We all want the best for our children, don't we? So why, when The Lancet Diabetes and Endocrinology asked me to convene a series on Maternal Obesity, did I hesitate for a moment? I knew the evidence that 'obesity begets obesity' - in that overweight mothers are more likely to have overweight children, with the resulting passage of risk of diseases such as diabetes from one generation to the next.
I also knew that this happens not simply because we inherit half our genes from our mothers but more importantly because the transgenerational passage of such risk is largely due to modifiable factors such as diet and lifestyle and adherence to out-of-date ideas such as 'eating for two' in pregnancy, or a that big bouncing baby will be a healthy baby.
So might the series on Maternal Obesity achieve nothing more than heaping an extra burden of responsibility on mothers, calling them to solve yet another of today's problems and making them feel guilty if they can't do so? I sincerely hope not.
True, the four papers in the series don't pull any punches in highlighting the scale of the challenge we all face, not just in affluent societies but increasingly in poorer resource setting too. The extent of the problem is shocking - 50 per cent of women between the ages of 25 and 34 are overweight or obese in the UK. Without doubt this affects the development of their offspring, whether in terms of risky birth of the baby or later health of the child and adult.
Moreover, the management by doctors of pregnancy in obese women, with the greater risk of gestational diabetes and other complications, is tricky and adds about another £500 to £1000 to the cost of their care in the UK. And current research trials aimed at helping women to eat more healthily and to be more physically active in pregnancy have yet to show substantial beneficial effects on their offspring.
So what are the solutions?
The Series concludes with a focus on interventions to reduce obesity in prospective parents, i.e. in the period before they conceive. This must involve not only adolescent and young adult women but their partners too. This is not just a mothers' problem to solve and they and their partners need help and support to engage with it.
This may be the most effective time in parents' lives to prevent transmission of obesity and disease risk to the next generation, as well as making them healthier themselves. But achieving this will require much more integrated healthcare, from contraception through pregnancy planning, preparation, and then during and after pregnancy. It will not be effective unless the 'top-down' provision of seamless services is balanced by a 'bottom-up' demand for such services from young people.
Unfortunately we are a long way from that. Currently the nature of this problem is not adequately appreciated and this is preventing us working towards a solution. The next generation does not have to suffer from obesity and its association conditions. As the future belongs to them and they, like us, want the best for their children, we owe it to our young people to help them to improve their health now.
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