Obesity and Infant Feeding Patterns
Linda N. Couvillion,
Starkville MS USA
From: LEAVEN, Vol. 38 No. 3, June-July 2002 p. 51.
Obesity in the United States is a major public health concern for the American Medical Association, the American Academy of Pediatrics, the United States Department of Health and Human Services, and throughout the health care system. Obesity leads to several serious chronic health problems, including cardiovascular, physiological, and psychological diseases. Recent research indicates the possible correlation between infant feeding practices in the United States and obesity during early childhood.
With the decline in breastfeeding in the United States, health care providers have observed an increase in obesity in young children (Nation’s Health 1999). The current growth charts that are used to record the development of infants were devised from records of development for artificially fed (formula-fed) infants. Now investigators are questioning the accuracy of these charts with breastfed infants. Growth statistics seem to reveal that breastfed infants slow down in weight gain around nine to 12 months, at which time many mothers are encouraged to supplement with formula or increase the infant’s complementary food (solids) intake (Hediger et al. 2000). This practice has been used throughout the United States because of the concern that the weight gain of breastfed infants was not satisfactory when compared with artificially fed infants. The US Department of Health and Human Services is studying the design of a new chart that would be geared to the normal growth of a breastfed infant. An independent investigation is also currently underway using a new growth chart, which will include and reflect both populations—artificially fed infants and breastfed infants.
Obesity in young children is a major public health concern and must be prevented in order to safeguard long-term good health for the population in the United States. Early identification of risk factors for increased adiposity (fat) can be instrumental in the prevention of obesity in young children and young adults (Settler et al. 2000). A study similar to the one conducted in Germany by von Kries (1999) should be replicated in the United States to collect data on children at the time of entrance into kindergarten. Such a study would analyze the history of infant feeding practices, the infant growth charts, the medical records, and the current growth data of these children.
Research suggests that the medical costs of artificially fed infants are higher than breastfed infants, and that the medical expenses continue to be higher throughout childhood for the artificially fed infant. It has been observed that artificially fed infants are at risk of developing several chronic illnesses, including those associated with obesity. Such obesity-related chronic conditions include cardiovascular diseases, diabetes, hypertension, and kidney diseases, all of which can lead to early death. The medical treatments to treat these conditions are expensive and long-term. If research continues to suggest that breastfed infants have lower risks for obesity, breastfeeding could become part of a preventive measure to fight against obesity in the United States.
With one out of five children obese, studies have begun to investigate early feeding patterns. Brophy Marcus (2001) stated that infants who were fed formula are 20 percent more likely to be overweight than infants who were breastfed for six months. "Mothers can tell when their breastfed baby has had enough more easily than bottle-feeding mothers."
Women’s Health Weekly (2001) reported there is a physiological and behavioral mechanism associated with breastfeeding that could lower the risk of obesity in adolescents. This risk of obesity in adolescents can lead to morbidity from several diseases in both males and females (Women’s Health Weekly 1998).
One study found a significant link between bottle-feeding and adolescent obesity in the lower socioeconomic status population. Kelly (2001) suggests that a higher caloric intake and increased weight for height score occur in children from lower socioeconomic status who live with an unmarried parent.
With early detection of high risk of obesity, healthy lifestyles can be encouraged and established before the two critical periods of development of obesity. The two critical periods that have been identified as "adiposity rebound" (increased skinfold thickness above the 85th percentile) occur at four to six years, and again during adolescence. Skinfold thickness is a measurement used in evaluating nutritional status by estimating the amount of subcutaneous fat. African Americans have a higher risk of obesity, according to Stettler et al (2000). Hediger et al (2001) reported that one of the strongest predictors of a child at risk of overweight is an overweight parent. Kelly (2001) also discusses this fact.
Von Kries et al. (1999) collected data from children entering school in Germany and he has become one of the advocates to identify breastfeeding as part of an effective protection against obesity. The therapeutic interventions used to help with weight loss are expensive and long-term with low success rates. The study that von Kries et al. conducted showed that breastfeeding develops a programming effect in preventing obesity or becoming overweight in later life. According to this study, infants who were exclusively breastfed for three to five months were 35 percent less likely to be obese. Science News (1998) reported the discovery that leptin, a hormone that controls obesity in adults, is present in human milk and suggested that leptin may have that same role in infants.
