BMJ  2005;331:454 (20 August), doi:10.1136/bmj.331.7514.454

Letter

Early life risk factors for obesity in childhood

Authors' reply

EDITOR—Greenhalgh and Buchan et al focus on interpretation of our results and the implications for obesity prevention. We adjusted for maternal education because it influenced both the potential risk factors and the outcome (obesity). Greenhalgh highlights the importance of socioeconomic status, although all social groups have been affected by the obesity epidemic.¹ Targeting maternal education may be useful in obesity prevention, but there is currently no (maternal) educational or socioeconomic intervention that successfully prevents obesity in children.²

Buchan et al recommend early feeding factors as targets of obesity prevention initiatives. Our results do not rule out a role for infant feeding as a cause of obesity. Breast feeding was protective against later obesity in two out of three statistical models, but not in our final model for reasons discussed in the paper. Evidence for timing of introduction of complementary foods, derived from analysis of 21 potential risk factors in the entire sample, was inconclusive. A systematic review was not supportive of timing of introduction of complementary feeding as a risk factor,³ and it is unlikely that it could have operated via the other factors in our final model (birth weight, parental obesity, sleep, and TV viewing at age 3) as suggested by Buchan et al. However, a more detailed analysis of a wider range of early feeding factors would be desirable.

Preventive interventions for childhood obesity should meet certain criteria.^{4 5} At present, these criteria may be met by few strategies: promoting breast feeding, reducing sedentary behaviour, and reducing the consumption of sugar sweetened drinks. Future interventions are probably most likely to succeed if they target these behaviours. Attempting to modify timing of introduction of complementary feeding might be beneficial in other respects but seems premature as a strategy for obesity prevention at this stage.

jjr2y{at}clinmed.gla.ac.uk
University of Glasgow Division of Developmental Medicine, Yorkhill Hospitals, Glasgow G3 8SJ

University of Glasgow Division of Developmental Medicine, Yorkhill Hospitals, Glasgow G3 8SJ

Unit of Paediatric and Perinatal Epidemiology, Institute of Child Health, University of Bristol

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Competing interests: None declared.

References

1. Armstrong J, Reilly JJ, Child Health Information Team. Use of the national child health surveillance system for monitoring of obesity, overweight, and underweight in Scottish children. Scot Med J 2003;48: 32-7.
2. Reilly JJ, Wilson M, Summerbell CD, Wilson D. Obesity diagnosis, prevention, and treatment: evidence-based answers to common questions. Arch Dis Child 2002;86: 392-5.[Abstract/Free Full Text]
3. Parsons TJ, Power C, Summerbell CD. Childhood predictors of adult obesity: systematic review. Int J Obesity 1999;23(suppl 8): s1-107.
4. Whitaker RC. Obesity prevention in pediatric primary care: four behaviors to target. Arch Pediatr Adolesc Med 2003;157: 894-9.[Abstract/Free Full Text]
5. Reilly JJ. Physical activity and obesity in childhood and adolescence. Lancet (in press).

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