Introduction

Over the past four decades, the global prevalence of childhood obesity has increased exponentially¹, with 37 million children under the age of five being overweight or obese². Being overweight or obese in the early years of life has been shown to increase the risk of developing a number of early diseases such as asthma, coronary heart disease, type 2 diabetes mellitus, osteoarthritis, some cancers and others^{3), (4}, and is responsible for 2.6 million deaths each year⁵. Preventing childhood obesity is therefore a priority⁶.

Early life is a critical period for the development of obesity. International child health organizations have developed guidelines and recommendations to prevent, control and reduce obesity during the first 1000 days⁷ - a crucial period of human development from conception to 2 years of age⁸. These recommendations aim to implement evidence-based interventions that comprehensively address key modifiable risk factors during the prenatal and postnatal stages to prevent childhood obesity^{9), (10}. It is, therefore, important to identify the types of interventions that have been implemented to prevent childhood obesity in the first 1000 days and whether they have evidence of effectiveness.

Previous systematic reviews have assessed interventions in these stages and found promising results; however, the prenatal or postnatal stages have been considered indistinctly^{11), (12}, so this review sought to assess only those interventions that considered both stages of development, as the evidence mentions the importance of considering the first 1000 days in a comprehensive way⁹. Therefore, the aim of this scoping review was to identify and characterize the interventions implemented in the first 1000 days (considering the prenatal and postnatal period together) for the prevention of overweight and obesity. The information gathered can serve as a guide for health care providers and researchers looking for opportunities to implement interventions aimed at preventing childhood obesity.

Materials and Methods

This a registered scoping review^{13), (14}, which used the 5 stages of Arksey and O'Malley's methodological framework¹⁵.

Research question identification

What international evidence exists on interventions that address the first 1000 days of life with the objective of preventing overweight and obesity in children under two years of age?

What are the characteristics of interventions that have been effective in preventing overweight and obesity in children under two years of age at the international level?

Relevant studies

In January 2023, a systematized search was conducted in the SCOPUS, EBSCOHost and PubMed databases, focused on the pre-established inclusion criteria and using the Medical Subject Headings (MeSH) vocabulary descriptors ofthe U.S. National Library of Medicine MeSH that included the words: Infancy, infants, first 1000 days, preventive measures, prevention, control, intervention, overweight, obesity, body weight, pediatric obesity, randomized controlled trial, clinical trial randomized, systematic review.

Study selection

Criteria: Systematic reviews of randomized clinical trials and/or articles documenting a single randomized clinical trial; published between 1 January 2012 and 31 December 2022; interventions should consider the first 1000 days and focus on obesity prevention in children aged 0-2 years; with weight or BMI z-score by age as the primary outcome to homogenize and contrast studies; no language restriction. Non-systematic literature reviews, protocols, grey literature and pre-prints were excluded.

Charting the data

The PRISMA-ScR extension framework was used to extract the information. The information was recorded independently by two of the authors using a form.

Comparing, summarizing and communicating the results

The interventions were identified and summarized according to the patterns found in the extracted information¹⁵. The database was stored in Mendeley Data¹⁶.

Ethical aspects

The review studies do not require ethics committee approval, but scientific rigor was essential in their realization.

Results

For interventions reported in systematic reviews, a total of 387 references were identified after removing duplicates; 378 were excluded based on title and abstract, leaving a total of 9 articles to be assessed in full text. The search was supplemented with a strategy to identify randomized clinical trials of individual interventions, of which 5 were excluded because they did not meet the criteria, and the remaining 9 trials were considered eligible. The total number of articles included in both searches was 14, comprising 10 interventions^{17), (30}. See Figure 1.

In order to answer the research questions, the corresponding articles were reviewed, and the results were categorized along three main dimensions: characteristics ofthe study population, characteristics of the intervention design, general characteristics and outcomes of effective interventions.

Study population characteristics

All interventions were carried out in high-income countries, none in middle- or low-income countries. Participants were women aged over 18 years from low socioeconomic backgrounds. Four of them belonged to the Latino subcultural group, one to the African American group, and the rest were not specified (n=5). Half of the interventions (n=5) started when the mother was in the third quarter of pregnancy, and the rest in the second and third quarters (n=5). See Table 1.

Design characteristics of the interventions

Seven interventions used behavior change theory in their design, with social cognitive theory being the most commonly used. All interventions were face-to-face and delivered mainly by nurses and dietitians. The duration of the interventions ranged from 2 to 3 years.

