and slept more.

“If we can help parents change some of these risk factors early in life,” says Taveras, “we may be able to protect against obesity later on—and possibly decrease the disparities we see with the disease in many nonwhite populations.”

But what about children who, at age 5 and older, are past the point of such early interventions?

“It’s certainly easier to start preventing childhood obesity very early on,” says Gillman. “It may be more difficult as kids get older, but we do need to continue making changes throughout their lives.”

Next: 800 Gallons of Coke