Obesity is an abnormally high accumulation of body
fat that is the result of an imbalance between
calories consumed (in food) and calories expended.
It is not widely appreciated that the prevention of
childhood obesity begins prior to conception. Many
factors that influence childhood obesity, such as a
healthy maternal diet and lifestyle during pregnancy
and the choice to breastfeed, depend on parental
knowledge, skills and choices about food and physical
activity for themselves and their families. By the
time a child starts kindergarten, a great deal of the
brain development that relates to appetite and food
preferences has occurred. Of equal importance, the
values and attitudes about food as well as eating
and exercise behaviors that impact energy balance
and obesity are well established by the age of 5. So
to prevent childhood obesity, it is important to start
early - prior to conception. The following describes
important factors that either predispose or protect
against obesity during the early developmental period:
Conception - Maternal obesity at the point of
conception is associated with a 4-fold greater risk of
childhood obesity by the age of four. The
importance of parental eating and exercise habits
prior to conception can not be emphasized enough.
For example, optimal maternal folate status (folic
acid is a vitamin that plays a critical role in cell
division) at conception is important to insure healthy
brain development. The brain and nervous system is
one of the very first systems to develop immediately
after conception. Where do you get folate? From
fruits and vegetables that are a natural source of
folate and from breads and cereals that are fortified
with folate.
Pregnancy - Wise food choices and a healthy
lifestyle during pregnancy promotes normal brain
development in the unborn baby. Sound nutrition
and avoiding smoking, drugs and alcohol during the
pregnancy period is especially important for obesity
prevention because certain regions of the brain that
develop in the first few weeks of pregnancy are
involved in appetite control and the regulation of
energy balance.
Infancy - Breastfeeding protects against the
development of obesity in childhood. The longer a
mother breastfeeds her baby and delays the
introduction of supplemental foods and fluids (other
than water), the stronger the protection.
Toddlers - At the age of 6 months or so, slowly
weaning baby onto solid foods that are appropriate
for infants is important for obesity prevention. If
possible, breastfeeding may continue until the child is
one year old. From birth, babies prefer sweet tastes
but they must learn to like other foods that do not
taste sweet. To encourage acceptance of fruits,
vegetables and other wholesome weaning foods that
are appropriate for toddlers, be prepared to patiently
and repeatedly (up to 10 times) offer new foods (in a
non-coercive manner) and take care that these
foods are offered in a form that will not cause
choking. Soda, candy, and desserts should be
avoided altogether in infants and toddlers.
1. Whitaker RC. Predicting preschooler obesity at
birth: The role of maternal obesity in early
pregnancy. Pediatrics 2004; 114(1): e29-e36.
2. Committee on Prevention of Obesity in Children
and Youth. Preventing Childhood Obesity: Health in
the Balance. Institute of Medicine of the National
Academies. The National Academies Press.
Washington DC. See pages 109 and 338.
3. See pages 339 and 340 in Preventing Childhood
Obesity: Health in the Balance
I have a BMI of 32 and I very much want to have a
baby. Because I am overweight, I am worried about
the higher risk of obesity in my baby. I don't want to
delay getting pregnant, in fact, it is possible I
already am pregnant. What should I do?
Answer:
Pregnancy is NOT the time to diet. Now is the time
to eat a balanced diet of wholesome foods. If your
BMI is above 29.0, the Institute of Medicine
recommends a weight gain during pregnancy of 15
pounds or more. Ideally, before you even become
pregnant is the time to focus on a healthier lifestyle
and wise food choices. Now is the time to plan and
take small steps in the right direction.
(1) If you feel you need more information on good
nutrition during pregnancy, the American Dietetic
Association has a 96 page book called Pregnancy
Nutrition: Good Health for You and Your Baby that
will give you tips and checklists for developing a
health eating plan during pregnancy. The ADA
website is www.eatright.org.
(2) To get started on an exercise regimen, it is a
good idea to assess your current level of fitness and
design a personal plan that will move you in a
healthier direction at a pace that is suited to you.
You can do that by going to the Shape Up
America! "Members Only" section (you have to
become a member of Shape Up America! to do this,
but membership is free) so that you can visit our
online or "virtual" Fitness Center. You can also
purchase a pedometer (a good one should cost no
more than $30) and start a walking program with the
goal of building more steps into your daily routine.
Check out our 10,000 steps program on
www.shapeup.org to get started.
(3) The next thing to think about is whether you can
exclusively breastfeed your baby for the first six
months of your baby's life. If you work and won't
get much in the way of maternity leave, this goal
can be challenging and will take a great deal of
planning. Many women feel that breast pumps do
not always work very well, so it is important to do
some research to learn which models work the best.
If you are considering breastfeeding and want to
inform yourself, a visit to the website of La Leche
[www.lalecheleague.org] is one way to get started.
Besides providing your child with optimal nutrition,
one added benefit of exclusive breastfeeding that
your physician may not even know about is that it
promotes more rapid recovery of uterine muscle tone
and it burns maternal body fat.
(4) Once your baby is born and your breastfeeding
pattern is well established, you can consider a
moderate diet but don't go overboard. Weight loss
of more than 1 to 2 pounds per week might interfere
with your milk production.
(5) No matter what your weight is today, remember
that your own behavior (and not your weight per se)
is what counts. If you make a commitment to a
healthier lifestyle and wiser food choices, your
actions will speak louder than words.
4. Subcommittee on Nutritional Status and Weight
Gain During Pregnancy. Institute of Medicine of the
National Academy of Sciences. Nutrition During
Pregnancy. 1990 National Academy Press,
Washington DC, page 10.