Although all the interventions started in the prenatal period, only two of them addressed maternal factors, such as gestational weight gain. The others developed educational programs that focused on postnatal factors, such as infant nutrition.

Integration of physical activity and sleep was less common. Finally, the Starting Early Program (StEP) ⁽²⁰, Minding the Baby²¹, and Healthy Beginnings^{29), (30} interventions were found to have statistically significant outcomes related to infant weight. See Table 2.

General characteristics and outcomes of effective interventions

Finally, as this is a scoping review, we did not carry out a comprehensive analysis of outcomes³¹; however, we found that effective interventions were delivered to pregnant women from the third quarter onwards. According to the components, these interventions were based on the major risk factors for childhood obesity, supported by cognitive-behavioral theories. Delivery was face-to-face, mainly by nurses, and the impact of the intervention was influential in maintaining or improving nutritional status. This is described in Table 3.

Discussion

The aim of this study was to identify and characterize interventions delivered during the first 1000 days of life for the prevention of childhood obesity. We identified 10 interventions reported in 14 articles between 2012 and 2022.

We found that the development and implementation of interventions are concentrated in high- income countries, in line with other systematic reviews^{11), (12), (32}, and that while in the past overweight was almost exclusively a problem of high-income countries, prevalence patterns have now changed, with low-and middle-income countries accounting for three-quarters of childhood overweight worldwide^{2), (33}. Policies focusing on the prevention of childhood obesity in the first 1000 days have recently been implemented in Latin America³⁴ and publications from this region with positive results are expected soon.

More than half of the interventions included racial/ethnic subgroups in their study populations, such as Latinos and African Americans, who are considered to be groups with a high prevalence of risk factors for childhood obesity^{35), (36}; however, they did not include cultural or environmental aspects beyond the vulnerability or ethnicity of the population, which is seen as an area of opportunity. This highlights the need for future interventions to consider the socioeconomic status, environment and culture in which children and families live, as these variables may influence weight-related behaviors, as do dietary practices and physical activity^{37), (38}.

Regarding the start of implementation, most interventions were initiated in the third quarter of pregnancy; however, evidence suggests that ideally they should be initiated before conception, but if this is not possible, they should be initiated from the first quarter of pregnancy and continued until the child is two years old³⁹. As previously mentioned, it was found that none of the interventions included preconception care, but they did include follow-up for two years or more, which aligns with the scientific evidence reported in previous systematic reviews^{11), (12), (40}. Preventive interventions delivered at these stages may prepare the mother-to-be to reduce risk factors for childhood obesity, and there is, therefore, a need to continue to research this period^{8), (9), (11), (38}.

This scoping review found three interventions with statistically significant results: StEP²⁰, Minding the Baby²¹ and Healthy Beginnings²⁹. Key features of these interventions were that they were multi component and targeted the main risk factors for obesity in early childhood; they also used theoretical models that focus on how perceptions, beliefs and thoughts influence behavior. This allows for a coherent, evidence-based structure that facilitates the understanding of health determinants, the prediction and evaluation of out comes,and the reproducibility and generalizability of interventions^{6), (9), (41}.

The delivery method for these three interventions was face-to-face home visits, with a minimum follow-up of 2 years. Evidence suggests that, beyond the provision of information, this individualized face-to-face support builds a relationship of trust between the facilitator and the mother, promoting favorable outcomes in terms of improvements in developmental indicators, infant feeding practices and parenting, all in disadvantaged families^{42), (43}.

Likewise, it was seen that the use of technology was incorporated into the interventions, the most common being telephone calls, text messages and computer use. The use of technological resources to promote health is an opportunity to bring educational strategies to the population⁴⁴. In recent years, the number of people using these tools on a daily basis has increased, providing an opportunity for educators and researchers to reduce the cost of implementing obesity prevention interventions, thus reducing the gap in access to health services^{45), (46}.

Cultural adaptations are considered necessary to improve identified outcomes⁴⁷, and the use of technology and interventions that take into account multifactorial aspects such as culture, dietary practices and physical activity has significant effects on participants' weight^{32), (48}.

Limitations include the fact that, by its nature, this scoping review did not include a quality assessment of the reviewed studies or an in-depth review of the statistical results, which may limit the generalizability of the findings. Strengths include that the design allowed for a systematic synthesis of research characteristics and findings, which could contribute to health professionals' decision making in preventing of childhood obesity.

