Читать книгу Clinical Obesity in Adults and Children - Группа авторов - Страница 63

In summary, strong evidence has identified a number of early life experiences that predict later obesity risk. However, we should be cautious about directly translating these observational associations into recommendations for public health or clinical practice, especially for exposures related to weight, weight gain, or growth. Beyond the general concern that it is difficult to fully eliminate confounding from observational studies, exposures such as “maternal obesity” or “fetal growth” do not directly map to a target trial. For some of the exposures discussed above, including maternal diet quality or smoking, one might imagine the intervention trial that would mimic with our observational analysis – for example, advice to stop smoking or not to consume sugary beverages during pregnancy. However, there are many likely paths that lead to, for example, maternal obesity entering pregnancy. Even if maternal obesity is a strong, consistent predictor of offspring obesity independent of likely confounding factors, we don’t know when and how we might intervene to interrupt this link. Should we act on the woman’s diet quality, her overall caloric intake, her physical activity, or all of these, and which would be most effective? Should the intervention occur 1 month, 1 year, or 10 years prior to conception? Because of these many complexities in a causal interpretation of weight‐related exposures, we should think of many of these factors as risk markers rather than causal risk factors.

Despite these considerations, we can use this knowledge to identify children at higher risk for subsequent obesity. We, therefore, encourage providers caring for children to take a complete health history going back to the prenatal period. Those caring for women should encourage dietary habits that will support long‐term health for the woman and may also benefit her offspring. Providers should work with women to help them enter pregnancy at optimal weight and with any chronic health conditions identified and in good control.

The evidence summarized above suggests that interventions promoting healthy diet and behaviors can redirect trajectories, especially if they begin early. Furthermore, because it is challenging for individuals to maintain healthful behaviors in the face of social and cultural pressures, we support policies that help limit exposures to likely obesogens. Examples include supporting smoke‐free public spaces, restricting the availability of sugary beverages in child care and school settings, and reducing exposures to toxic chemicals. It should also be remembered that the children of today will be the parents of tomorrow, and so improvements in obesity risk factors might benefit more than one generation.