Photo Credit: iStock.com/ELENA BESSONOVA

Ihuoma Eneli, MD, MS, discusses early intervention in childhood obesity to reduce long‑term risk and supporting families with tailored, accessible care.

Rapid weight gain in early childhood is a risk factor for obesity. Despite this, there’s a lack of obesity prevention programs and interventions that target early childhood, defined as the first 1,000 days. In a commentary published in Pediatrics, researchers highlight the need for more obesity prevention trials in early childhood.

In the callout, Richard E. Boles, PhD, and Ihuoma Eneli, MD, MS, identify major risk factors for infant and early childhood weight gain that are prevalent during pregnancy and in the first 1,000 days of childhood.

During pregnancy:

• High pre-pregnancy weight
• Excessive gestational weight gain
• Gestational diabetes
• Epigenetic programming of the fetus during pregnancy

During the first 1,000 days of childhood:

• Feeding behaviors that neglect the infant’s hunger and satiety cues
• Social and environmental factors such as low socioeconomic status
• Early adiposity rebound

The callout also highlights multiple best practices for preventative care, including implementing the Starting Early Program (StEP), a care protocol starting in the third trimester and ending when the child is 33 months old. Past evidence suggests StEP is highly effective for reducing childhood obesity, though the benefits are better sustained when families attend most or all StEP sessions. In the article, the researchers note that a minimum of 26 contact hours with the family is required for optimal prevention.

Dr. Eneli spoke with Physician’s Weekly (PW) about these prevention programs and ways that pediatricians can help reduce weight gain in early childhood.

PW: How can early obesity prevention improve the future of pediatric care?

Ihuoma Eneli, MD, MS: Childhood obesity is associated with physical and psychosocial comorbidities that negatively affect the child’s health and quality of life. In addition, obesity in childhood often persists into adulthood`. The likelihood of persistence increases with the child’s age; for example, an adolescent with obesity has a higher risk of having obesity as an adult compared with a young child. Thus, preventing obesity offers the best opportunity to avoid these adverse outcomes.

The StEP program showed initial success, but effects weren’t sustained long-term. What modifications would you recommend to clinicians?

This starts with recognition that obesity is a chronic disease. When a child has risk factors but has not developed the disease, we must continue to provide preventive care and support for the family and appropriately match intensity and dose of the intervention. We also need to pick up on when a child is gaining weight rapidly or crossing percentiles so we can intervene earlier. However, we cannot overlook systemic factors, such as access to care, socioeconomic status, neighborhood safety, or walkability, that make it more challenging for some individuals to maintain a healthy weight.

How can programs be structured to maximize family participation?

In my experience, the first step is to create a safe space that avoids blame and shaming. I have found explaining the pathophysiology of obesity (eg, the role of biology, genes, and systemic risk factors), addressing the lived experience related to weight bias, individualizing the intervention to match the child’s family needs, and focusing on building the patient/family agency for change helps with engagement. It is also important that the patient feels this intervention can help them with this problem (ie, how they perceive the response efficacy of the intervention).

How can clinicians improve access to childhood obesity interventions?

The 2023 American Academy of Pediatrics (AAP) Clinical Practice Guidelines has a section that discusses different approaches (eg, virtual visits, including allied providers, thinking about community programs, etc.). There are also free materials available from the AAP that a clinician can download to help them with implementation. The AAP published a statement on prevention; if you haven’t seen that, it may be worth looking at.

How can clinicians assess and enhance families’ social support networks as part of obesity prevention efforts?

This can be challenging, but it starts with assessment during the visit of the social history for the child. Asking those questions helps me and the parent to become aware of their level of social support, plus the strengths and the gaps. The clinician can then problem-solve with the parents, using motivational interviewing skills, about how it can be enhanced. Another way is to identify resources in your neighborhood and have those resources to share. The child’s school network is a great place to start. Clinicians can also lean on social workers or community health workers if they are available. They are a wonderful resource.

How would you recommend clinicians prioritize and allocate potentially limited prevention resources?

I believe in being pragmatic about what can help and using shared decision making. As pediatricians, we are also advocates for the children in the community, thinking outside the box about advocacy-related activities such as sharing expertise in community and with legislators & government agencies. It really does take a village. I see prevention working if we work together and have different programs in a variety of settings that have consistent messaging.