Conclusion

It is encouraging that from the ten selected interventions, three were found to be effective in preventing childhood overweight and obesity in the first 1000 days of life. The characteristics summarized in terms of study population, intervention design and outcomes of effective interventions provide evidence that can be used to determine whether these interventions will work in other contexts, such as low- and middle-income countries and in groups vulnerable to developing childhood obesity.

In addition, the use of cultural adaptation processes could be a useful strategy to reduce development and implementation time and optimize resources. Ensuring that interventions cover all of the above aspects will result in better prevention of childhood obesity.

References

Horesh A, Tsur AM, Bardugo A, Twig G. Adolescent and Childhood Obesity and Excess Morbidity and Mortality in Young Adulthood-a Systematic Review. Curr Obes Rep. 2021;10:301-10. https:// doi.org/10.1007/s13679-021-00439-9

World Health Organization. Obesity and overweight. WHO [Internet] 2023 [Referenced on: 2023, October 15]. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and- overweight

Lister NB, Baur LA, Felix JF, Hill AJ, Marcus C, Reinehr T, et al. Child and adolescent obesity. Nature Reviews Disease Primers. 2023;9(1):1-19. https://doi.org/10.1038/s41572-023-00435-4

Deal BJ, Huffman MD, Binns H, Stone NJ. Perspective: Childhood Obesity Requires New Strategies for Prevention. Advances in Nutrition. 2020;11(5):1071-8. https://doi.org/10.1093/ ADVANCES/NMAA040

World Health Organization. Noncommunicable diseases: Childhood overweight and obesity [Internet] 2020 [Referenced on: 2023, October 15]. Available at: https://www.who.int/news-room/questions-and-answers/item/noncommunicable-diseases-childhood-overweight-and-obesity

Larqué E, Labayen I, Flodmark CE, Lissau I, Czernin S, Moreno LA, et al. From conception to infancy - early risk factors for childhood obesity. Nat Rev Endocrinol. 2019;15:456-78. https://doi. org/10.1038/S41574-019-0219-1

United Nations Children’s Fund. Recomendaciones de política pública nacional, estatal y local resumen ejecutivo [Internet] 2019 [Referenced on: 2023, October 15]. Available from: https://www.unicef.org/mexico/media/5326/file/Documento%20de%20recomendaciones.pdf

Schwarzenberg SJ, Georgieff MK, Daniels S, Corkins M, Golden NH, Kim JH et al. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics. 2018;141(2):e20173716. https://doi.org/10.1542/peds.2017-3716

Pietrobelli A, Agosti M, MeNu Group. Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science. Int J Environ Res Public Health. 2017;14(12):1491. https:// doi.org/10.3390/IJERPH14121491

Karacabeyli D, Allender S, Pinkney S, Amed S. Evaluation of complex community-based childhood obesity prevention interventions. Obes Rev. 2018;19(8):1080-92. https://doi. org/10.1111/OBR.12689

Hennessy M, Heary C, Laws R, van Rhoon L, Toomey E, Wolstenholme H, et al. The effectiveness of health professional-delivered interventions during the first 1000 days to prevent overweight/ obesity in children: A systematic review. Obes Rev . 2019;20(12):1691-707. https://doi.org/10.1111/ OBR.12924

Blake-Lamb TL, Locks LM, Perkins ME, Woo Baidal JA, Cheng ER, Taveras EM. Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review. Am J Prev Med. 2016;50(6):780-9. https://doi.org/10.1016/J.AMEPRE.2015.11.010

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169:467-73. https://doi.org/10.7326/M18-0850

Zepeda PA, Cárdenas VM, Sifuentes DC. Interventions for early prevention of childhood obesity during the first 1000 days: A scoping review protocol 2023. https://doi.org/10.17605/OSF. IO/5BAMK

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616

Zepeda PA, Cárdenas VM, Sifuentes DC, Guevara MC. Intervenciones para prevenir la obesidad en los primeros 1000 días: Scoping Review - Mendeley Data V1. https://doi.org/10.17632/ zvk4wby72y.1

Reifsnider E, McCormick DP, Cullen KW, Todd M, Moramarco MW, Gallagher MR, et al. Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population. Acad Pediatr. 2018;18(3):324-33. https://doi.org/10.1016AI.ACAP.2017.12.007

McCormick DP, Reyna L, Reifsnider E. Calories, Caffeine and the Onset of Obesity in Young Children. AcadPediatr. 2020;20(6):801-8. https://doi.Org/10.1016/J.ACAP.2020.02.014

