Childhood obesity prevention needs to start earlier
Efforts to prevent childhood obesity must begin much earlier than currently thought – perhaps even before birth – especially for minority children, according to a new study that tracked 1826 women from pregnancy through their children the first five years of life.
Most prevention programs for obesity – including national initiative launched recently by First Lady Michelle Obama – Objective Children 8 years and older. The Harvard scientists in the Department of Health Care Pilgrim Institute of Population Medicine, an affiliate of Harvard Medical School, now say that the factors that place children at greater risk of obesity begin in childhood, and in some cases, during pregnancy. His research also suggests that risk factors such as poor feeding practices, lack of sleep and televisions in the rooms are more common among minority children than white children.
“This period of early life – prenatal, infancy through age 5, is a key period for the prevention of childhood obesity, especially for minority children,” says Elsie Taveras, lead author and assistant professor of population medicine at Harvard Medical School and director of the Step Ahead program at Children’s Hospital Boston. “Almost every risk factor in that period before age 2, even in the prenatal period, was disproportionately higher among minority children.
For the study, published online 1 March in the journal Pediatrics, researchers interviewed 1343 white, 355 black and 128 Hispanic women pregnant at the end of the first and second quarters, in the first days after birth, and when the children were 6 months and 3 years of age. The women also completed questionnaires when the children were 1, 2 and 4 years old.
Compared with Caucasian women, researchers found that minority women were more likely to be overweight when they became pregnant and Hispanic women had a higher rate of gestational diabetes, both risk factors for childhood obesity. Although the prevalence of two risk factors – smoking and depression – during pregnancy was higher among African American and Hispanic women, rates decreased significantly when the researchers adjusted for socioeconomic status, suggesting that at least two risk factors can be affected by income and education levels.
When the researchers looked for other risk factors for children during the first five years, found that black and Hispanic children are more likely than Caucasians to be born small, gain weight after birth, they begin to eat solid food before 4 months of age and less sleep. During their preschool years, the study suggests, minority children to eat more fast food, drink more sugary drinks, and is more likely to have televisions in their rooms than Caucasian children.
A common theory is that the presence of these and other risk factors is caused by limited access to health care, poverty and low educational levels. However, when Taveras and colleagues adjusted for socioeconomic status, found that the prevalence of many risk factors remains the same.
Most likely, Taveras says, the risk factors derived from the behavior and customs passed from generation to generation, or may be culturally ingrained. “For many patients I see in my clinic, is intergenerational – for example, the grandmother at home influences her daughter feeding her own son.” This is especially true when it comes to what age mothers begin to give their children food or when the mother decides to stop breastfeeding, Taveras says.
“Sometimes trying to cope with intergenerational influences can be very difficult, but in reality is the promise that some of the areas in which differences are modifiable,” Taveras notes. “Anyone who works with families of young children, including pediatricians and child care providers, can work on these issues.”
The most difficult task would be to solve the problems that are related to socioeconomic status. In this study, which did not play a big role, because people have access to good prenatal and pediatric care for their children and were well educated.
“We found these striking disparities, even in this town, where families had racial and ethnic minorities who were relatively higher education and income,” she says. “Imagine what the difference is that in a population of lower socioeconomic status.
That is a question Taveras plans to tackle next. The goal now is to look at other novel risk factors may be more common among minorities – including those probably related to income and education.
“All the factors of risk factors we examined in this study are known to have been published in the literature, including some of our own literature,” says Taveras. “But there are risk factors still little studied, we have a common sense, and that is where we plan to go next.”
This research was funded by the National Institutes of Health’s National Center on Minority Health and Health Disparities and the Robert Wood Johnson Foundation.
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