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Preventing child obesity in the next generation

newborn_224x135Preventing child obesity in the next generation must start before conception

The key to preventing obesity in future generations is to make (their) parents healthier before they conceive, leading health researchers suggest.

In a series of papers published in The Lancet Diabetes and Endocrinology the researchers, including those from the Division of Womens' Health, say that the time before couples conceive represents a missed opportunity to prevent the transmission of obesity risk from one generation to the next. They argue that a new approach is needed to motivate future parents to live a healthier lifestyle.

There is now a wealth of evidence that the risk of obesity and its associated conditions, such as heart disease diabetes and some cancers, are passed to the baby while growing in the womb. In turn, when the child becomes a young adult they may pass the risk of obesity on to their children – it is a vicious cycle.

The nature of this problem is not adequately appreciated, say researchers. Many young people, whilst appearing outwardly healthy, are nonetheless on a risky path to obesity and chronic disease, more likely to pass this risk to their children, the researchers warn. Many pregnancies are unplanned, and the special needs of adolescents and young people at this important time are not sufficiently recognised. Far from helping them to prepare and plan for pregnancy and parenthood, many public health programmes assume that their needs are similar to the general population and require no special measures or provisions.

Each of the four papers in the Lancet series tackles a different aspect of the challenge. The first paper, a review from King’s and the USA National Institute of Health, was led by Professor Lucilla Poston, Head of Division of Women’s Health at King’s.

The review looked at trends in the global prevalence of obesity among women and the adverse consequences for reproductive health and pregnancy outcome, especially in those countries least able to accommodate associated health-care costs. A number of studies have shown the high prevalence of maternal obesity in high income countries; the rise in obesity among European countries and in the US have been rapid.

In low-income and middle-income countries (LMICS) major changes in diet and physical activity patterns during the past three decades have resulted in a continuous upward trend in obesity, with increasingly present levels of obesity in women from rural areas. Particularly striking rises have occurred in some of these countries. In India, 0.8 million women were obese in 1975 compared to an estimated 20 million in 2014. The increase in obesity is a major cause of infertility and is responsible for spiralling rates of gestational diabetes and delivery of overweight babies.

Lead author Professor Lucilla Poston, said: ‘Most women with obesity who intend to conceive are not aware of the risks of infertility or complications. Obesity challenges the health of the mother and has much wider and long-lasting consequences than are generally appreciated by either health professionals or women themselves. A pragmatic solution is required on a global scale, particularly in low-income and middle-income countries where we see a rapidly rising problem.’

Authors from the review paper call for larger-scale observational studies to determine the scale of complications in these countries, which may not be prepared to manage the increasing burden on healthcare resources, and for an international drive to reduce obesity in women of reproductive age.

The Lancet Diabetes and Endocrinology series on Maternal Obesity was launched at the Power of Programming 2016 conference in Munich today (13 October) and is available online at: http://www.thelancet.com/series/maternalobesity