Gross RS, Mendelsohn AL, Gross MB, Scheinmann R, Messito MJ. Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices. J Pediatr. 2016;174:171-177. https://doi.org/10.1016/JJPEDS.2016.03.060

Messito MJ, Mendelsohn AL, Katzow MW, Scott MA, Vandyousefi S, Gross RS. Prenatal and Pediatric Primary Care-Based Child Obesity Prevention Program: A Randomized Trial. Pediatrics . 2020;146(4):e20200709. https://doi.org/10.1542/peds.2020-0709

Ordway MR, Sadler LS, Holland ML, Slade A, Close N, Mayes LC. A Home Visiting Parenting Program and Child Obesity: A Randomized Trial. Pediatrics . 2018;141(2). https://doi.org/10.1542/ PEDS.2017-1076

Parat S, Nègre V, Baptiste A, Valensi P, Bertrand AM, Chollet C, et al. Prenatal education of overweight or obese pregnant women to prevent childhood overweight (the ETOIG study): an open-label, randomized controlled trial. Int J Obes (Lond). 2019;43:362-73. https://doi.org/10.1038/ S41366-018-0205-Z

Fangupo LJ, Heath ALM, Williams SM, Somerville MR, Lawrence JA, Gray AR, et al. Impact of an early-life intervention on the nutrition behaviors of 2-y-old children: a randomized controlled trial. Am J Clin Nutr. 2015;102(3):704-12. https://doi.org/10.3945/AJCN.115.111823

Taylor RW, Williams SM, Fangupo LJ, Wheeler BJ, Taylor BJ, Daniels L, et al. Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight: A Randomized Clinical Trial. JAMA Pediatr. 2017;171(9):838-846. https://doi.org/10.1001/JAMAPEDIATRICS.2017.1284

Taylor RW, Gray AR, Heath ALM, Galland BC, Lawrence J, Sayers R, et al. Sleep, nutrition, and physical activity interventions to prevent obesity in infancy: follow-up of the Prevention of Overweight in Infancy (POI) randomized controlled trial at ages 3.5 and 5 y. Am J Clin Nutr . 2018;108(2):228-36. https://doi.org/10.1093/AJCN/NQY090

Fiks AG, Gruver RS, Bishop-Gilyard CT, Shults J, Virudachalam S, Suh AW, et al. A Social Media Peer Group for Mothers To Prevent Obesity from Infancy: The Grow2Gether Randomized Trial. Child Obes. 2017;13(5):356-68. https://doi.org/10.1089/CHI.2017.0042

Thomson JL, Goodman MH, Tussing-Humphreys LM, Landry AS. Infant growth outcomes from birth to 12 months of age: findings from the Delta Healthy Sprouts randomized comparative impact trial. Obes Sci Pract. 2018;4(4):299-307. https://doi.org/10.1002/OSP4.272

Wasser HM, Thompson AL, Suchindran CM, Goldman BD, Hodges EA, Heinig MJ, et al. Home based intervention for non-Hispanic black families finds no significant difference in infant size or growth: results from the Mothers & Others randomized controlled trial. BMC Pediatr. 2020;20:1-13. https://doi.org/10.1186/s12887-020-02273-9

Wen LM, Baur LA, Simpson JM, Rissel C, Wardle K, Flood VM. Effectiveness of home based early intervention on children’s BMI at age 2: randomised controlled trial. The BMJ. 2012;344:e3732. https://doi.org/10.1136/BMJ.E3732

Wen LM, Baur LA, Simpson JM, Xu H, Hayes AJ, Hardy LL, et al. Sustainability of Effects of an Early Childhood Obesity Prevention Trial OverTime: A Further 3-Year Follow-up of the Healthy Beginnings Trial. JAMA Pediatr . 2015;169(6):543-51. https://doi.org/10.1001/JAMAPEDIATRICS.2015.0258

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18:1-7. https://doi.org/10.1186/S12874-018-0611-X

Salam RA, Padhani ZA, Das JK, Shaikh AY, Hoodbhoy Z, Jeelani SM, et al. Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis. Nutrients. 2020;12:2208. https://doi.org/10.3390/NU12082208

Fondo de las Naciones Unidas para la Infancia. La obesidad no es una tendencia imparable. Referenced on: November 03, 2023. Available at: https://www.unicef.org/lac/historias/la- obesidad-no-es-una-tendencia-imparable

