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Nutrition in the first 1,000 days: ten ways to lower the risk of obesity

Author Dr. J. Hower, paediatrician from Germany

The prevalence of overweight and obesity in childhood has increased in recent decades in most countries. Put simply, obesity can be seen as a result of the imbalance between energy intake and energy expenditure.

Can correct nutrition in early childhood lower the later risk of obesity?

The first 1,000 days of life begin with pregnancy, and during this period there is already a unique opportunity to make a contribution towards prevention. Taking into account the latest findings, the authors of a Mediterranean nutrition group have prepared and discussed 10 ways to minimise the risk of becoming obese in the first 1,000 days.

  1. Both maternal AND paternal behaviour is important. A balanced diet, with a reasonable fat and protein intake and a preference for fruit and vegetables, is recommended for both parents during conception and pregnancy. In addition, overweight/obese women who are planning to get pregnant should reduce their weight before conception. 
  2. Monitoring development. During pregnancy, at birth and in early childhood, it is vitally important to monitor body measurements in order to check the normality of growth and development.
  3. Breastfeeding for the best start in life. Exclusive breastfeeding is recommended from birth to an age of six months.
  4. The introduction of solids. The age of four to six months is the ideal time to introduce solids. Up to the age of one year, breast milk or follow-on formula is the most important recommended source of nutrition. Plain cow’s milk should be avoided until a child is one year old.
  5. Early introduction of fruit and vegetables. A variety of meals every day and repeatedly offering foods that have been refused are effective strategies when it comes to improving acceptance. It is not necessary to include sugar, sugary drinks or salt in a child’s diet.
  6. Respect your child’s appetite. Avoid force feeding practices such as telling children to eat up everything on their plate. Adjust the size of the portions offered depending on which kind of food it is, and do not use food as a reward for good behaviour.
  7. Limit the intake of animal proteins. The intake of animal proteins should be limited, especially during early infancy, in order to lower the risk of early obesity. Follow-on formula for children between one and three years of age is preferable to plain cow’s milk for meeting the requirements of micro- and macronutrients such as omega-3 fatty acids and iron.
  8. Ensure the intake of high-quality fats. The intake of sufficient fats with essential fatty acids should be encouraged.
  9. Parents as role models. Parents should be role models at meal times, which means that TV and other devices should be turned off during meal times.
  10. Encouraging physical activity and sufficient sleep. Physical activity should be encouraged, and the child should be getting sufficient sleep. A lack of sleep increases the risk of obesity.


The authors believe that concerted efforts of all those involved in child development in the public health sector are necessary to counter the increasing prevalence of obesity with correct nutrition and physical activity.

Comment: The causes of the obesity epidemic are complex and are influenced by biological and social risk factors. The concept of early metabolic programming inspired the authors to search through published research for factors which make an important contribution to weight development in the first 1,000 days of life. They belong to the “Mediterranean Nutrition Group”, a working group from the Mediterranean region that searches for strategies for the prevention of obesity. All ten rules can be backed up by corresponding study results. Following these recommendations is expected to promote not only childhood health, but also health in later life.