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Early life factors that affect obesity and the need for complex solutions

Nature Reviews Endocrinology volume 21, pages 31–44 (2025)Cite this article

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Abstract

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

Key points

  • A large proportion of obesity risk originates in early life, making this life phase an opportune time for primary prevention.

  • Obesity risk factors occur across individual and biological, sociocultural, and environmental and system levels; some are unique to early childhood (such as breastfeeding) whereas others are relevant across the life cycle (such as diet and movement behaviours).

  • The interplay of risk factors contributes to the complexity of obesity and its development and highlights the need for complex solutions.

  • Focusing the narrative on supporting health behaviours rather than on obesity and weight might be more palatable and result in greater engagement from practitioners and families.

  • It is time to move beyond single behaviour interventions, which have limited effectiveness in early childhood, to focus on more complex multi-behaviour interventions, tailored to individual or specific population needs, to tackle the multiple influences on obesity.

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Fig. 1: Global trends in overweight and obesity among children and youth.
Fig. 2: Early childhood obesity risk factors within a socioecological framework.

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Acknowledgements

K.D.H. is supported by a Heart Foundation Future Leader Fellowship (105929). M.Z. is supported by a National Health Medical Research Council Early Career Fellowship (GNT1124283).

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  1. Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, Victoria, Australia

    Kylie D. Hesketh, Miaobing Zheng & Karen J. Campbell

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Related links

CDC’s Developmental Milestones: https://www.cdc.gov/ncbddd/actearly/milestones/index.html

Developmental Milestones: Birth to 5 years: https://med.stanford.edu/content/dam/sm/pediatricsclerkship/documents/5-Developmental-Milestones-MedU.pdf

WHO Child Growth Standards: Training Course on Child Growth Assessment: https://www.who.int/publications/i/item/9789241595070

WHO Global Health Observatory data repository, BMI anthropometry: https://apps.who.int/gho/data/node.main.BMIANTHROPOMETRY?lang = en

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Hesketh, K.D., Zheng, M. & Campbell, K.J. Early life factors that affect obesity and the need for complex solutions. Nat Rev Endocrinol 21, 31–44 (2025). https://doi.org/10.1038/s41574-024-01035-2

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