Diabetes 2013 Aug-6


A narrative literature review of the development of obesity in infancy and childhood


Journal of Child Health Care (2012) 16(4): 339-354

Sally Robinson and Katie Yardy, Canterbury Christ Church University, Canterbury, UK.

Victoria Carter, National Health Service, Medway, UK



This narrative review explains the development of excess weight gain in babies and children. It takes a life course approach which includes genetics, pre-conception, pregnancy, infancy and childhood. The paper focuses on feeding behaviours, physical activity, parental influences and the wider social and environmental context. Risk factors which can cumulatively lead to excess childhood weight gain include: under or over weight during pregnancy; the presence of diabetes during pregnancy; low or high birth weight; having obese parents; early weaning; prolonged formula feeding; rapid weight gain in the first year; disinhibited eating patterns and the consistent availability of energy dense food at home; feeding practices which are not responsive to the child’s cues; insufficient sleep among pre-school children; sedentary parents; low parental education; living in poor socio-economic circumstances; absence, or perceived absence, of safe play areas; parents who lack time or confidence to authoritatively parent; environments where there is poor access to affordable lower energy dense foods; and parents who do not accept that excess weight is a health problem. Recommendations for health professionals are made.



Risk factors for excess weight gain and Recommendations for health professionals


Risk factors for excess weight gain in babies and children

Recommendations for health professionals

Overweight or underweight during pregnancy. High or low birth weight. Encourage a healthy pre-conception and pregnancy weight and smoking cessation for all.
Presence of diabetes during pregnancy. Explain how the presence of diabetes is a particular risk factor during pregnancy.
Obese parents. Note whether a child has lean or obese parents.
Teenage and/or single mothers and those living in deprived circumstances who might need additional support with breastfeeding. Support mothers with breastfeeding up to six months, with particular attention to teenage or single mothers.
Early weaning and prolonged formula feeding. Support breast-friendly initiatives.
Rapid weight gain in first year. Note rapid weight gain during the first year.
Parents who perceive that an overweight child is a healthy weight. Parents who don’t believe that excess weight can be a health risk. Provide education about healthy weight for age and sex.
Parents who eat in a disinhibited way and a family eating pattern of disinhibited eating. Inactive, sedentary parents. Encourage a whole-family approach towards reducing disinhibited eating and reducing sedentary behaviour.
Homes where there is a constant supply of energy dense food. Provide education about energy dense foods and alternatives, being mindful of cost, practicality and availability.
Parents who lack time and/or confidence in themselves to authoritatively parent. Parents who overly restrict their children’s food or pressurize children into eating, perhaps insufficiently responsive to cues from children. Provide support and guidance about authoritative parenting and authoritative-responsive feeding.
Pre-school children having insufficient hours of sleep, possibly associated with higher or later hours of watching television. Emphasise the importance of sleep, especially for pre-schoolers.
Low parental education. Families of lower income. Be aware that low parental education and living in poor socio-economic circumstances are risk factors for childhood obesity, and that therefore these families might need to be given particular attention.
Families who live in urban areas without affordable and safe play areas. Families who are unaware of appropriate space for play and activity. Research the local environment to identify affordable and safe play areas and sources of good value non-energy dense food. Lend support to initiatives to increase the opportunities for affordable, safe play and affordable sources of non-energy dense food.
Families who live in areas where there is poor availability of affordable food of lower energy density such as fruit and vegetables. Research the local environment to identify affordable sources of good value non-energy dense food. Lend support to initiatives to increase the opportunities for affordable sources of non-energy dense food.
  Take responsibility for own professional development by seeking out guidance from local nutritionists, dieticians, health improvement and public health practitioners.
  Check that educational opportunities, such as ante-natal classes and one-to-one consultations, are regularly updated, underpinned by the latest evidence and tailored towards local, family or individual needs.


Dr Sally Robinson leads the health promotion and public health team at Canterbury Christ Church University. She is particularly interested in the promotion of children’s health and wellbeing. http://canterbury.academia.edu/SallyRobinson

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