The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention. The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.

The prevalence of childhood overweight and obesity has increased in most countries the last decades. Considering this in a simplistic way, we can say that obesity is the result of an imbalance between energy intake and energy expenditure. Moreover, the environment from conception to childhood could influence the child’s future health. The first 1000 days of life start with woman’s pregnancy, and offer a unique window of opportunity to contribute to obesity prevention. In light of the actual literature, the aim of our article is to discuss a proposal of 10 good practices to minimize obesity in the first 1000 days emerging from published science. (1) Both the mother’s and the father’s behaviors are important. A balanced diet with appropriate fat and protein intake, and favoring fruits and vegetables, is recommended for both parents during the conception period and pregnancy. Furthermore, overweight/obese women who are planning to become pregnant should reduce their weight before conception. (2) During pregnancy, at birth, and during early life, body composition measurements are crucial to monitor the baby’s growth. (3) Exclusive breastfeeding is recommended at the beginning of life until six months of age. (4) Four to six months of age is the optimal window to introduce complementary feeding. Until one year of age, breast milk or follow-on/commercial formula is the main recommended feeding source, and cow’s milk should be avoided until one year of age. (5) Fruit and vegetable introduction should begin early. Daily variety, diversity in a meal, and repeated exposure to the food, up to eight times, are efficient strategies to increase acceptance of food not well accepted at first. There is no need to add sugar, salt, or sugary fluids to the diet. (6) Respect the child’s appetite and avoid coercive “clean your plate” feeding practices. Adapt the portion of food and don’t use food as reward for good behavior. (7) Limit animal protein intake in early life to reduce the risk of an early adiposity rebound. Growing-up milk for children between one and three years of age should be preferred to cow’s milk, in order to limit intake and meet essential fatty acid and iron needs. (8) The intake of adequate fat containing essential fatty acids should be promoted. (9) Parents should be role models when feeding, with TV and other screens turned-off during meals. (10) Preventive interventions consisting of promoting physical activity and sufficient time dedicated to sleep should be employed. In fact, short sleep duration may be associated with increased risk of developing obesity. Based on literature reviews, and given the suggestions described in this manuscript, concerted public health efforts are needed to achieve the healthy objectives for obesity and nutrition, and to fight the childhood obesity epidemic.