(iStock)

There’s troubling new evidence that the obesity epidemic might start in the delivery room, or even before.

Historically, legislators and medical professionals haven’t focused attention on precisely what, and how much, babies and toddlers eat. That’s about to change.

“There was a time when we did not view 0 to 2 as a target for obesity prevention,” said Lorrene Ritchie, a nutrition and nutrition policy specialist in Berkeley, Calif. “We felt young children were much better at self-regulating. Obesity is the canary in the coal mine for health. It’s kind of like the climate change of public health.”

Last week, the group that will write the 2020 dietary guidelines held its inaugural two-day meeting in Washington.

The Department of Health and Human Services and the Agriculture Department have issued dietary guidelines for Americans every five years since 1980, but about babies and toddlers they’ve always been mum. The 2020 guidelines will attempt for the first time to provide strong, evidence-based recommendations for pregnant women, infants and young children.

Why have there not been dietary guidelines for these nutritionally vulnerable populations in the past? The cynic would say that the $70 billion global baby food and formula industry has an interest in preventing clear messaging — messaging like “breast is best” — to reach the target audience: expectant or new mothers.

A more interesting question is why these demographics are being looked at now, after years of neglect. The effort, it turns out, has been gestating for a decade.

In 2008, the British medical journal the Lancet published papers that identified the period from conception to 24 months as playing a powerful role in child brain development and future health. They found the consequences of malnutrition during that time were lifelong and irreversible, and linked to a predisposition to obesity, heart disease and other health problems.

“The papers changed the way we were looking at hunger and nutrition,” said Lucy Sullivan, founder and executive director of 1,000 Days, a nonprofit in Washington working to improve mothers’ and children’s nutrition from conception to a child’s second birthday (the first 1,000 days). “We thought if we focus on the first 1,000 days, we have this window of opportunity.”

“The U.S. kept popping up on these charts of problematic countries when it came to low birth weight, breast-feeding and child overweight,” Sullivan said. “Low birth weight can be a risk factor for obesity later in life. That baby is programmed to have a body type that is hoarding those calories. And if a child is overweight by age 5, there is a great risk the child will be dealing with obesity his entire life. It can be a life sentence.”

Parents turn to “What to Expect When You’re Expecting,” Facebook groups and online community boards for prenatal and postnatal nutrition guidance. The federal government has been silent, so lots of other voices, many with profit motives, have crowded in, said Roger Thurow, author of the 2016 book, “The First 1,000 Days.”

“Who has had influence in this period? The corporate influence: the marketing and advertising of unhealthy foods directly to children. That’s what these guidelines would be running against culturally. There’s gathering momentum to look at anemia rates, childhood obesity, the rising prevalence of diabetes and other nutrition-related illnesses and diseases, and the cumulative cost. In our country 1 in 6 kids grows up in a food-insecure family. That should be a concern for all of us.”

It is too early to say what specific recommendations the committee will make, but Ritchie would like to see: a preference for breast-feeding over formula and beginning to transition to solid foods at around 6 months, with a focus on a diet that is mostly plant-based, low in sugar, salt and fat. Another shortcoming of current guidelines, she says, is that they give no recommendations for the consumption of water. (Most other countries include water guidelines).

“Even infants beginning at 6 months should be exposed to water in a cup. Optimally, the only beverages children should drink are milk and water, no other beverages artificially or naturally sweetened,” she said.

Sullivan says these guidelines could help determine what foods are served by many public and private programs and policies, from the National School Lunch Program to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). In 2016, 8.8 million low-income women, infants and children were enrolled in WIC.

Most grown-ups know about what used to be called the USDA food pyramid and is now called MyPlate — and they still may ignore it entirely, opting for processed foods and lots of sugar over whole foods and lean meats. We splurge; we vow to do better tomorrow. Thurow thinks babies, toddlers and pregnant women may be better pupils.

“There’s a craving for that knowledge: What is the best nutrition for me and what do I do for this child? It is one of the commonalities I found following moms all over the world. We always say that children are our future. If it’s true, why aren’t we making sure that all our kids around the world get off to the best start in life?”