Attempts to treat established obesity in adulthood may be too late to have important impacts on disease prevention or health improvements as there is evidence that obesity in children and adolescents has already resulted in long-lasting metabolic and vascular abnormalities, write Dr Debbie Lawlor (Bristol University) and Dr Nish Chaturvedi (Imperial College, London) .

They argue that targeting the prevention of obesity during key periods of a child's development could be the way to reduce subsequent risks of adult obesity and associated chronic disease.

The perinatal period and puberty/adolescence could be two critical periods during which interventions might have long-term effects.

There is increasing evidence that intrauterine over-nutrition predicts life-long obesity. High maternal glucose, free fatty acid and amino acid plasma concentrations result in over-nutrition of the foetus which, through permanent changes in appetite control, neuroendocrine functioning or energy metabolism in the developing foetus, leads to obesity in later life. Strict glycaemic control during pregnancy could held to prevent this.

Adolescence may also offer a unique opportunity to modify the risk of future obesity, perhaps via short-term interventions as behaviours such as dietary patterns and levels of physical activity are largely formed in adolescence and persist into adulthood.

Dr Lawlor said: "New behavioural, environmental and pharmacological approaches for the prevention and treatment of obesity in children are needed. However, the epidemic of childhood obesity is unlikely to be resolved without concerted political action."

Debbie A Lawlor and Nish Chaturved: Commentary: Treatment and prevention of obesity are there critical periods for intervention? Int J Epidemiol., doi: 10.1093/ije/dyi309

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Contact: Hannah Johnson
hannah.johnson@bristol.ac.uk
44-117-928-8896
University of Bristol
1-Feb-2006