Early-Life Obesity Prevention: Critique of Intervention Trials During the First One Thousand Days

John J Reilly, Anne Martin, Adrienne R Hughes, John J Reilly, Anne Martin, Adrienne R Hughes

Abstract

Purpose of review: To critique the evidence from recent and ongoing obesity prevention interventions in the first 1000 days in order to identify evidence gaps and weaknesses, and to make suggestions for more informative future intervention trials.

Recent findings: Completed and ongoing intervention trials have had fairly modest effects, have been limited largely to high-income countries, and have used relatively short-term interventions and outcomes. Comparison of the evidence from completed prevention trials with the evidence from systematic reviews of behavioral risk factors shows that some life-course stages have been neglected (pre-conception and toddlerhood), and that interventions have neglected to target some important behavioral risk factors (maternal smoking during pregnancy, infant and child sleep). Finally, while obesity prevention interventions aim to modify body composition, few intervention trials have used body composition measures as outcomes, and this has limited their sensitivity to detect intervention effects. The new WHO Healthy Lifestyles Trajectory (HeLTI) initiative should address some of these weaknesses. Future early obesity prevention trials should be much more ambitious. They should, ideally: extend their interventions over the first 1000 days; have longer-term (childhood) outcomes, and improved outcome measures (body composition measures in addition to proxies for body composition such as the BMI for age); have greater emphasis on maternal smoking and child sleep; be global.

Keywords: Children; Early-life interventions; Infants; Obesity prevention; Pediatric obesity; Review.

Conflict of interest statement

Conflict of Interest

John J. Reilly, Anne Martin, and Adrienne R. Hughes declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Funding

The authors are currently in receipt of research grant funding from the WHO Healthy Lifestyles Trajectory Initiative (HeLTI).

Figures

Fig. 1
Fig. 1
a Number of obesity prevention interventions in early life (first 1000 days) identified by successive systematic reviews. b Number of completed and ongoing early-life interventions by geographical region [ •]. c Number of early-life obesity prevention interventions by life-course stages [ •]. d Number of early-life obesity prevention studies reporting body composition (body fatness) outcomes [ •]

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Source: PubMed

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