EARLY INTERVENTION TO PREVENT CHILDHOOD OBESITY
PREVENTING THE ONSET of overweight and obesity in children is an important public health priority. Rates of childhood obesity in Australia are one of the highest in developed nations. The overall prevalence of overweight and obesity in Australian children doubled between 1985 and 1995 and the epidemic is evident in children as young as 2 years.
Whilst overweight and obesity typically have their greatest impact later in life, longitudinal studies have shown that they have significant adverse effects when acquired early. Further, obese children have a 25-50% risk of progressing to obesity in adulthood and this risk may be as high as 78% in obese adolescents. In addition, there are significant medical and psychosocial consequences, which affect the obese child during the childhood period.
There is increasing epidemiological evidence linking early nutrition with the development of obesity in children and adults. A recently published meta-analysis has shown that children who were breastfed have significantly lower levels of obesity than those who were formula fed.
Early introduction of solids and consumption of energy dense foods are associated with higher rates of obesity. A strong, positive association has been found between the consumption of soft drinks and obesity in different cohorts of older children.
Energy expenditure, like energy intake, is an important factor in the development of obesity. Physical activity has a protective effect against weight gain in children. Prolonged exposure to sedentary activities, known to be commonplace amongst Australian children, is positively associated with the presence of obesity.
This suggests that obesity interventions need to commence as early as possible. The impact of the child’s environment on their nutrition and physical activity also suggests that a family-focused approach is required.
WHAT IS THE HEALTHY BEGINNINGS TRIAL?
THE HEALTHY BEGINNINGS trial is a randomised controlled trial to test effectiveness of a home-based early intervention program designed to reduce family and behavioural risk factors for childhood obesity.
The intervention consisted of eight home visits from specially trained community nurses delivering a staged home-based intervention, one in the antenatal period, and seven at 1, 3, 5, 9, 12, 18 and 24 months after birth. Timing of the visits was designed to coincide with early childhood developmental milestones.
During the trial trained community nurses visited first-time mothers from disadvantaged areas of South Western Sydney. At these set-intervals visits nurses provided advice on infant feeding, nutrition and physical activity, as well as discussing parent-child interaction, parenting style and family support.
The Healthy Beginnings trial was developed in 2007 by Dr Li Ming Wen and Dr Chris Rissel (South Western Sydney and Sydney Local Health District Health Promotion Service), together with Prof Louise Baur (University of Sydney) and was funded by National Health and Medical Research Council (NHMRC #393112; 2007-2010).