Obesity is generally thought of as a diet and lifestyle-related condition which should be addressed through interventions targeting the behaviours of older children and adults.
However, often the origins of obesity (and other chronic health conditions) lie in the pre-natal and early childhood period. Strategies implemented during this crucial period can help reduce obesity in later life and build a secure foundation for lifelong health.
The Early Life Nutrition Coalition advocates for an increased focus on nutrition during the ‘First 1,000 Days’ (the pre-natal, infancy and early childhood period). The Coalition, Chaired by Professor Peter SW Davies, was established in 2017 as a sub-committee of the Perinatal Society of Australia and New Zealand.
It is an affiliation of concerned professional, academic, advocacy, corporate and healthcare groups working collaboratively to communicate and promote the importance of early life nutrition as a long-term preventative health measure to health care professionals, new and expectant parents and adolescents.
The Coalition has provided a detailed submission to the current Inquiry into the Obesity Epidemic being held by the Senate Select Committee. This Inquiry covers a broad range of issues relevant to obesity, with a particular focus on children. It is taking submissions until 6 July 2018.
The Early Life Nutrition Coalition’s submission outlines opportunities for the Federal Government to support health care professionals in better engaging and educating new and expectant parents on how to maximise nutritional status during the First 1,000 Days.
It argues that Government intervention and support during this critical window of opportunity can help break the cycle of obesity and related disease across generations.
The Early Life Nutrition Coalition writes:
The rapid increase in prevalence of chronic diseases, specifically metabolic disease related to obesity, is a significant national health problem, with a growing body of evidence now linking the nutritional environment in early life to an increased risk of disease in adulthood.
The risk of obesity is influenced by a range of factors across an individual’s lifespan. Environmental exposures during fetal development and infancy are now considered responsible for a significant part of lifetime disease risk, as they can trigger changes in the developing offspring.
Research has identified vulnerable time periods, including prior to conception and during fetal and early postnatal development, where exposure to environmental factors, including poor nutrition, can trigger adaptations in the growing fetus.
While these effects may be adaptive in the short-term, they may also be associated with adverse outcomes in childhood and later life, including a greater risk of obesity, type 2 diabetes and heart disease, as well as allergy.
Among other factors, maternal and paternal health and lifestyle behaviours are key determinants of pregnancy outcomes and the longer-term health of the offspring. Identifying vulnerable periods in fetal development provides an important opportunity for parents and caregivers, healthcare professionals, society and policy makers to intervene and optimise future health outcomes.
The Coalition suggests the following four strategies:
Strategy 1: Medicare rebates for dietitians during pregnancy
For many women, an at-home pregnancy test, or the belief that they may be pregnant will lead to an appointment with a health care practitioner, usually a general practitioner (GP). For others, the desire to fall pregnant may lead to a GP appointment to review their current health and ensure they are physically prepared for conception.
These appointments provide an opportunity for the GP to organise the first tests and investigations associated with pregnancy. Often, the GP will request a pregnancy urine or blood test, as well as ensure any medications the patient is taking are safe in pregnancy, including any natural or alternative medicines.
The Early Life Nutrition Coalition believes these GP (or obstetrician or midwife) appointments provide the perfect opportunity for the health care professional to refer those wishing to become pregnant or who are newly pregnant to an accredited practising dietitian for advice on nutrition before and during pregnancy, while breastfeeding and throughout the first years of the child’s life.
The Coalition recommends a review of the current level of rebate associated with accredited practising dietitian consults and that a Medicare rebate be made available for nutrition advice to all first time mothers, for those women planning on becoming pregnant, as well as for subsequent pregnancies where the mother is considered overweight or obese (as indicated by her Body Mass Index) or at high risk of developing gestational diabetes (based on medical history, etc.).
Strategy 2: Allied health professionals in childcare settings
According to the Australian Bureau of Statistics, approximately 50 per cent of children aged 0-12 years attend some type of childcare. This presents an opportunity to coordinate the involvement of Allied Health Professionals with registered and accredited childcare centres to provide nutrition-based advice and information to a large number of parents and carers.
Evening information sessions organised by childcare centres are commonplace. Attaching a Medicare rebate to activities relating to dietary and nutritional advice delivered by an accredited Allied Health Professional will increase the viability and demand for these services.
Strategy 3: GP and new and expectant parent nutrition education
In addition to expanding the Medicare rebate to include early life nutrition advice during the stages of pregnancy and childhood, the Early Life Nutrition Coalition recommends equipping GPs and expectant parents with advice relating to nutrition prior to conception, during pregnancy and in the first few years of their offspring’s life.
During this First 1,000 Days window, a GP has routine points in time where they are in a position to interact with expectant and new parents, namely: the first appointment to confirm pregnancy; and the child’s two, four, six, 12 and 18 month immunisation appointments.
Developed by the Early Life Nutrition Coalition in consultation with the Federal Department of Health, a consumer information booklet will be provided to GPs to discuss and provide to patients at each of these appointments. Initially targeted at GPs, but potentially extending to other health care practitioners who may influence parents in the First 1,000 Days, the booklet will be developed in accordance with relevant National Health and Medical Research Council and other nutrition guidelines and will be reviewed and updated periodically.
The information booklet will focus on the First 1,000 Days time period and provide nutritional information relevant to parents prior to conception, during pregnancy and from birth up until the age of two years. During these critical stages, even the smallest positive change to diet and lifestyle can have a significant impact on long-term health. Advice included in the booklet will include:
- Impact of maternal and paternal nutrition and nutritional status prior to conception
- Importance of appropriate weight gain during pregnancy
- Appropriate changes to the maternal diet
- Importance and benefits of exclusive breastfeeding to the infant and mother
- When to introduce solids, including known allergens
- The importance of positive role-modelling to establish positive eating behaviours
- Contact details for relevant health care associations and organisations
Strategy 4: Improved access to Gestational Diabetes Mellitus education and support services
Currently, women with Gestational Diabetes Mellitus (GDM) do not qualify for any Medicare rebate for services such as access to diabetes education, dietitian or other allied health services. This is largely due to the criteria that stipulate a chronic disease lasts for more than six months.
Once a woman is diagnosed with GDM, they are placed on the public health waiting list or pay for unfunded private diabetes education. For many, this is simply a cost they cannot afford.
Credentialed Diabetes Educators who specialise in GDM education and management report it can take up to a year for women who join public health system priority lists for self-management education services until they commence insulin therapy. As such, in many instances insulin initiation and potential health complications could have been prevented if they had received early educational intervention.
There is a growing body of evidence that highlights the importance of managing GDM as early as possible to reduce the high risk of poorer immediate outcomes for the baby, and the risk that they will develop type 2 diabetes in later life. This is equally relevant for the mother, who after developing GDM is also at greater risk of developing type 2 diabetes.
Ensuring the services vital to the treatment and education of mothers who develop GDM attract a Medicare rebate will allow earlier intervention and greatly reduce the long-term burden associated with type 2 diabetes.
The Early Life Nutrition Coalition presents these recommendations with the aim of addressing and combating Australia’s growing rates of obesity, type 2 diabetes, heart disease and allergy. The Coalition welcomes the opportunity to discuss the role of Early Life Nutrition during the First 1,000 Days as a preventative health measure.