Early Prevention of Childhood Obesity: Another Promise or a Reliable Path for Battling Childhood Obesity?

A recently published article by Gillman and Ludwig [1] strongly advocates for early obesity prevention. Indeed a child’s obesity life course appears to be determined by the age of 6 years as shown in compiled data on the natural course of BMI distribution from birth to 14 years ( fig. 1 ) in three German birth cohorts (Kiel Obesity Prevention Study (KOPS) [2] , Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study [3] , Multicenter Allergy Study (MAS) [4] ) in a collaboration facilitated by the German Adiposity Network (EPI Germany; www.kompetenznetz-adipositas.de/kompetenznetz/konsortien. html?L = 1 ). The patterns in boys and girls were very similar. Among the obese children with a BMI above the 97th percentile at 6 years 50.0% (95% CI 33.3–66.7%) remained obese, and 40.0% (95% CI 26.7–53.3%) became overweight (BMI > 90th percentile). Among overweight children with a BMI between the 90th and 97th percentile at 6 years 24.2% (95% CI 13.6– 34.9%) stayed overweight until age 14 years, and 27.3% (95% CI 16.7–37.9%) became obese, whereas only 2.1% (95% CI 1.6–3.1%) of the children who had a BMI below the median at the age of 6 years developed obesity at the age of 14 years. Overweight at age 5 was the strongest predictor of being overweight at age 10 years after adjustment for several co-factors, as also demonstrated in another German cohort [5] . Therefore, any effort to avoid an elevated BMI within the first 6 years of life appears to be strongly justified. But is there sufficient evidence for effective preventative action? Gillman and Ludwig [1] based their argument on evidence from animal studies demonstrating irreversible derangements in offspring’s adiposity and metabolism related to adverse preand perinatal conditions. Such proof of principle, however, is difficult to translate into effective prevention programs in humans, although the authors suggested that a large Received: February 10, 2014 Accepted: February 11, 2014 Published online: March 26, 2014