Posts Tagged ‘breastfeeding’

Does Breastfeeding Increase Infant Weight?

October 31st, 2015

According to a new article by Michael Goran and colleagues it depends on which components of breast milk, (sugary complex carbohydrates called human milk oligosaccharides (HMOs) are present. 25 mother-infant dyads were studied at one and six months of age. Goran is quoted in the Irish Times saying, “But typically we think of obesity risk kicking in after weaning, the timing of introduction to solid foods, early exposures to sugary beverages. Clearly there is something going on before weaning even in babies who are exclusively breast-fed.”

Two HMOs, LNFPII and DSLNT, were each associated with about an extra pound of fat mass at 6 months. Another, LNFPI,  seemed to be protective, linked to a pound less of fat at six months.

 

CDC Spins Breastfeeding-Obesity Link

October 27th, 2015

CDC is continuing to perpetuate the old canard that breastfeeding is protective against childhood obesity. In the recently released publication, Vital Signs: Improvements in Maternity Care Policies and Practices that Support Breastfeeding-United States, 2007-2013,  the CDC states “In addition, evidence suggests that breastfeeding is associated with a reduction in the risk for obesity and diabetes in children (3).”

The reference is a 2007 evidence report on CDC’s sister agency, the Agency for Healthcare Research and  Quality website. However, unlike several other citations, there is no link to the paper. Why? Perhaps because AHRQ identifies the paper as “Archived” and states, “It (the paper) was current when produced and now may be out of date.” Here’s the link:  http://archive.ahrq.gov/clinic/tp/brfouttp.htm#Report.

Maybe out of date? No fooling! See here, here and here for updated research which CDC decided to overlook.

 

Overselling Breastfeeding

October 21st, 2015

Courtney Jung has an interesting opinion piece in the New York Times, “Overselling Breastfeeding.” The writer points out that the goals for the duration of breastfeeding are more accessible to upper and middle-class white women than other mothers. Furthermore, she decries the drift from making breastfeeding a choice for mothers to make to policy decisions which penalize non-breastfeeding mothers. She writes, “Demographic differences in breastfeeding rates also justify government interventions that punish poor women who do not breastfeed. This isn’t just the little unobtrusive little “nudge” in the right direction, designed to compel people to make better decisions. It’s more like a shove, with a kick for good measure.”

Jung notes that arguments that breastfeeding prevents childhood obesity have been largely disproved. See our analysis on this point.

 

A new finding on breastfeeding and obesity

December 16th, 2014

Advocates of breastfeeding as a strategy to prevent the development of obesity persist in the absence of definitive data. So here is another study from Europe which found a ‘non-significant’ trend of breastfeeding toward a protective effect on adolescent abdominal obesity. Nevertheless, the title of the study, “Breastfeeding Shows a Protective Trend toward Adolescents with Higher Abdominal Adiposity,” is somewhat misleading.

 

New Study Confirms Breastfeeding Not Protective for Childhood Obesity

March 14th, 2013

A new study published in JAMA concludes that breastfeeding is unlikely to prevent the development of obesity in children up to 11 ½ years old. The study, involving 17, 046 breastfeeding mother-infant pairs,  contributes to the conclusion reached in an earlier posting, Breastfeeding and Obesity.

Breastfeeding and Obesity

November 28th, 2012

Breastfeeding has long been considered to be protective against the development of adult obesity in the child but a causal relationship has been difficult to establish. Early Life Determinants Evidence from epidemiological research indicates that overweight and obese women are less likely than normal weight women to initiate breastfeeding or maintain it for shorter durations. However, whether this is due to biological, psychological or cultural reasons is unclear.  Systematic Review of maternal obesity and breastfeeding The Growing Up Today Study of 15,000 children showed that, if breastfed longer than seven months, a child was less likely to be obese. Overweight Adolescents and breastfeeding More recent studies appear to mute the benefit of breastfeeding vis a vis child’s adult weight. A study of over 7,000 children found the effects vanished when other factors, such as parental smoking, education and age were analyzed. Exclusive breastfeeding of Swedish children Most recently, a randomized trial of breast feeding promotion in Belarus of 17,000 infants raised the rates of breastfeeding but had no effect on weight. Randomized breast-feeding trial in Belarus

However, reliance on this advice may be misplaced. According to an update of a Cochrane Review, Optimal Duration of Breastfeeding. http://www.ncbi.nlm.nih.gov/pubmed/22895934

“Exclusive breastfeeding for six months versus three to four months, with continued mixed breastfeeding thereafter) reduces gastrointestinal infection and helps the mother lose weight and prevent pregnancy but has no long-term impact on allergic disease, growth, obesity, cognitive ability or behavior. ..A reduced level of iron has been observed. ..

