12 Sep 2018 #UKCO Conference: Preconception to pension – obesity throughout the lifecourse
Located in the beautiful setting of the historic Newcastle University campus, this year’s Association for the Study of Obesity Congress on Obesity took place on the 6th and 7th September.
This year’s theme focussed on prevention and treatment of obesity throughout the life course, from pre-conception to pension and Food Active were lucky enough to attend both days of the conference and listen to some of the exciting emerging research. The event programme was jam-packed consisting of a number of plenary lectures, symposiums and seminars. We have picked out some of our highlights from the two-day conference.
Periconceptional parental nutrition and mHealth interventions to support health care
The conference was opened by Professor Régine Steegers from Erasmus MC, who gave a fantastic overview of the importance of peri-conceptional care in the prevention of ill health and disease. Régine discussed the crucial role a healthy diet (particularly those rich in oily fish) can play in the following factors:
- Increasing the chance of good health in the mother and baby.
- Can reduce the chances of spina bifida by 72%, congenital heart defects by 70%, clefts by 90% and increase chances of becoming pregnant by 40%.
- Accelerates embryonic development. By contrast, ‘Western’ diets typically have smaller embryos, which are linked to complications during pregnancy such as mis-carriages, small gestational age and low body weight. This is also found to be linked to increased cardiovascular risk factors, cholesterol and body fat percentage when the child is six years of age.
- Whilst individual diets play an important role in diet quality, it is also important to recognise the environmental and social determinants of health. ‘Your ZIP code may be more important than your genetic code’.
In an ideal world, all women of child-bearing age would have a healthy BMI, participate in regular physical activity, not smoke and limit consumption of alcohol. However, we know that in both the UK and across the globe this is not the case and these are some of the challenges we face in tackling early origins of obesity and chronic disease. Régine also discussed some of the recent findings from a randomised controlled trial involving a personalised online coaching tool (Smarter Pregnancy) for women planning a pregnancy, which was found to effectively improve nutrition and lifestyle in couples contemplating pregnancy (follow this link to see the paper).
Weight management and diet quality before and after pregnancy: Public perception, priority areas and what interventions work?
This symposium was chaired by Dr Laura McGowan from Queen’s University in Belfast and focused on the evidence that demonstrates that the reproductive period as a golden window of opportunity for long term health outcomes, following on from the plenary lecture from Régine Steegers.
Presentations came from a number of leading academics from University College London and Queens University Belfast and there was a general consensus from the speakers that this is an overlooked area in the prevention of chronic diseases, particularly overweight and obesity. However, research from all speakers shows that interventions in pregnancy are arguably too late and we need to shift focus to those planning a pregnancy and the child-bearing age population to ensure the best possible outcomes from both the mother and baby. However, research shows many prospective mothers are wholly unaware of the preparations they and their partner should be making from at least 3 months before trying to conceive.
Professor Judith Stephenson from University College London posed the idea whether nutrition, diet and weight should be incorporated in current sex education for children, so that from a young age they are aware a healthy lifestyle is a core component of a healthy and successful conception and pregnancy. Linking in with the Making Every Contact Count approach, could GP’s raise the question of planning a pregnancy at routine appointments or check up’s with women of a child-bearing age, and signpost/refer to correct information and services?
Concerns were also raised by the number of folate and iodine deficiencies in pregnant women in both the UK and Ireland, as these are two very important micronutrients at both conception and pregnancy. Pregnant women up to 12 weeks are strongly advised to take a 400mg supplement of folic acid, as this helps prevent neural tube defects (NTDs) in the foetus – the challenge is that around half of all pregnancies are unplanned, with many not finding out until around 10 weeks after conception and currently 92% of the childbearing age population do not attain this threshold. There has been a long-standing campaign for mandatory fortification of folic acid in flour, as research shows this could prevent 2,000 NCD’s every year.
Also discussed were the opportunities to help women with weight management post-partum and in between pregnancies at routine check-ups, following a number of randomised controlled trials currently being conducted.
Are ‘systems’ and ‘evidence-based/programme-focused’ approaches contradictory or complementary in obesity prevention, how shall we move forward? An international symposium to exchange lessons learnt from studies undertaken in developing and developed countries.
A member-led symposium chaired by Dr Bai Li from the University of Birmingham discussed the role of ‘systems thinking’ in obesity interventions and comparing the effectiveness of school-based trials in the UK with those in less economically developed countries.
China has the world’s largest number of obese children, and a staggering 1/5 of the worlds obese children are Chinese. This epidemic is relatively in its early stages in comparison to the UK, as Western diets and lifestyles have slowly infiltrated into traditional Chinese culture and diets through globalisation and their emerging economy. This has also been attributed to the high frequency of consuming out-of-home foods and dining out and owing to the single child policy, grandparents have a tendency to spoil and treat their grandchild when in their care. In addition, China has the highest number of caesareans across the globe, which is also a noted risk factor for childhood obesity.
The CHIRPY DRAGON school-based obesity intervention produced positive reductions in BMI scores and significantly improved diet quality and waist circumference – the greatest effect seen in the most obese children in the trial.
However, similar trials in the UK have failed to replicate such results and have been deemed by the media as ‘ineffective’ – but why? One of the authors of these trials Professor Peymane Adab from the University of Birmingham considered whether we need to intervene at an earlier stage, or whether interventions be simpler? Are randomised controlled trials the definitive answer when it comes to tackling obesity? Compared to China, the UK’s obesity epidemic is very different – more advanced, Western-style diets are well established and have been developing for decades. As a result, it could be argued that a ‘systems approach’ is warranted to tackle the deep-rooted causes of obesity in the UK – something which may not yet be established in China.
Professor Harry Rutter from the University of Bath concluded the symposium by raising the question ‘if we only intervene at one point of a child’s life, how is this ever going to treat an issue that occurs across the life course?’ – school-based interventions may tackle the issue at a single population at a single point in time, but we must move away from looking just one step ahead in obesity prevention and towards a more holistic view of promoting healthy weight throughout the life course.
Further presentations across the conference included a European public health perspective of obesity throughout the life course from Jo Jewell from WHO Europe, a life course approach to obesity policy in the UK from Public Health England’s Dr Alison Tedstone, N8 AgriFood Symposium and much more.
The Food Active 2018 conference on 6th November, Manchester picks up many of the key themes in relation to promoting healthy weight across the life course, specifically focussing on pre-conception to pre-school. If you are interested, please follow this link to find out more about the event and register for your place: https://www.eventbrite.co.uk/e/childhood-obesity-lets-start-at-the-very-beginning-tickets-49841285627?utm_term=eventurl_text
Follow #UKCO2018 for all of the delegate tweets from the conference and save the date for next year’s ASO’s Congress on Obesity in Leeds on 12th-13th September.
Further information here: https://www.aso.org.uk/event/save-the-date-2/