Get in early

Every week seems to bring another headline about Britain’s
obesity epidemic. And with good reason. The number of obese 15 year
olds has doubled over the past two decades. Children who are obese
are more likely to be obese as adults, with all the risks to health
this brings. Government concern about these statistics has led to a
flurry of activity aimed at preventing obesity, such as including
more sport on the curriculum and providing healthier school
lunches.

Many have welcomed these measures as sound preventive policies.
However, if we’re really going to tackle obesity we need to
intervene earlier. Obesity among pre-school aged children has
increased at an even greater rate than among school-aged children,
trebling from 3 per cent 20 years ago to 9 per cent in 2004. It is
becoming increasingly clear that nutrition and diet during the very
earliest stage of a child’s life – pregnancy and the first
year – is an important factor behind this problem.

We’ve known for some time now that low birth weight babies
are more likely to die in their first year, have disabilities and
hospitalisations as children, and suffer from illnesses as adults
including heart disease and diabetes. Studies now show they are
also more likely to become obese. It seems that babies deprived of
adequate nutrition in the first two trimesters of pregnancy respond
by enlarging their nutrient gate. This can translate to overly
rapid weight gain after birth, and throughout life.

Breastfeeding decreases the incidence and severity of a range of
childhood infections and allergies, and has also been linked to
healthy brain development. Research has shown that babies breastfed
for a year or longer are five times less likely to be obese by the
time they start primary school than their bottle-fed peers. Low
birth weight babies are at particular risk of obesity if they are
bottle-fed. Bottles deliver more calories than breast milk and
formula milk is less digestible, leading to weight gain that is too
rapid.

Most practitioners and parents know that breast is best for
babies. Far fewer understand the importance of effective weaning.
Introducing high-carbohydrate, sugary foods like cereal and juice
too early may lead to a process called “metabolic programming” –
where the metabolism slows down so that it takes longer to burn
calories, thereby increasing the chances of weight gain. Nearly
half of mothers introduce solids before their baby is four months
old, when the recommended minimum age is six months. Keeping a baby
on a diet of mainly formula milk for too long can also lead to
excessive weight gain. Formula milk supplies too high a level of
calories after a baby’s first birthday, and is also lacking
in several key nutrients, like iron.

Poverty is a key factor underlying all these issues. Babies born
to mothers in social class V are 60 per cent more likely to be low
birth weight than babies born in social class I. Nine out of 10
mothers in social class I initiate breastfeeding compared with just
over half in social class V. Weaning is also affected by poverty.
Families living on a low income may find it cheaper to continue
bottle feeding their babies than to start weaning them onto solid
food. A study in the most deprived wards in Peterborough found that
half of children had a primarily milk-based diet at the age of 21
months.

A lack of practical information and advice about good nutrition
during pregnancy and the first year of a child’s life is
another important issue. For example, the high-sugar, high-salt
diets that many adults eat are completely unsuitable for babies,
but so too are the high-fibre, low-fat diets that are usually
recommended for adults. A healthy weaning diet for babies should be
rich in fruit and vegetables, as well as protein and unsaturated
fats.

So what should be done to tackle these problems? Firstly,
financial support for low income families should be increased
during pregnancy. This could be done by providing a pregnancy
premium for families on income support or by introducing a
pregnancy tax credit so that women can start claiming child tax
credit when they are pregnant. Another option would be to increase
financial support in kind. Healthy Start (which is set to replace
the Welfare Food Scheme) will provide low-income pregnant women and
new mothers with vouchers to buy fruit and vegetables as well as
milk and infant formula. However, women will only receive vouchers
worth £2.80 a week. This is far too little when a modest but
adequate diet during pregnancy costs around £20 a week.

Secondly, pregnant women and new parents need better information
about healthy nutrition during pregnancy and their children’s
early years, including breastfeeding. This isn’t simply a
matter of providing women with leaflets or telling them what to do
– it means providing practical help and advice. Sure Start and
children’s centres provide an excellent model for delivering
this support, with midwives and health visitors working alongside
other professionals and voluntary groups in a community
setting.

Pregnancy and the first year must be taken seriously in the
fight against child obesity, or yet more babies will grow into
unhealthy, unhappy children.

Jenny North is policy officer at the Maternity
Alliance.

Tips for practitioners

• Midwives and Sure Start workers should target pregnant women
  who are likely to have a poor pregnancy diet with advice and
  support about their food choices.
• Provide support for particular client groups on cooking and
  eating healthily.
• Advise disadvantaged pregnant women and new mothers about how
  to claim benefits they are entitled to, including through the
  Welfare Food Scheme (which will become Healthy Start).
• Midwives and health visitors to set up peer support groups,
  where women who have breastfed or weaned successfully can provide
  help and advice to other new mothers.
• Ensure through training and information that GPs, midwives,
  health visitors and Sure Start workers routinely advise and support
  new parents on effective weaning, taking into account cultural
  issues, lack of income, and lack of knowledge about food
  preparation and nutrition.