Back 30 January 2017

Midwives can help break the obesity legacy


This article is written by Berthold Koletzko, Professor of Paediatrics at the Medical Center, Ludwig-Maximilians-Universität Munich, where he heads the Division of Metabolism and Nutrition at Dr von Hauner’s Children’s Hospital. He is also Coordinator of the EarlyNutrition Project.

For the last five years, I have been working alongside experts from 35 institutions in 12 different countries to investigate how early nutrition can have an impact on life-long health as part of the EC-funded EarlyNutrition Project.

The €11 million project – the largest ever study into early nutrition – has provided us with a golden opportunity to help break the obesity legacy in future generations and it’s important that we pass on what we have learned to anyone planning to start a family as well as to the healthcare professionals who support and guide them. 

Early Nutrition article #Professor

Professor Berthold Koletzko, coordinator of the EarlyNutrition Project

Prepare well in advance

What we now know is that to help prevent future generations developing serious health problems, it’s vital that couples prepare well in advance of conception and that both women and their partners should be a healthy weight before they embark on parenthood. In order to reach people at this vital stage, we are urging healthcare professionals to make sure prospective parents are made aware of our findings and of what can be done to give their children the best possible chance of lifelong health.

The mother’s nutrition, both before and during her pregnancy, and the quality of food her child receives in the first two years of life have a measurable impact on metabolism and health throughout later life. If the mother is overweight when she becomes pregnant, her child has double the risk of being obese as an adult. If the mother is obese, the risk to the child is trebled. We also know that the bodyweight of the father can also have a direct impact on a baby’s health – the heavier the father at conception, the heavier his baby will be.

Worldwide obesity epidemic

Pregnancies complicated by obesity are growing in number because of the current worldwide obesity epidemic. It is now the most common complication and must be identified and managed during the prenatal period.

Women, and their partners, should do all they can to get their weight to a healthy level before they become pregnant. Sticking to a balanced diet - one rich in vegetables and fish, supplemented with folic acid – before pregnancy is essential. During pregnancy the demand for certain critical nutrients rises far more sharply than the demand for energy. By the end of her pregnancy, a woman only needs to consume 10% more energy than before but this equates to only one slice of wholemeal bread and a small glass of milk extra per day.

Think for two, don’t eat for two

 In other words, the idea of ‘eating for two’ is nothing more than a myth. We should think for two rather than eat for two.

Once born, breast-feeding reduces the child’s long-term risk of becoming overweight by 10-20% compared to conventional bottle-feeding. In particular, the protein content of conventional baby formula, and of the complementary foods provided during weaning, has a marked impact on future health.  The use of infant formula with lower protein at this stage has a clear, positive effect on the child’s subsequent health.

The EarlyNutrition Project’s ten key recommendations for families, as agreed by our consortium of international experts, are as follows:


  1. It’s never too early to start preparing for pregnancy and parenthood.
  2. Talk to your healthcare professional about nutrition, healthy weight, and healthy lifestyle ahead of conception.
  3. A healthy weight before conception gives your baby the best possible chance of lifelong health.


  1. Don’t eat for two, but think for two. Eat a healthy diet and only increase your dietary energy intake in late pregnancy by no more than 10%, which is about 180-200 calories.
  2. Stay physically active during pregnancy.
  3. Take 400 µg of folic acid before and during pregnancy.


  1. Breastfeeding women should eat a balanced diet.
  2. Infants born at term who are not fully breastfed should be fed an infant formula with reduced protein content more similar to breastmilk.


  1. No cow’s milk in the first year of life
  2. Complementary feeding should begin at between 17 and 26 weeks.

Our aim is to reach as many women and families as possible with our key recommendations. To that end, we have produced a series of videos that deliver the key recommendations and include interviews with leading pregnancy and infancy experts.  The key advice has also been translated into several different languages – including Dutch, Polish, German, Spanish, Spanish LATAM, Greek and Italian – so that healthcare professionals around the world can use the information to reach out to couples before they conceive.

Click here to watch the videos and to access the key recommendations in English and other languages and to find out more about The EarlyNutrition Project visit our website at



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