Skouteris Helen, Bergmeier Heidi J, Berns Scott D, Betancourt Jeanette, Boynton-Jarrett Renée, Davis Martha B, Gibbons Kay, Pérez-Escamilla Rafael, Story Mary
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia.
Warwick Business School, University of Warwick, Coventry, UK.
Matern Child Nutr. 2021 Jan;17(1):e13094. doi: 10.1111/mcn.13094. Epub 2020 Oct 17.
High-quality mother-child interactions during the first 2,000 days, from conception to age 5 years, are considered crucial for preventing obesity development during early life stages. However, mother-child dyads interact within and are influenced by broader socio-ecological contexts involved in shaping child development outcomes, including nutrition. Hence, the coexistence of both undernutrition and obesity has been noted in inequitable social conditions, with drivers of undernutrition and overnutrition in children sharing common elements, such as poverty and food insecurity. To date, a holistic life-course approach to childhood obesity prevention that includes an equitable developmental perspective has not emerged. The World Health Organization (WHO) Nurturing Care Framework provides the foundation for reframing the narrative to understand childhood obesity through the lens of an equitable nurturing care approach to child development from a life-course perspective. In this perspective, we outline our rationale for reframing the childhood narrative by integrating an equitable nurturing care approach to childhood obesity prevention. Four key elements of reframing the narrative include: (a) extending the focus from the current 1,000 to 2,000 days (conception to 5 years); (b) highlighting the importance of nurturing mutually responsive child-caregiver connections to age 5; (c) recognition of racism and related stressors, not solely race/ethnicity, as part of adverse child experiences and social determinants of obesity; and (d) addressing equity by codesigning interventions with socially marginalized families and communities. An equitable, asset-based engagement of families and communities could drive the transformation of policies, systems and social conditions to prevent childhood obesity.
从受孕到5岁的最初2000天里，高质量的母婴互动被认为对预防生命早期阶段的肥胖发展至关重要。然而，母婴二元组在塑造儿童发展结果（包括营养）的更广泛社会生态背景中进行互动并受其影响。因此，在不平等的社会条件下，营养不良和肥胖并存的情况已被注意到，儿童营养不良和营养过剩的驱动因素有一些共同因素，如贫困和粮食不安全。迄今为止，尚未出现一种包括公平发展视角的全面的儿童肥胖预防生命历程方法。世界卫生组织（WHO）的关爱照护框架为重新构建叙述提供了基础，以便从生命历程角度通过公平的关爱照护方法来理解儿童肥胖。从这个角度出发，我们概述了通过将公平的关爱照护方法纳入儿童肥胖预防来重新构建儿童叙述的基本原理。重新构建叙述的四个关键要素包括：（a）将关注点从目前的1000天扩展到2000天（受孕到5岁）；（b）强调培养相互回应的儿童与照顾者关系直至5岁的重要性；（c）认识到种族主义和相关压力源，而不仅仅是种族/族裔，是不良儿童经历和肥胖的社会决定因素的一部分；（d）通过与社会边缘化家庭和社区共同设计干预措施来解决公平问题。基于资产的公平地让家庭和社区参与，可以推动政策、系统和社会条件的转变，以预防儿童肥胖。
