Preventing Childhood Obesity: A Two-pronged Approach Starting in Pregnancy and the First Year Postpartum
Condition: Childhood Obesity; Excessive Weight Gain in Pregnancy With Baby Delivered; Dietary Modification; Healthy Lifestyle Habits
MeSH terms: Obesity; Pediatric Obesity; Weight Gain
Study type: Interventional

Summary: 
      Our longitudinal aim is to reduce childhood obesity using our two-pronged intervention
      program, which includes healthy food choices and increased physical activity initiated during
      pregnancy and re-instated in the early period after delivery for overweight and obese women.
      We will accomplish this with our family-based Nutrition and Exercise Lifestyle Intervention
      Program (NELIP) to promote healthy family living. An intervention targeting school-aged
      children on the importance of healthy lifestyles occurs too late to prevent childhood obesity
      and establish lifelong healthy body weights. To break this spiraling cycle of generations of
      unhealthy body weights in Canadian children, and to reduce the risk of future obesity-related
      health problems, it is necessary to prevent excessive pregnancy weight gain, high blood
      sugars in the mother and to promote a healthy lifestyle during pregnancy and early post
      delivery. With our NELIP team as a cornerstone, and our pilot data already collected with
      promising results, we foresee an opportunity over the next 3 years to contribute to changing
      patient care with emphasis on disease prevention and healthy family lifestyle initiation
      early in life to reverse the trend of childhood obesity. With a solid research-based
      initiative from the lab to the community by educating health care providers, future health
      care can be improved by putting prevention-based programs into practice.

      Healthy women = healthy babies = healthy families = healthy futures!!
    

Detailed description: 
      Overweight and obesity have been identified as major neglected public health issues, as the
      prevalence of unhealthy body weights is increasing world-wide at an alarming rate. There is a
      robust link between the fetal environment and its long-term influence on health and
      susceptibility to future chronic disease in the offspring. Obesity begets obesity, and an
      unhealthy maternal metabolic state can have a profound influence on the risk of early obesity
      development in the child. Excessive pregnancy weight gain and high pre-pregnant body-mass
      index (BMI) have been linked to gestational diabetes (GDM) and macrosomic infants (birth
      weight >4.0kg. Since much of the influence of the intrauterine milieu is transmitted to the
      next generation non-genetically, potentially deleterious effects can be reversed and
      prevented. An intervention targeting school-aged children on the importance of healthy
      lifestyles occurs too late to prevent childhood obesity and establish lifelong healthy body
      weights. To break the spiralling cycle of generations of unhealthy body weights in Canadian
      children, and to reduce the risk of future obesity-related health problems, it is imperative
      to prevent excessive pregnancy weight gain, GDM and to promote a healthy prenatal and early
      postnatal lifestyle.

      Reversing the obesity epidemic will involve a lifetime of effort by the medical and research
      communities, however, over the next 3 years, we believe that we may contribute to the
      solution by using a two-pronged approach by first targeting pregnant overweight and obese
      women with a healthy lifestyle approach called the Nutrition & Exercise Lifestyle
      Intervention Program (NELIP) combined with a Family-based Behavioural Treatment (FBBT) that
      will prevent excessive weight gain and GDM, and promote a healthy fetal environment. The
      second prong will use this healthy lifestyle (NELIP+FBBT) approach starting at 2 months
      postpartum continuing to the first year, to minimize postpartum weight retention, encourage
      breastfeeding, and promote a healthy family lifestyle.

      Primary objectives are:

        1. To prevent excessive pregnancy weight gain and GDM in order to decrease the incidence of
           macrosomia and large for gestational age babies

        2. To prevent weight retention postpartum and encourage healthy infant feeding practices in
           order to decrease the risk of developing obesity during the first year of life.

      Secondary objectives are:

        1. To track pregnancy weight gain and postpartum weight loss, gradually reducing body
           weight as needed (0.5 kg per week) to achieve and maintain a healthy body weight in the
           mother

        2. To track birth weight and infant growth within the first year of life (at 2, 6 and 12
           months), including body weight, height, BMI, and body fatness, using the World Health
           Organization growth charts as a standard.

      Currently, the R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab at the University
      of Western Ontario is the only research laboratory in North America actively investigating
      metabolic changes in exercising pregnant and postpartum women. Our longitudinal aim is to
      reduce obesity, and chronic disease risks (such as diabetes) in the offspring of overweight
      and obese women using our two-pronged intervention program, which includes healthy food
      choices and increased physical activity (NELIP and FBBT) initiated during pregnancy and
      reinforced in the early postpartum period. With our NELIP team as a cornerstone, and our
      pilot data already collected, we foresee an opportunity over the next 3 years to contribute
      to intervention strategies and patient care with emphasis on disease prevention and healthy
      family lifestyle initiation early in life to reverse the trend of childhood obesity. With a
      solid research-based initiative from the lab to the community by knowledge translation to
      health care providers, future health care costs can be reduced by putting prevention-based
      programs into practice.
    

Intervention name(s): Nutrition & Exercise Lifestyle Intervention Program (NELIP)
Intervention type(s): Behavioral
Intervention description(s): Nutrition- individualize total energy intake with a minimum of 2000 kcal/day with a restriction of not more than 33% total energy intake, total carbohydrate of 40-50% total energy intake, total fat intake of 30% of total energy intake (substituting monounsaturated fatty acids for saturated and trans-fatty acids), and approximately 30% dedicated to protein intake.
Exercise-25 minutes of walking per session, 3-4 times per week, each subsequent week increasing by 2 mins to a maximum of 40 mins/session.
Family-based Behavioural Treatment (FBBT) Coupled with the individualized NELIP for each woman, FBBT will be presented in 3 group sessions (including family members), focussing on strategies to make healthy lifestyle choices with behavioural strategies.
Other intervention name(s): NELIP; FBBT
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: pregnancy; intervention; exercise; nutrition; infants