Feeding the family: the Intergenerational approach to fight obesity

WHO describes the pediatric obesity epidemic as one of the most serious public health challenges of the 21st century. Italian data on more than 50000 children (age 6-9 years) show that prevalence of overweight/obesity in childhood is around 20.4%, with percentage of overweight and obesity around 4% and 2.4%, respectively.
Obesity is a chronic disease defined as abnormal or excessive fat accumulation due to an imbalance between energy intake and energy expenditure. 
Pathways to childhood obesity are complex, multifactorial and include individual-level factors, (e.g., biological risks), acting within the influence of the child’s family environment, which is, in turn, embedded in the context of the community environment, as well as the social and cultural habitat. In this contest, maternal health is critical for healthy child growth and development; maternal factors such as high maternal pre-pregnancy BMI, excessive gestational weight gain, gestational diabetes can impact the risk to develop obesity in offspring during lifespan. Along with the previously mentioned maternal factors, also socio-economic status has been identified as a determinant for later obesity. 
 

The purpose is to identify determinants for early onset of obesity considering both maternal and children risk factors in a sample of mother-child dyads attending a paediatric outpatient clinic of the Vittore Buzzi Children’s Hospital in Milan, Italy. To reach this objective the FACILITY project will consist of a first observational cross-sectional study followed by a retrospective case-control study Specifically, a suitable number of mother-children dyads (aged ≥ 18 years and ≥ 10 years, respectively) with children with overweight/obesity will be enrolled at Ospedale Dei Bambini “Vittore Buzzi” (Milan, Italy) for the first study phase. Then, a subgroup of mother-child dyads with children with early adiposity rebound (EAR) will be selected for the second study phase.
The evaluation of the maternal-infant risk factors for childhood obesity will be conducted through an eco-social conceptual framework, investigating both health and nutritional aspects, as well as social-cultural environmental determinants. The information will be collected through interviews, validated questionnaires and by consulting medical records. 
Maternal information include current and pre-pregnancy nutritional status; type of pregnancy, number of previous pregnancies, pregnancy related-diseases, type of delivery, supplements consumed during pregnancy; lifestyle habits (i.e.; dietary habits, physical activity, smoking habits and alcohol consumption) during and after pregnancy; Mediterranean diet adherence; food knowledge; socio-economic status; family relationships; social capital; neighborhood food environment characteristics; local social capital and social participations; cultural habits. Children information include current and at birth nutritional status; feeding mode; time and characteristics of weaning; lifestyle habits (i.e., dietary habits, physical activity, sleep and screen time; smoking habits and alcohol consumption for adolescents) during the first 1000 days and after; Mediterranean diet adherence; binge eating symptoms.
Moreover, demographic data, pathological/physiological history related to mother and children will be collected. 
 

During the cross-sectional phase, a mapping of the nutritional and socio-economic-cultural status of the target sample will be conducted, as well as the analysis of the impact of lifestyle and socio-economic-cultural factors on the target population. Afterwards, during the retrospective study, lifestyle determinants in the first 1000 days of life of the child driving to EAR directly associated with childhood obesity will be identified. Furthermore, a culture-accepted and early-tailored “model to action” aligned with the MNCH continuum care approach will be developed based on the knowledge gained through the 2 study phases.