In the May 2001 issue of the Journal of the American Medical Association, (JAMA), two articles about studies on the correlation between breastfeeding and the low risk of obesity appeared. The study by Gillman et al. suggested that overweight in adolescents can be associated with the type of infant feeding and that breastfeeding can lower the risk of obesity. Hediger and colleagues investigated the patterns of infant feeding in the United States and stated that there are many variables which have to be considered to get a clear view on the preventive effects of breastfeeding. However, in the same issue of JAMA, Dietz stated in his editorial,
The rapid spread of the obesity epidemic and its implications for illness and health care costs emphasize the urgency with which potentially effective strategies, particularly those with few adverse consequences, should be implemented…. The increased initiation and duration of breastfeeding may also provide a low-cost, readily available strategy to help prevent childhood and adolescent obesity.
Breastfed infants at the age of one year have leaner bodies. Data indicates that breastfed infants have more activity of their upper limbs which could contribute to their leaner body structures. Ahrendsen (2001) summarized a Swedish study in which infants who were breastfed for more than three months were leaner and showed a trend toward lower skinfold values (a measurement used in evaluating nutritional status by estimating the amount of subcutaneous fat). Hediger et al. (2001) stated that the higher protein/nitrogen content of infant formula compared with breast milk may cause a metabolic response of increased insulin and insulin-like growth factor-1 secretion leading to excessive weight gain in formula-fed infants.
The Mississippi Department of Health and Human Services started its breastfeeding campaign through the Women, Infants, and Children (WIC) program (a program in the US that provides supplemental nutrition for low-income families). The breastfeeding promotion campaign with the WIC program in that state serves as the model program in the United States. With those strong findings, more health care providers have joined the US Department of Health and Human Services Breastfeeding Promotion Campaign to make breastfeeding promotion a public health nutrition priority (Hughes 2000).
Editor’s note: Although Leaven generally features articles that directly help Leaders help mothers, we are pleased to share "Obesity and Infant Feeding Patterns" because it contains information that will be interesting to you as Leaders and mothers of breastfed children. Rather than use this information beyond the scope of our roles as Leaders, e.g., to attempt to "diagnose" a baby who may (or may not) be following a different growth curve, or genetically predisposed to be thinner, Leaders who are concerned about a baby’s weight gain should encourage a mother to consult with the baby’s health care provider.
Linda N. Couvillion was accredited as an LLL Leader in Auburn, Alabama, USA in 1976 and is currently the Leader of LLL of Starkville/Columbus Mississippi USA Group. Linda earned her IBCLC in 1999, received her BS in Human Development and Family Studies from Mississippi State University (MSU) in December 2001, and is currently in a Masters program in Extension Education. She lives with her two youngest children(Justine and Steve) in Starkville, Mississippi, USA. This article was the literature search for one of her projects in the MSU School of Human Sciences.
Ahrendsen, J. Outcomes of breastfeeding versus formula feeding. www.drjaygordon.com/bf/bfoutcomes.htm (Web site) March 2001.
Breastfed infants less likely to be obese adolescents. Women’s Health Weekly 2001 Jun; 15-17.
Brophy Marcus, M. Breast-fed babies make leaner kids. US News & World Report 2001 May; 130(21): 59.
Dietz, W. H. Breastfeeding
may help prevent childhood overweight. JAMA 2001 May; 285(19):
Gillman, M. W., Rifas-Shiman, S. L., Camargo, C. A., et al. Risk of overweight among adolescents who were breastfed as infants. JAMA 2001 May; 285(19): 2461-2468.
Hediger, M. L. Association between infant breastfeeding and overweight in young children. JAMA 2001 May; 285(19): 2453-2460.
Hediger, M. L., Overpeck, M. D., Ruan, W. J., et al. Early infant feeding and growth status of US-born infants and children aged 4-71 months: analyses from the third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr 2000 Jul; 72(1):159-167.
Hughes, R., & Williams, J. The Tasmanian Breastfeeding Support Coalition—A case study for increasing breastfeeding promotion capacity. Australian Journal of Nutrition & Dietetics 2000 Dec; 57(4): 233-237.
