Could changes in early-life care prevent childhood obesity?

The US is seeing historically high rates of childhood obesity, but researchers in the US have claimed that intervention in the early stages of a child’s life could make all the difference. 

A new study published in Pediatrics found fewer infants gained excess weight when low-income pregnant women received individualised health coaching, in tandem with clinicians in community health centres and public health programs systematically changing how they delivered care to women and their infants. 

“Most interventions to prevent obesity in children attempt to change the behaviour of the child’s parent or family,” explained lead author Elsie Taveras,  chief of the Division of General Academic Pediatrics at Massachusetts General Hospital (MGH).

“But a child’s health is also influenced by how well clinical and public-health systems interact with families and provide care targeted to reducing the risk of obesity.” 

The intervention, called the First 1,000 Days program, has the potential to have a broader impact on childhood obesity because it reaches all women and infants.

“We can be so much more effective at preventing childhood obesity if all obstetricians pay close attention to a woman’s excess weight gain in pregnancy and if all paediatricians are trained in identifying problematic weight gain in infants,” said Taveras.

The First 1,000 Days program can also attempt to combat obesity in the first trimester of pregnancy and focus on low-income families – who have the highest risk for childhood obesity. 

The investigators compared infants’ weight outcomes in women and infants who received the intervention, and those who received usual care. The intervention group included 995 pregnant women in their first trimester, and their infants receiving care at two community health centres. The comparison group consisted of 650 pregnant women and their infants who received usual care at two other community health centres serving low-income patients.

The aims of the intervention were to promote the adoption of healthy behaviour in the women and their infants, and to make systematic changes in the clinical care the women and infants received.

The systems-level component of the intervention included, for example, standardising obesity-prevention training for paediatric clinicians and staff, close tracking of infants’ weight gain, screening pregnant women for adverse health behaviours and social determinants of health, and providing educational materials and text messages to families that promoted healthy feeding and sleeping behaviours of their infants. In addition, women in the intervention group received individual support and coaching during pregnancy and the first six weeks postpartum on diet, physical activity, sleep and stress reduction. 

Infants in the intervention group had 54 percent lower chance of being overweight at six months, and a 40 percent lower chance of being overweight at 12 months compared to those who received usual infant care – the researchers will continue to follow the children through age two.

Mothers at the intervention sites had modestly lower, but clinically insignificant, weight retention at six weeks postpartum in comparison with mothers receiving usual care. However, more women in the intervention group had a postpartum visit with a clinician than the women who received usual care.

“The first six weeks after delivery are very important for positively influencing a woman’s health trajectory,” explained Taveras.

“We may need a more robust intervention to achieve postpartum weight reduction,” she added. 

The next steps for the research are to find the best approaches to distribute the intervention to other health systems that care for low-income families, and to train frontline clinicians in how to implement the program for preventing childhood obesity into their practices. Taveras added, “we believe we can create a sustained reduction in childhood obesity by moving beyond simply modifying individual behaviours and risk factors, one parent at a time.”