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Preventing Childhood Obesity: How Breastfeeding Can Help

Gregory J. Soukup, Sr.
San Marcos TX USA
From: LEAVEN, Vol. 43 No. 1, January-February-March 2007, pp. 2-4

Since the 1960s, rates of overweight and obese American children have steadily and significantly increased. This problem is not as prevalent in other countries, but is beginning to surface. An estimated 10.4 percent of two- to five-year-olds, 15.3 percent of six- to 11-year-olds, and 15.5 percent of 12- to 19-year-olds are overweight (Ogden et al. 2002). The older an overweight/obese child becomes, the greater the likelihood he or she will become an overweight/obese adult. A 17-year longitudinal study found that 77 percent of overweight children became overweight adults (Freedman et al. 2001). Being overweight and obese significantly increases individual risks for cancer, cardiovascular disease, diabetes, gall bladder disease, hypertension, and renal disease. Preventing children from becoming overweight/obese is the most effective way for parents to significantly reduce the risk of their children developing many life-threatening diseases as adults. Several genetic and behavioral factors seem to contribute significantly to children being overweight; however, a large body of recent research suggests that breastfeeding will significantly reduce and prevent children from becoming overweight and lessen their chances of becoming overweight adults.

Defining Overweight and Obesity for Children

Many times, the terms overweight and obesity are used interchangeably, but they are not the same. The body mass index (BMI) is a simple equation—body weight in kilograms divided by height in meters squared (kg/m2)—that is used to estimate percent body fat quickly and easily. Overweight is defined as a moderate degree of excess weight-for-height and a BMI from 25 to 29.9. Obesity is a more serious state of an exaggerated excess of body fat that frequently results in a significant impairment of health. A BMI over 30 is considered obese. The BMI has been found to be a valid and reliable means of assessing body fat in children. BMI rates change substantially in relation to the age and gender of the child. Once a BMI is determined, the child is assigned a percentile. A BMI that puts a child in the 60th percentile means that 60 percent of other children of the same age and gender have a lower BMI. The US Centers for Disease Control (CDC) has indicated that BMI ranges from the 85th to 95th percentile by age and gender constitute a child at risk of being overweight. A BMI at the 95th percentile or above identifies a child as being overweight (Kuczmarski et al. 2002).

Genetic Predisposition to Overweight and Obesity

Research on human genetic mapping has identified several specific genes and gene mutations that are believed to cause human obesity (Perusse et al. 2001). Research found that a child born to a parent in the upper five percent of the BMI distribution has a 60 to100 percent greater risk of being obese compared to a child born to parents with normal, healthy weights (Katzmarzyk et al.1999). A study by the US Department of Health and Human Services (2001) determined that a child born with one or more parents overweight has an 80 percent chance of being overweight. The strongest predictor of overweight for a child is the mother's weight; a child's risk of being overweight triples if the mother is overweight and quadruples if the mother is obese (Hediger et al. 2001).

Behaviors That Affect Childhood Overweight and Obesity

Family and child behaviors significantly influence childhood overweight and obesity. In particular, healthy diet and exercise behaviors significantly impact healthy weights for children. Parents can help by providing a healthy diet for their children and by regularly including their children in moderate to vigorous physical activity.

A healthy diet is one of the best ways to prevent obesity in children. Significant increases in obesity among American children have been related to higher rates of sugar intake and fat in their diets. Over the past two decades, consumption of high fructose corn syrup in drinks, baked goods, candies, and other packaged goods has quadrupled. Unlike other sugars, fructose is more readily converted into fat (Bray et al. 2004). Fat is one of the macronutrients (nutrients required in relatively large amounts) the body needs to stay healthy. However, consumption of excessive amounts of fat significantly increases the risk of obesity. Children two and older should consume no more than 30 percent of their total caloric intake from fat (USDHHS and USDA 2005). A correlation has been found between children with strong preferences for fatty foods and obesity (Fisher and Birch 1995). By providing their children with diets based on whole foods, which are naturally lower in both sugar and fat than highly processed foods, parents can greatly reduce their children's risk of becoming obese.

Children in the United States are at an increased risk of obesity because of increasingly more sedentary lifestyles. Recent research has shown that children as young as three are not active enough and are developing overly sedentary lifestyles and behaviors (Reilly et al. 2004). Daily physical activity is necessary for children to maintain an appropriate weight and to promote overall health. Physically active children are more likely to become physically active adults. Researchers suggest that children should participate in a minimum of 20 to 60 minutes of moderate to vigorous physical activity per day. Sedentary activities such as watching television and playing video games have been shown to significantly increase rates of obesity in children as young as three years old (Reilly et al. 2005). Studies suggest that children watch no more than two hours of television a day (Proctor et al. 2003). Because every minute of physical activity burns the equivalent of 10 kilocalories, exercise and physical activity help children control body weight, prevent obesity, and reduce body fat. The most effective way for an obese child to maintain weight loss is for a sustained increase of physical activity equivalent to 200 kilocalories per day.

How Breastfeeding Helps Prevent Overweight and Obesity in Children

Research on breastfeeding and obesity can seem contradictory. Several confounding variables influence body weight in children and many possible factors may contribute to overweight/obesity prevention. However, a growing body of research suggests that breastfeeding has a significant impact on reducing overweight/obesity from infancy to adulthood. A dose-response relationship has been documented that demonstrates that the longer an infant is breastfed, the lower the risk he/she has of being overweight and obese as he/she matures. Breastfed babies have significantly lower rates of fat compared to formula-fed babies at one year of age, and breastfeeding offers protection from future obesity (Dewey et al. 1993; Kramer et al. 1985). At five to six years of age, children who were never breastfed had obesity rates of 4.5 percent compared to obesity rates of 0.8 percent for children who were breastfed for more than 12 months (von Kries et al. 1999). When children reached nine to 12 years of age, those who were breastfed for the first six months of their lives had overweight rates that were 22 percent lower than infants who were not breastfed. Children and early adolescents who were breastfed for longer than six months had even lower rates of overweight and obesity (Gillman et al. 2001). At 18 years old, young adults who were exclusively breastfed for three months or longer were significantly leaner and had less body fat (Tulldahl et al. 1999). Breastfed infants learn to control the amount of human milk and calories they consume better than bottle-fed infants, who are often forced to continue feeding and finish a bottle after they are satisfied. Energy-dense infant formulas may stimulate the endocrine system to secrete more insulin and growth factor than human milk does, which leads to increased rates of body fat in formula-fed babies (Hediger et al. 2001).

How the Mother and Family Can Help

Mothers and family can have an enormous impact on a child's attitudes, behavior, and diet. Families need to be actively involved in helping children develop preferences for nutritional foods. Foods high in sugar and fat should be consumed only as occasional treats. Healthy attitudes toward exercise and physical activity need to be developed in early childhood. Parents should limit the amount of time children participate in sedentary activities such as watching television and playing computer games, and set aside at least one hour every day for activities that encourage exercise and physical activity. Unstructured playtime that allows children to create their own activities needs to be promoted throughout childhood. At about three to five years of age, more structured activities such as games or sports can be introduced to promote cognitive development and physical activity. Parents are strong role models who significantly impact the development of healthy attitudes and behaviors related to preventing obesity. One of the best ways for children to learn healthy habits related to diet and exercise is by watching their parents be good role models. Make it a goal to implement play, exercise, and healthy diet into the everyday lives of everyone in your family.

References

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Fisher, J.O. and Birch, L.L. Fat preferences and fat consumption of 3- to 5-year-old children are related to parental adiposity. J Am Diet Assoc 1995; 95:759-64.
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