Childhood obesity is increasing, particularly in low- and middle-income countries. In high–income countries, while prevalence may be plateauing, it remains high; and we are seeing an increase among children living in disadvantage.
In January 2016, a report by the World Health Organisation’s Commission on Ending Childhood Obesity called for prevention efforts to target early life, specifically three critical periods:
…preconception and pregnancy, infancy and early childhood and older childhood and adolescence.
An early-life focus is important because the health and social impact of excess weight and obesity in childhood persists into later stages of life, negatively affecting health, educational attainment and general life quality.
Current high rates of childhood obesity are the product of a perfect early-life storm. Understanding the combination of factors that put children living in disadvantage at risk of obesity provide a clear focus for public health action.
A perfect storm
More children are now growing up in societies that facilitate weight gain and obesity by creating environments where a healthy choice is not the cheapest or the easiest option.
Further reading: ‘Living here will make you fat’ – do we need a public health warning?
Our recent review identified a range of factors likely to influence a child’s increased weight gain.
These include maternal factors, prior to and during pregnancy. Diet, smoking, being overweight or obese when becoming pregnant, gaining excess weight during pregnancy and developing gestational diabetes can all increase the risk of the child being overweight. A father being overweight or obese at conception is also a risk for the child’s future weight.
In the early months and years of a child’s life, many factors pose a risk to becoming overweight. These include the child not being breastfed or being breastfed for too short a time.
A child’s risk of obesity is also strongly affected by the diet they learn to enjoy from the start of life, so early food exposures are important. For instance, weaning children off milk and onto sweetened drinks rather than water, or introducing sweet or high-fat biscuits as snacks rather than fruits or vegetables will promote preferences for sugar and fat that can be difficult to change.
The lack of physical activity and sleep, and more screen time, were also flagged as important influences in children’s obesity risk.
While the factors that will promote child overweight and obesity are wide ranging, the uniting factor is that nearly all of them are more common among people experiencing disadvantage.
Tackling the problem
It is not surprising that we see strong socioeconomic trends in early, rapid growth among infants (an important predictor of later child overweight and obesity). We also see obesity and overweight prevalence increase more quickly in children experiencing disadvantage, as they move through the first few years of life.
Further reading: Social determinants – how class and wealth affect our health.
The WHO Commission’s report provided a welcomed restating of common sense, that “no single intervention can halt the rise of the growing obesity epidemic”.
Promotion of healthy eating, increased physical activity and reduced time being sedentary needs to be embedded across society – from individuals and their families to organisations and communities.
The InFANT Program, designed and trialled by researchers from the Institute for Physical Activity and Nutrition at Deakin University, focuses on early-life obesity prevention and the family’s ability to negotiate the obesity-promoting environment. It’s a good example of an evidence-based intervention at work.
This program, run in a number of local government regions, supports new families to engage their toddlers in behaviours of good diet and physical activity from birth. It has shown promise in improving mother and child diet, and in reducing child television viewing.
One challenge of such programs is to ensure that they do not inadvertently increase socioeconomic disparities and to ensure that those most at risk are engaged. Recent experiences in the program trial in Victoria highlight that women living in relative disadvantage are engaging with this program. We are currently undertaking research to describe how and why this is the case.
It is important to note that programs such as this cannot work in isolation. They must sit alongside initiatives and policies that address the wide ranging factors that promote healthy child and parent weight.
The recent focus on re-thinking sugary drinks and call for a national physical activity plan highlight some examples of the collective will of health organisations to promote healthier environments in which all parents and their young children will function.
Kylie Hesketh receives funding from the Australian Research Council and the National Health and Medical Research Council.
Karen Campbell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.