Ríos-Reyna C, Díaz-Ramírez G, Castillo-Ruíz O, Pardo-Buitimea NY, Alemán-Castillo SE. Políticas y estrategias para combatir la obesidad en Latinoamérica. Rev Med Inst Mex Seguro Soc. 2022;60(6):666-674. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10395955/

Isong IA, Rao SR, Bind MA, Avendaño M, Kawachi I, Richmond TK. Racial and ethnic disparities in early childhood obesity. Pediatrics . 2018;141(1):e20170865. https://doi.org/10.1542/peds.2017- 0865

Andrea SB, Hooker ER, Messer LC, Tandy T, Boone-Heinonen J. Does the association between early life growth and later obesity differ by race/ethnicity or socioeconomic status? A systematic review. Ann Epidemiol. 2017;27(9):583-592. https://doi.org/10.1016/J.ANNEPIDEM.2017.08.019

Ayala GX, Monge-Rojas R, King AC, Hunter R, Berge JM. Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos. Obes Rev . 2021;22:e13350. https://doi.org/10.1111/OBR.13350

Iguacel I, Gasch-Gallén Á, Ayala-Marín AM, De Miguel-Etayo P, Moreno LA. Social vulnerabilities as risk factor of childhood obesity development and their role in prevention programs. Int J Obes (Lond) . 2021;45:1-11. https://doi.org/10.1038/S41366-020-00697-Y

Reilly JJ, Martin A, Hughes AR. Early-Life Obesity Prevention: Critique of Intervention Trials During the First One Thousand Days. Curr Obes Rep . 2017;6:127-33. https://doi.org/10.1007/ S13679-017-0255-X

Moreno JM, Collado MC, Larqué E, Leis MR, Sáenz-de-Pipaon M, Moreno LA, et al. Los primeros 1000 días: una oportunidad para reducir la carga de las enfermedades no transmisibles. Nutr Hosp. 2019;36(1):218-32. https://doi.org/10.20960/NH.02453

Palacios C, Magnus M, Arrieta A, Gallardo H, Tapia R, Espinal C. Obesity in Latin America, a scoping review of public health prevention strategies and an overview of their impact on obesity prevention. Public Health Nutr. 2021;24(15):5142-55. https://doi.org/10.1017/S1368980021001403

Goldfeld S, Price A, Smith C, Bruce T, Bryson H, Mensah F, et al. Nurse home visiting for families experiencing adversity: A randomized trial. Pediatrics . 2019;143(1): e20181206. https:// doi.org/10.1542/peds.2018-1206

Tiruneh GT, Shiferaw CB, Worku A. Effectiveness and cost-effectiveness of home-based postpartum care on neonatal mortality and exclusive breastfeeding practice in low-and-middle- income countries: A systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019;19:1- 19. https://doi.org/10.1186/s12884-019-2651-6

Molloy C, Beatson R, Harrop C, Perini N, Goldfeld S. Systematic review: Effects of sustained nurse home visiting programs for disadvantaged mothers and children. J Adv Nurs. 2021;77(1):147-161. https://doi.org/10.1111/JAN.14576

Turner T, Spruijt-Metz D, Wen CKF, Hingle MD. Prevention and treatment of pediatric obesity using mobile and wireless technologies: a systematic review. Pediatr Obes. 2015;10(6):403-409. https://doi.org/10.1111/IJPO.12002

Bonvicini L, Pingani I, Venturelli F, Patrignani N, Bassi MC, Broccoli S, et al. Effectiveness of mobile health interventions targeting parents to prevent and treat childhood Obesity: Systematic review. Prev Med Rep. 2022;29:101940. https://doi.org/10.1016AI.PMEDR.2022.101940

Narzisi K, Simons J. Interventions that prevent or reduce obesity in children from birth to five years of age: A systematic review. Journal of Child Health Care. 2021;25(2):320-334. https://doi. org/10.1177/1367493520917863

Fowler LA, Grammer AC, Staiano AE, Fitzsimmons-Craft EE, Chen L, Yaeger LH, et al. Harnessing technological solutions for childhood obesity prevention and treatment: a systematic review and meta-analysis of current applications. International Journal of Obesity. 2021 45:5 :957-981. https://doi.org/10.1038/s41366-021-00765-x

Autor notes

^*Correspondence. Velia Margarita Cárdenas Villarreal. E-mail: velia.cardenasvl@uanl.edu.mx