Overcoming Childhood Obesity:
The Lifecourse Framework
Rafael Pérez-Escamilla, PhD
Professor of Epidemiology & Public Health
rafael.perez-escamilla@yale.edu
YSPH Alumni Day
New Haven, June 1st 2012
Prevalence of High Weight for Recumbent Length Among US Children From
Birth to 2 Years of Age, 2007-2008a,b
14%
12.5%
12%
10.3%
10%
8.7%
8%
6%
4%
2%
0%
Ogden, C. L. et al. JAMA 2010;303:242-249
White
Black
Hispanic
The childhood obesity epidemic: Lifecourse framework
Pre-pregnancy BMI
A
Early childhood obesity risk
Gestational weight gain
Infancy weight gain rate
Post-partum weight retention
Suboptimal Infant feeding
Pérez-Escamilla & Bermudez (2012)
B
Neonatal
predisposition
Odds of each childhood obesity risk factor in black and Hispanic participants,
relative to white participants*
©2010 by American Academy of Pediatrics
*Odds ratios adjusted for maternal age,
education, parity, and prepregnancy BMI;
paternal BMI; household income; and
child gender..
Taveras E M et al. Pediatrics 2010;125:686-695
Social-ecological framework depicting the
multiple influences on what people eat
The childhood obesity epidemic: Lifecourse framework
Pre-pregnancy BMI
A
Early childhood obesity risk
Gestational weight gain
Infancy weight gain rate
Post-partum weight retention
Suboptimal Infant feeding
Pérez-Escamilla & Bermudez (2012)
B
Neonatal
predisposition
Integrate through 2015
Dietary Guidelines?
Recommendation: Multi-component
“lifecourse” indicator
proportion of women who:
• enter pregnancy with appropriate weight
• gain weight during gestation within
recommendations
• return to pre-pregnancy weight by 6 months postpartum
• breastfeed their babies exclusively for 6 months
• introduce nutritious complementary foods at 6
months
• continue breastfeeding until child is one year old