Starting childhood obesity prevention early


Many interventions have been thought of to tackle the childhood obesity epidemic. Could starting the intervention before a child is born make progress?

There have been many attempts to tackle the childhood obesity crisis, ranging from body mass index scores to ‘prescribing’ fruits and vegetables to children and families. An investigation in Pediatrics looks at whether a primary care-based prevention intervention that begins during pregnancy could change early childhood weight outcomes in low-income Hispanic families.1

The investigators ran a randomized control trial that compared mother-infant pairs who received standard care with pairs that received the Starting Early Program, which included prenatal nutrition counseling, postpartum nutrition counseling, and nutrition support groups for parents that target key obesity-related feeding practices. The researchers’ primary outcomes included obesity prevalence (weight for age ≥ 95th percentile), reduction in weight-for-age z-scores (WFAzs) from clinical anthropometric measures, and excess weight gain (WFAz trajectory) from birth to age 3 years.

There were 566 women who enrolled in the study during their third trimester of pregnancy. Five hundred thirty-three of the women were subsequently randomized to either standard care, 267 women, or the intervention, 266 women. During the course of follow-up, 358 children had their weight measured and recorded when they were aged 2 years and 285 children had their weight recorded at age 3 years. Overall, infants who had mothers in the intervention group were found to have lower average WFAz at 18 months of age (0.49 vs 0.73, P = .04) and at age 2 years (0.56 vs 0.81, P = .03). The effect was not found when the children were aged 3 years (0.63 vs 0.59, P = .76), however. No group differences were found when examining obesity prevalence. When the researchers used estimating equation, they found that significant average treatment effects were seen between 10-26 months (B = −0.19, P = .047), but not through 3 years of age. Additionally, obesity rates were found to decrease as the rate of attendance increased in within group dose analyses at 3 years.

The investigators concluded that the intervention led to positive effects in the group that received the intervention through the first 2 years of life, but the effect did not continue through age 3 years. They believe that further study is needed to see how the effects can be sustained past 2 years of age.


1. Messito M, Mendelsohn A, Katzow M, Scott M, Vandyousefi S, Gross R. Prenatal and pediatric primary care–based child obesity prevention program: a randomized trial. Pediatrics. September 3, 2020. Epub ahead of print. doi:10.1542/peds.2020-0709

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