Kelly, R. A. A predictive model for risk of overweight among children 3-5 years of age: A test of glycemic index of the diet. Unpublished doctoral dissertation, Mississippi State University, Starkville: 2001; 63-98.
Mother’s milk contains leptin. Science News 1998 Jan; 153(4): 59.
Mohrbacher, N. and Stock, J. Breastfeeding Answer Book, Revised Edition. Schaumburg, Illinois: LLLI, 1997; 136.
Obesity hinders breast-feeding. Women’s Health Weekly 1998 Jan; 12-14.
Overweight steadily increasing, breastfeeding rate far below goal. Nation’s Health March 1999; 6.
Stettler, N. Early risk factors for increased adiposity: A cohort study of African American subjects followed from birth to young adulthood. Am J Clin Nutr 2000 Aug; 72(2): 378-383.
von Kries, R., et al. Breastfeeding and obesity: Cross sectional study. BMJ 1999 Jul; 319(7203): 147-151.
THE WOMANLY ART OF BREASTFEEDING. Schaumburg, Illinois: LLLI, 1997; 143-46.
New Pediatric Growth Charts from the Centers for Disease Control and National Center for Health Statistics
By Andrea Eastman, MA, IBCLC
In 2000, the Centers for Disease Control (CDC) and the National Center for Health Statistics (NCHS) released new clinical pediatric growth charts to be used by health care professionals to monitor growth in children from infancy to 20 years of age. The NCHS press release states that these new growth charts "are not only updated and more representative of the US population, but will now include a new assessment for body mass index (BMI). This key tool will help identify weight problems early on in children. These growth charts will be used by pediatricians, nurses, and nutritionists to monitor children’s growth."
In January 2002, Pediatrics published a study by Cynthia L. Odgen and colleagues that was designed to compare the 2000 CDC growth charts to the 1977 NCHS charts. This study found that the new charts are significantly more accurate. The authors state, "The 2000 CDC charts represent a cross-section of children who live in the United States; breastfed infants are represented on the basis of their distribution in the US population. The 2000 CDC growth charts more closely match the national distribution of birth weights than did the 1977 NCHS growth charts, and the disjunction between weight-for-length and weight-for-stature or length-for-age and stature-for-age found in the 1977 charts has been corrected. Moreover, the 2000 CDC growth charts can be used to obtain both percentiles and z scores. Finally, body mass index-for-age charts are available for children and adolescents two to 20 years of age." The authors recommend the use of the 2000 growth charts and state, "pediatric clinics should make the transition from the 1977 NCHS to the 2000 CDC charts for routine monitoring of growth in infants, children, and adolescents."
A press release on January 7, 2002 from the American Academy of Pediatrics, the 2000 CDC growth charts "of average height, weight and head circumference are based on a more recent ethnic and economic cross-section of children in the United States. The CDC charts also take into account both formula-fed and breastfed infants, since breastfed infants may grow differently in the first year of life."
The new charts also measure body mass index (BMI). BMI is calculated by dividing the weight by the height squared, and is used to measure total body fat and whether an individual is overweight.
An article in the New York Times quoted Dr. Robert Kuczmarski: "Our data show that by the age of 8 you can predict with great precision which child is likely to be overweight later in life. BMI is one extra tool that will allow physicians to track this trend and, hopefully, do something about it." In the same New York Times article, Dr. William Dietz is quoted: "We know from a preliminary survey that only 20 to 30 percent of American pediatricians have an adequate understanding of the new growth charts, how to apply the BMI, or are even using them." Hopefully, the AAP will be able to fully educate all of its members in the appropriate use of the new 2000 CDC growth charts.
In 1994, the World Health Assembly issued resolution WHA47.5, which requested the development of a new international reference to assess the growth of breastfed infants. The World Health Organization (WHO) is conducting a multicountry study in diverse geographical settings (Africa, the Americas, Asia, and Europe). The WHO is slated to release its own pediatric growth charts in 2003.
Andrea Eastman lives in Granville, Ohio with her husband, Doug, and her daughters, Chelsea and Amanda. She has been a Leader since 1993, an IBCLC since 1998, and is currently the Chairman of the Board of Directors of AnotherLook, a nonprofit organization dedicated to gathering information, raising critical questions, and stimulating needed research about breastfeeding in the context of HIV/AIDS.
2000 CDC Clinical Pediatric