In a world-first prospective meta-analysis, we found that early obesity prevention interventions resulted in a modest reduction in body mass index (BMI) z-score and improved weight-related behaviours at 1.5 to 2 years of age.1 Yet, there is little evidence regarding the longer term effects (i.e. sustainability) of such interventions for the prevention of childhood obesity.
We aimed to determine whether these intervention benefits were sustained at 3.5 and 5 years of age.
Follow-up of the Early Prevention of Obesity in Childhood (EPOCH) individual participant data (IPD) prospective meta-analysis (PMA) of four randomised controlled trials comprising 2196 mother-infant dyads. The trials were conducted in Australia or New Zealand, and evaluated the effectiveness of childhood obesity prevention interventions commencing in late pregnancy or within 6 months of birth and ending before two years of age. Interventions comprised support and education for weight-related behaviours and controls received standard care. The pre-specified primary outcome was BMI z-score initially measured at 1.5-2 years and followed up at 3.5 years and 5 years of age. Secondary outcomes included prevalence of overweight/obesity, waist-to-height-ratio, dietary intake, feeding practices, physical activity, television viewing, sleep, and parenting practices.
Positive initial intervention effects on BMI z-scores at 1.5-2 years of age disappeared by 3.5 years of age (-0.04 adjusted mean difference, 95% CI, -0.14 to 0.06, p=0.424), and 5 years of age (0.03; 95% CI, -0.08 to 0.14, p=0.60). While intervention benefits remained for some weight-related behaviours at follow-up (feeding practices, television viewing), these effects diminished over time.
In the absence of continued intervention, initial positive effects of early childhood obesity prevention interventions were not sustained. This suggests a life-course approach involving frequent complementary interventions across childhood is needed to address the major public health problem of obesity and sustain effects of early interventions.