Obesity prevention: are we missing the (conception to infancy) window?

摘要

Despite decades of research and public policy efforts, obesity continues to be a major public health threat. Effective, sustainable weight loss treatments in adults have been elusive1 and prevention and treatment efforts aimed at children, although somewhat more promising, have failed to have a significant impact on the obesity epidemic.More recently, some obesity researchers have started to focus on the earliest period of life, from conception to infancy, and have found compelling evidence to suggest that this period may be a critical window of opportunity for prevention of lifelong obesity.2,3It is commonly believed that obesity is caused by a simple thermodynamic equation (energy in, minus energy out) and that an individual’s weight is the result of personal choices of excess consumption and inadequate activity. This assumption forms the basis of almost all of our obesity prevention and treatment programmes but it oversimplifies a very complex condition. In fact, individual choices may only be symptoms of an underlying problem in regulation of appetite or energy metabolism.4 We all know ‘metabolically gifted’ individuals who remain thin with no apparent effort or extraordinary willpower. Every individual seems to have a pre-determined weight ‘set point’ and a strong biologic tendency to defend it. Though much of this is genetically determined, there is a growing body of evidence to suggest that it may also be related to modifiable factors established early in life.Many of the risk factors associated with obesity have their origins in the perinatal period: maternal weight, smoking …