Editors' ChoiceObesity

Sustained obesity starts in early childhood

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Science Translational Medicine  17 Oct 2018:
Vol. 10, Issue 463, eaav3890
DOI: 10.1126/scitranslmed.aav3890


Accelerated weight gain during early childhood predicts sustained obesity.

Global rates of childhood obesity continue to rise and are linked to an early onset of adverse conditions, including diabetes and heart disease. Prior studies have shown that the majority of obese teenagers remain obese through adulthood, and that once obesity is established it’s very hard to reverse. Until now, little was known about whether being obese during specific time periods in childhood would portend a greater likelihood for sustained obesity or whether patterns of weight gain during childhood would predict obesity during the teenage years.

A new study by Geserick et al. addressed these questions by tracking the trajectories of weight gain and body mass index standard-deviation scores (a measure of relative weight adjusted for child age and sex) in more than 50,000 healthy German children from infancy through adolescence. The study was a longitudinal, population-based design that included a combination of retrospective and prospective analyses. Data on the children’s age, sex, height, and weight were measured during well-child visits to pediatricians and were retrieved from a patient registry. Children included in the study had at least one visit with a pediatrician between 0 and 14.9 years of age (“childhood”) and another visit between 15 and 18.9 years of age (“adolescence”). Retrospective analyses showed that most obese adolescents had been normal weight as infants, but over 50% had become overweight or obese by the time they were five years old. Prospective analyses showed that about half of the children who were overweight before the age of two years returned to normal weight in adolescence, whereas the probability of being overweight or obese in adolescence was almost 90% in children who were obese at 3 years of age. The greatest acceleration in weight occurred when children were between 2 and 6 years old, and the probability of obesity in adolescence was higher in children who had accelerated weight gain during their preschool years. These patterns were similar in girls and boys.

Collectively, these data show that early childhood is a critical and relatively narrow window that predicts the establishment of sustained obesity down the road. This study was not designed to determine the causes of early-onset obesity, and future work is urgently needed to identify environmental factors that underlie accelerated weight gain in early childhood. Nevertheless, this important study provides insights into the critical windows of opportunity for the implementation of interventions to prevent excessive weight gain in children and to reduce the risk of continued obesity.

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