Maternal obesity, excessive gestational weight gain (GWG) and rapid weight gain (RWG) in infancy are known, modifiable risk factors of obesity and non-communicable diseases in children. The lack of long-term sustainability and the cost of secondary prevention of obesity urge for action to identify strategies in primary and primordial prevention. Hence, it is important to elucidate the origins of obesity and identify opportunities to prevent its occurrence at primary and primordial levels. A wealth of evidence has emerged over the last 2 decades from human and animal studies on the mechanistic role of maternal obesity and GWG on offspring adiposity and the plausible preventive interventions at individual as well as community level. Maternal factors including obesity, nutrition, lifestyle and GWG can alter the intrauterine milieu that result in epigenetic changes through DNA methylation of fetal metabolic genes and exposure of the developing fetus to abnormal levels of leptin and adiponectin.  Community-wide research from west show that postpartum weight reduction, antenatal lifestyle modifications and physical activity during pregnancy are effective in preventing intrauterine epigenetic and metabolic alterations. While epigenetic mechanisms have been implicated in the development of NCDs in later life through fetal programming, recent epidemiological research points out that nutritional manipulation during early infancy could prevent accelerated post-natal growth and associated adverse metabolic health outcomes. As such, interventions to achieve normal preconceptual BMI, GWG and preventing RWG in infancy have the potential to prevent the development of obesity at primary and primordial levels. Globally, prevention of childhood obesity should focus on identification of cost-effective, feasible and sustainable community programmes. Research from low and low-middle-income (LMI) countries who are more affected by the obesity epidemic, are expected to contribute to  policymaking and development of an appropriate framework that could  be implemented at ground level.

Dr. Vasana Kiridana is a Consultant Pediatrician with special interest in childhood obesity and metabolic syndrome. She is the lead consultant of the childhood weight management clinic at the University Teaching Hospital Kandy, Sri Lanka. Her current research is on epigenetics, adipokines and maternal factors in the pathogenesis of childhood obesity. She is a trial representative of the TOPCHILD global collaboration, the largest multi-center research on interventions to prevent childhood obesity. Dr. Kiridana has many publications and abstracts to her credit, locally and internationally.