Early origins of obesity: developing strategies for intervention

Rates of obesity in childhood are rising rapidly, with potentially enormous implications for future health. Overweight is usually measured by relating weight to height using the body mass index (BMI). BMI tracks from childhood and as early as age five may predict future mortality. Thus childhood obesity seems to represent a time bomb that we ignore at our peril. On the other hand we know that that the majority of todays fat adults were not themselves overweight in childhood, other studies have found that thinness in early childhood may also relate to poorer adult health and we know that BMI is measuring build and lean mass as well as fatness. If we are to plan effective and safe interventions it is thus a matter of urgency that we find out more about which individuals in early childhood are truly fat and how this relates to feeding patterns, physical activity and family lifestyles.

The Gateshead Millennium Baby Study is already following 1029 children recruited at birth in 1999 and 2000 and we have information on feeding, growth and social circumstances from birth to 13 months. We will study these children again aged 6-7 years in order to collect a range of measures of fatness, build and muscularity and relate these to activity and diet information measured at the same time, as well as the infancy data we already hold. We will also find out how worried parents are about their childrens overweight and what sorts of preventive interventions they would potentially be willing to accept.

Rates of obesity in childhood are rising rapidly, with important implications for future health, but little is known about risk factors for childhood obesity, partly because body mass index (BMI) is both insensitive and non specific as a measure of fatness in childhood and because no-one has yet directly assessed the role of physical activity. There is thus a need for a new prospective cohort study which links specific measures of body fat to early risk factors for obesity and identifies important potentially modifiable correlates in the child and family, such as parental perceptions and attitudes and risk related health behaviours such as physical activity and diet.
The Gateshead Millennium Study recruited 1029 newborn babies who will be aged 6-7 years in 2006. Data are available on feeding behaviour, growth, social circumstances and feeding behaviour in the first year. The families are currently being re-contacted and parents will receive postal questionnaires about family circumstances, childhood behaviours including emotional and behavioural difficulties, and their childs eating and feeding behaviour. We expect to trace 80% of the subjects and plan that the work will be completed by April 2006.
This proposal is a new two stage study. In Stage One we will directly assess the children in school or via home visits. Measurements will include body composition (BMI, bioelectrical impedance, skin folds, waist circumference, body frame size), diet (FAST questionnaire), activity (accelerometry), and psychosocial factors in order to identify potentially modifiable risk factors in early life or current lifestyle which predict body fatness at age 6-7 years, as opposed to muscularity or large frame size. The study will also assess parental adiposity (BMI, bioelectrical impedance) and the relationship between this and their attitude to health related behaviours and levels of concern about adiposity in their child.
In the second stage of the study, key subgroups of parents will be invited to focus groups and interviews to explore perceptions of and attributions for adiposity and identify factors amenable to change. The work will inform the development of effective interventions designed to reduce risk exposure, influence health behaviour and reduce the number of new cases of childhood obesity.
The proposal will fund a project manager, two junior research associates, two research nurses and clerical support as well as lay observers in Newcastle, supervised by Dr Adamson, and a biostatistician in Glasgow working on the analysis with Dr Wright and Dr Reilly.