Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 31
childhood obesity rates and their consequences.
Barker showed an association between low birth
weight and weight at the age of 1 year in determining
the risk of cardiovascular disease ( CVD ) in later life,
especially in children who showed “ catch - up ” growth
or became obese. Barker ’ s research prompted international
studies and public health recommendations to
promote maternal nutrition and infant growth, largely
through primary health care. 1 Fetal and early postnatal
nutrition were thought to be the “ common soil ”
that program the metabolic syndrome. This “ common
soil ” hypothesis, postulated originally in 1984, suggested
that early nutrition was a common link in the
development of Type 2 diabetes and CVD, implying
that CVD is not a complication but shares genetic and
environmental antecedents with Type 2 diabetes. 2
Experimental rat studies have demonstrated that poor
maternal nutrition is associated with increased insulin
resistance and elevated blood pressure in the offspring.
3 Accelerated weight gain during infancy is
also associated with increased insulin resistance as
well as overweight and higher leptin and blood pressure
levels in adolescence and adulthood. 3 Maternal
over - nutrition is also of concern, as higher birth
weights are associated with higher BMI during childhood
and adulthood, as well as increased risk of
obesity and diabetes.
Management
Therefore, the management of maternal nutrition is
important in reducing obesity during childhood and
later (and for many other reasons). Early detection
and careful management of gestational diabetes in
primary care is essential with not only the potential
for congenital abnormalities and macrosomia if
poorly controlled, but also increased adiposity and
insulin levels even at the age of 5 years. 3 In the UK,
the NICE guidance on maternal and child nutrition
recommends the provision of information on the
benefits of a healthy diet and practical and tailored
advice on healthy eating throughout pregnancy. 4 Low
birth weight is associated with subsequent obesity, so
smoking cessation interventions in pregnancy are also
important as they have been shown to reduce smoking
rates and improve birth weight. 5
As breastfeeding reduces risk for both CVD and
Type 2 diabetes, and other benefits of breastfeeding
are incontestable, breastfeeding promotion is of para-
mount importance in primary care and community
health facilities. Philip and Radford argue that the
risks of being formula fed are now well established. 6 A
systematic review commissioned by the World Health
Organization ( WHO ) and published in 2007 found
that breastfed individuals were less likely to be considered
as overweight/obese. 7 Scholten et al ’ s more recent
study examined longitudinal data from 2,347 children
born in 1996/97 and found that children who were
breastfed for more than 16 weeks had a lower BMI at
1 year than non - breastfed children. A high BMI at 1
year was strongly associated with a high BMI between
the ages of 1 and 7 in the same model. 8
In the UK it is a requirement that approved NICE
guidance is implemented within the NHS, and for
primary care this means through primary care trusts. 9
One example of this is the UNICEF Baby Friendly
Initiative that promotes breastfeeding. The Baby
Friendly Initiative is a worldwide program developed
by the WHO and UNICEF and was launched in
1991. 10 Baby Friendly accreditation requires that community
health care facilities implement seven points
(Table 31.1 ). Achievement of the seven points is
Table 31.1 The seven - point plan for the protection,
promotion and support of breastfeeding in community
health care settings.
1 Have a written breastfeeding policy that is routinely
communicated to all health care staff.
2 Train all staff involved in the care of mothers and
babies in the skills necessary to implement the policy.
3 Inform all pregnant women about the benefits and
management of breastfeeding.
4 Support mothers to initiate and maintain
breastfeeding.
5 Encourage exclusive and continued breastfeeding,
with appropriately - timed introduction of
complementary foods.
6 Provide a welcoming atmosphere for breastfeeding
families.
7 Promote cooperation between health care staff,
breastfeeding support groups and the local
community.
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