Childhood obesity has high societal and economic impact but current treatment approaches are sub-optimal. In the last decade, important studies have been conducted aiming to identify strategies to prevent obesity during critical periods of life. Updated recommendations for childhood obesity prevention are needed. We present data from systematic reviews and meta- analysis, randomised controlled trials (RCTs) and large observational studies, published from 2011 onwards that consider the possible role of the following factors in obesity development: breast-feeding; macronutrient composition and method of complementary feeding; parenting style; dietary patterns; sugar-sweetened beverage consumption; eating behaviour (eg, skipping breakfast, family dinners. etc); meal frequency and composition (fast foods, snacking), portion size; dietary modulators of gut microbiota (including pre-, pro-, and synbiotics); physical activity and sedentary behaviour. We used the Medline database and the Cochrane Library to search for relevant publications. Important research gaps were also identified. This position paper provides recommendations on dietary factors, food habits, and lifestyle to prevent childhood obesity development, based on the available literature and expert opinion. Clinical research and high-quality trials are urgently needed to resolve numerous areas of uncertainty.

CNRC Baylor College of Medicine Houston TX

Department of Clinical Sciences Pediatrics Umeå University Umeå Sweden

Department of Health Sciences

Department of Neonatal Intensive Care Oslo University Hospital Norway

Department of paediatric Gastroenterology Great Ormond Street Hospital for Children NHS Foundation Trust London United Kingdom

Department of Paediatrics University Hospital Motol Prague Czech Republic

Department of Pediatrics Vittore Buzzi Children's' Hospital University of Milan Italy

Dipartimento di Scienze Mediche e Chirurgiche University of Foggia Italy

Human Nutrition School of Medicine Dentistry and Nursing University of Glasgow New Lister Building Glasgow Royal Infirmary Glasgow United Kingdom

Newcastle Neonatal Service Newcastle Hospitals NHS Trust and Newcastle University Newcastle upon Tyne

Paediatric Gastroenterology Erasmus MC Sophia Children's Hospital Rotterdam the Netherlands

Paris Descartes University APHP Necker Enfants Malades hospital Paris France

Pediatric Hepatology Gastroenterology and Transplantation ASST Papa Giovanni XXIIII Bergamo Italy

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