Newswise — The key to preventing obesity in future generations is to make their parents healthier before they conceive, leading health researchers suggest.
In a series of papers, published in The Lancet Diabetes and Endocrinology, the researchers say that the time before couples conceive represents a missed opportunity to prevent the transmission of obesity risk from one generation to the next. They argue that a new approach is needed to motivate future parents to live a healthier lifestyle.
There is now a wealth of evidence that the risk of obesity and its associated conditions, such as heart disease diabetes and some cancers, could impact the developing baby. In turn, when the child becomes a young adult they may pass the risk of obesity on to their children – it is a vicious cycle.
The nature of this problem is not adequately appreciated. Many young people, whilst appearing outwardly healthy, are nonetheless on a risky path to obesity and chronic disease and more likely to pass this risk to their children, the researchers warn. Many pregnancies are unplanned, and the special needs of adolescents and young people at this important time are not sufficiently recognised. Far from helping them to prepare and plan for pregnancy and parenthood, many public health programmes assume that their needs are similar to the general population and require no special measures or provisions.
In a comment piece accompanying the research papers, Professor Mark Hanson of the University of Southampton, says an entirely new approach is needed that engages parents-to-be and encourages them to be part of the solution.
“The approach needed is both top-down and bottom-up, but even more importantly requires something in between which young people can help to create themselves,” Professor Hanson writes.
“If at present many young people do not seem to care about their health or view it as a low priority, perhaps they have not been given clear information about what they can do to optimise their health for themselves and their children. All societies owe their adolescents the chance to make their future healthier. Additionally, the political leaders who have committed to the new Global Strategy for Women’s, Children’s and Adolescents’ Health must give adolescent health priority in national health strategies, plans, and budgets. Only these actions will enable the transformation required.”
The Lancet Diabetes and Endocrinology series on Maternal Obesity was launched at the Power of Programming 2016 conference in Munich today (13 October).
Each of the four papers in the Series tackles a different aspect of the challenge. The first paper (Poston et al.) explores trends in the global prevalence of obesity among women and the adverse consequences for their reproductive health and the outcome of their pregnancy, especially in those countries least able to accommodate associated health-care costs. The authors call for larger studies to determine the scale of complications in these countries, which may not be prepared to manage the increasing burden on healthcare resources, and for an international drive to reduce obesity in women of reproductive age.
The second paper (Ma et al.) focuses on the clinical management of women with obesity, especially during pregnancy when the risks of conditions such as pre-eclampsia, high blood pressure and gestational diabetes are major concerns. There are also consequences for the baby, with greater risks of stillbirth, obstructed labour and congenital abnormalities. Clinicians are increasingly realising that the problems of obesity can manifest even in early pregnancy, again directing attention to addressing the problem before conception and between pregnancies.
The third paper (Godfrey and Reynolds et al.) explores the range of effects that maternal obesity can have on the child including greater adiposity (fat tissue), increased risk of allergies and effects on brain and behavioural development, such as autism and ADHD. The authors discuss the results of studies into the mechanisms linking maternal obesity to these adverse outcomes in their children, particularly epigenetic processes by which aspects of parental (both mothers and fathers) lifestyle can affect the way the baby’s genes operate during development. These can change the person’s responses to the challenges of, for example, living in an ‘obesogenic’ environment.
The final paper (Hanson et al.) suggests that the focus of interventions needs to be redirected to the preconception or post-partum periods of parents’ lives. This requires a top-down approach from policy makers and service providers to improve the opportunities for young people, especially those in at risk groups, to lead healthier lives. But this alone may not be enough, the experts say. In addition, there is a need for a broader social movement that generates bottom-up mobilisation of communities and individuals, to create a demand for such services and opportunities. Engaging future parents in leading healthier lives will not only promote their health later, but will give their children a healthier start to life.
ENDS
Notes to Editors
1. Copies of the commentary and the papers in the Maternal Obesity Series are available from Media Relations upon request. Once the embargo lifts, the Series will be available at: http://www.thelancet.com/series/maternal-obesity
2. Paper references are below accompanied by supporting quotes from lead authors.
Obesity and the health of future generations. Mark Hanson, Peter Gluckman, Flavia Bustreo. http://dx.doi.org/10.1016/S2213-8587(16)30098-5
Preconceptional and maternal obesity: epidemiology and health consequences. Lucilla Poston, Rishi Caleyachetty, Sven Cnattingius, Camila Corvalán, Ricardo Uauy, Sharron Herring, Matthew W Gillman. http://dx.doi.org/10.1016/S2213-8587(16)30217-0
Lead author Professor Lucilla Poston, Head of Division of Women’s Health at King’s College London, said: “Most women with obesity who intend to conceive are not aware of the risks of infertility or complications. Obesity challenges the health of the mother and has much wider and long-lasting consequences than are generally appreciated by either health professionals or women themselves. A pragmatic solution is required on a global scale, particularly in low-income and middle-income countries where we see a rapidly rising problem.”
Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum. Ronald Ching Wan Ma, Maria Ines Schmidt, Wing Hung Tam, Harold David McIntyre, Patrick M Catalano. http://dx.doi.org/10.1016/S2213-8587(16)30278-9
“Obesity has significant impact on reproduction for women of child-bearing age,” said Professor Ronald Ma, Professor at the Department of Medicine and Therapeutics, The Chinese University of Hong Kong. “Obesity is associated with reduced fertility, and pregnancies complicated by maternal obesity have higher risks of different complications, including a two to four fold risk of gestational diabetes, as well as increased risk of elevated blood pressure, preterm birth, caesarean deliveries, infections and bleeding, which make the medical and obstetric management of the obese woman particularly challenging.” He also remarked that some of the changes are present from early pregnancy, hence “reducing maternal obesity before conception is perhaps the best strategy forward.”
Patrick M. Catalano, MD, the Dierker-Biscotti Women's Health and Wellness Professor and Director of the Center for Reproductive Health at MetroHealth and Director of the Clinical Research Unit of the Case Western Reserve University, commented: “The management of obesity in pregnancy begins before, during and after pregnancy. Lifestyle modifications of healthy eating, physical activity and behavioral modifications during pregnancy have had limited benefits on improving adverse perinatal outcomes, with the exception of reducing excessive gestational weight gain, on the average of ~1.5 kg in obese women. There is limited evidence based data on how best to mitigate adverse metabolic effects of obesity on mothers (spontaneous miscarriage, gestational diabetes, preeclampsia and need for cesarean delivery) and their offspring (congenital anomalies, neonatal adiposity and risk for childhood obesity) once a woman is pregnant. Basic questions as to what is the optimal diet or weight gain during pregnancy need to be addressed. In the interim, until a comprehensive potentially personalized life-course approach is instituted, efforts during pregnancy will by necessity be aimed at recognizing and mitigating the adverse metabolic consequences of maternal obesity during pregnancy on both the mother and her child.”
Influence of maternal obesity on the long-term health of Offspring. Keith M Godfrey*, Rebecca M Reynolds*, Susan L Prescott, Moffat Nyirenda, Vincent W V Jaddoe, Johan G Eriksson, Birit F P Broekman. http://dx.doi.org/10.1016/S2213-8587(16)30107-3 Professor Keith Godfrey, Director of the NIHR Southampton Biomedical Research Centre in Nutrition at the University of Southampton, commented: “It is widely recognised that obesity in pregnancy impacts on the woman’s own health, putting her at greater risk of gestational diabetes and a range of pregnancy complications. What is only now becoming clear is that maternal obesity also places the offspring at risk, particularly of developing childhood obesity and associated disorders in later adulthood, including coronary heart disease, stroke and type 2 diabetes. Maternal obesity may also increase the child’s risks of asthma and neurodevelopmental disorders including cerebral palsy, and there is increasing evidence it can lead to poorer cognitive performance in the offspring. As a result, the long-term effects of maternal obesity have profound public health implications. There is now an urgent need for studies to define the underlying mechanisms and to identify effective interventions to reverse the epidemic of obesity in women of child-bearing age and to mitigate its consequences for the offspring.”
Professor Rebecca Reynolds, Director of the BHF Centre for Cardiovascular Science, University of Edinburgh, said: “Pregnancy offers a unique opportunity to impact on health of the mother, her children and potentially her grandchildren. With the rising prevalence of obesity among women of reproductive age, we now need more studies to investigate mechanisms so that we can design effective intervention strategies.”
Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Mark Hanson, Mary Barker, Jodie M Dodd, Shiriki Kumanyika, Shane Norris, Eric Steegers, Judith Stephenson, Shakila Thangaratinam, Huixia Yang http://dx.doi.org/10.1016/S2213-8587(16)30108-5
Mark Hanson, who is Director of the Institute of Developmental Sciences and British Heart Foundation Professor at the University of Southampton, said: “We won’t stop the seemingly relentless rise in obesity in any country unless we adopt a life course approach to prevention. It’s no good waiting to intervene until children, let alone adults, become obese. We need to prevent the risk of obesity before the next generation is born, probably even before they are conceived. Helping today’s young people, many of whom are already on a risky path to obesity, to have healthier lifestyles will not only benefit them in the future but can save their future children from obesity too. There is no single solution – tax on sugar, limiting advertising of unhealthy snacks, etc. – we need to attack the problem on many fronts. To move forward, we need a concerted ‘top-down’ approach from governments and healthcare professionals to provide joined-up services for young people; but we also need a ‘bottom-up’ initiative which engages young people themselves in demanding such services. They are the future – don’t they deserve better than a life sentence of obesity?”
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For more information:
Becky Attwood, Media Relations, University of Southampton, Tel 023 8059 3212, email [email protected] twitter beckyattwood07
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