The First 1000 Days Of Life: A Window Of Opportunity For Novel Interventions Of Childhood Obesity

Izzuddin Aris, PhD

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Childhood overweight/obesity remains a substantial problem globally. Rising trends in children's and adolescents' body mass index have plateaued in many high-income countries, childhood obesity rates have dramatically increased in parts of Asia over the past few decades. Mounting evidence suggests that the period between conception and age 2, otherwise known as the “first 1000 days of life”, is important in shaping a child’s future risk of obesity. While previous studies have identified numerous maternal factors that can boost subsequent childhood obesity risk  (e.g., maternal obesity, diabetes, excessive weight gain during pregnancy, etc.), researchers have only considered them in isolation. Recent findings from the Project Viva and Southampton Women’s Survey cohorts have highlighted that these interlinked risk factors, both independently and cumulatively, contribute to a child's future risk of obesity.

Complementing these findings, my colleagues and I reported in the upcoming issue of International Journal of Obesity, that several early-life risk factors, namely maternal and paternal overweight/obesity; excessive weight gain during pregnancy; elevated blood glucose during pregnancy; breastfeeding for less than four months; and introducing solid food before four months added cumulatively to increase the risk of overweight/obesity in early childhood (~4 years of age) in a multi-ethnic Asian cohort from Singapore. Interestingly, mother's and father's weight status made an equal and additive contribution to a child’s risk of excess weight. If either the mother or father was overweight, the probability that their child would be overweight was similar; but if both parents were overweight, the probability that their child would be overweight would double.

Each risk factor we assessed is potentially modifiable through changes in behavior. For example, interventions that limit excessive weight gain during pregnancy, reduce blood glucose during pregnancy, promote breastfeeding duration and educate mothers regarding timing of solid food introduction have had some success. Interventions which aim to target these risk factors in tandem may amplify their individual positive effects on preventing childhood overweight/obesity.

The World Health Organization Commission on Ending Childhood Obesity has developed a set of recommendations to tackle childhood and adolescent obesity in different contexts globally, of which two key recommendations include “Preconception and pregnancy care” and “Early-life childhood diet and physical activity.” The first 1000 days of life therefore represents a key window of opportunity:  targeting families where many of these risk factors are present, and novel intervention approaches which jointly target these risk factors, may go a long way in preventing childhood overweight/obesity and its long-term consequences.