Prevention of obesity in young children: A critical challeng

Obesity results when susceptible (i.e., genetically pre-disposed) individuals are placed in "adverse" environments.1 Dietz4 has suggested that there are 3 critical periods for the development of obesity. These include: 1) the intrauterine environment or early infancy, 2) 5 to 7 years of age (adiposity rebound), and 3) adolescence. Both Law and associates and Dietz4 propose that weight and adiposity are entr

Research indicates that weight and adiposity are significantly influenced by early life experiences.4,5 Jackson and colleagues provide a strong argument for nutrition-induced changes in the hypothalmic-pituatary-adrenal axis in the mother and the fetus.43 Therefore, the local availability of nutrients during pregnancy, especially in relation to protein intake, has strong implications for future metabolic health. This relationship may reflect adjustments that occur to protect brain tissue preferentially over visceral and somatic growth resulting in an altered metabolic profile.43 Stern and others68 suggest that the impact of a thrifty genotype on birth weight may actually worsen an already altered metabolic profile later in life. Thus, nutrition during and after pregnancy has strong implications for future obesity and related chronic disease. Moreover, low birth weight and breast-feeding history should be considered factors in obesity development in young children.

There is insufficient research to support effective methods to prevent obesity in children and adults. However, indirect support is available through research in the successful management of childhood obesity.78,101 A logical area to begin prevention efforts would be in youth with special emphasis on younger children.105-107 Although long-term maintenance of weight loss in obese adults is rare, research indicates that weight loss during childhood can be maintained into adulthood.1,101 The goal for the treatment and prevention of childhood obesity is the regulation of body weight and fat with adequate nutrition for growth and development. Prevention and treatment interventions for childhood obesity should promote the replacement of unhealthy eating and exercise behaviors with new healthier behaviors.1,106,108 Reducing television viewing time, increasing sports and leisure physical activity time, avoiding snacking, replacing high sugar beverages with water, and regulating m! eal times are examples of simple measures to reduce the risk of obesity in children.105,109,110 The potential role of prevention through primary care is currently underrated by the medical community.71 In one study, it was concluded that frequent medical clinic visits in preschool-aged children might reduce the degree of obesity in the patients.3 The Committee on Nutrition of the American Academy of Pediatrics recommends family-based therapy including diet, psychosocial therapy, and exercise for obese children. Furthermore, targeting families of susceptible children with nutrition and lifestyle behavior education may create an added benefit to the other family members.71

Whitaker and colleagues40 identified parental obesity as an important predictor of adult obesity in both non-obese and obese children under 10 years of age. Children 1 to 2 years of age with 1 obese parent expressed a 28% increased risk of obesity. Furthermore, the obesity status of children over 6 years of age was shown to be a strong predictor of adult obesity. However, before 3 years of age the obesity status of the child was not a predictor of adult obesity. And particularly in non-obese children less than 6 years of age, obesity in both parents significantly increased the risk of adult obesity.40 In a retrospective study of 3,277 obese adults, greater obesity prevalence was observed in the mothers of the obese individuals than the fathers.60 A similar trend was found in the obese grandmothers compared to the obese grandfathers of the subjects.60

By using selective prevention measures, it is hoped that successful prevention of obesity in young children is feasible.71 To date, there are few controlled trials that have successfully illustrated prevention of obesity in non-obese children.71 More prospective research is needed to identify effective strategies for preventing obesity in young children. Controlled trials are required to examine the impact of family-based educational interventions on young children at risk for

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