The epidemiologic evidence is now overwhelming that, even in developed countries, breastfeeding protects against gastrointestinal and (to a lesser extent) respiratory infection, and that the protective effect is enhanced with greater duration and exclusivity of breastfeeding. Prolonged and exclusive breastfeeding has also been associated with a reduced risk of the sudden infant death syndrome and, in preterm infants, necrotizing entrerocolitis. Breastfeeding is life-saving in developing countries; a meta-analysis reported markedly reduced mortality (especially due to infectious disease) with breastfeeding even into the second year of life…

The evidence of long term effects of breastfeeding on obesity and mean body mass index (citations omitted) or blood pressure, type 1 or type 2 diabetes, or ischemic heart disease is also weak.

Importantly, they comment on the possibilities of bias in the scientific evidence, stating,

Most of the scientific evidence on the health effects of breastfeeding has been based on observational studies, with well-recognized sources of potential bias. Some of the biases tend to favor exclusively breastfed infants, while others favor those who receive earlier complimentary feeding. Reverse causality is an important potential source of bias. Infants who continue to be exclusively breasted tend to be those who remain health and on an acceptable growth trajectory; significant illness or growth faltering can lead to interruption of breastfeeding or supplementation with infant formula or solid foods. Infants who develop a clinically important infection are likely to become anorectic (loss of appetite) and to reduce their breast milk intake, which can in turn lead to reduction in milk production and even weaning. The temporal sequence of the early signs of infection and weaning may not be adequately appreciated; infection may be blamed on the weaning, rather than the reverse. Advanced neuromotor development may also lead to earlier induction of solid foods, which could then receive ‘credit’ for accelerating motor development.  Poorly-growing infants (especially those in developing countries) are likely to receive complementary feedings earlier because of their slower growth. In developing countries, however, rapidly-growing infants may require more energy than can be met by the increasingly spaced feedings typical of such settings. This may result in crying and poor sleeping, supplementation with formula or solid foods, or both, reduced suckling, and a vicious cycle leading to earlier weaning. ..

Finally, the underlying assumption in this field has been that ‘one size fits all’, i.e. that average population effects can be applied to individual infants. There has been little discussion of the fact that all  infants, regardless of how they are fed, require careful monitoring of growth and illness, with appropriate interventions undertaken whenever clinically indicated.”

In case you haven’t noticed, our pubic health leaders push policies which are virtually 180 degrees away for the Cochrane conclusion. Why such a discrepancy between the highly-regarded Cochrane review and US public health authorities

In May 7, 2012, Health and Human Services Secretary Kathleen Sebelius told the audience at the Weight of the Nation conference, that, in regard to obesity, “ We know that a mother’s health during pregnancy and decisions like whether or not to breastfeed, can have a huge impact on both the mother and child’s health. And these impacts last a lifetime.”  HHS:Speeches:Sebelius: Weight of the Nation

Genetic studies may clarify the mixed outcomes of many studies. Laurent Briollais and colleagues in Canada and Australia have studied 1,096 Australian children from birth to 14 years of age. They found that the presence of the risk allele of the FTO gene, SNP rs9939609. In girls, exclusive breastfeeding for three months interacts with the SNP at baseline and can reverse the increase in BMI. In boys, exclusive breastfeeding reduces BMI in both carriers and non-carriers of the SNP. Six months of exclusive breastfeeding put the boys’ BMI growth curves back to the normal range. If validated by other studies, this finding could bring a new dimension to the breastfeeding and obesity issue.Impact of breastfeeding on  FTO-related BMI

 

Republican Party Platform Guts Obesity Policies

August 30th, 2012

Among the provisions in the Republican Party Platform adopted this week in Tampa, Florida are these affecting obesity:

Food stamps and other nutrition programs be sent in block grants to the states.

On Medicare and Medicaid, the platform states,  “The problem (with these programs) goes beyond finances. Poor quality healthcare is the most expensive type of care because it prolongs afflictions and leads to ever more complications. Even expensive prevention is preferable to more costly treatment later on. When approximately 80 percent of healthcare costs are related to lifestyle – smoking, obesity, substance abuse – far greater emphasis has to be put upon personal responsibility for health maintenance. Our goal for both Medicare and Medicaid must be to assure that every participant receives the amount of care they need at the time they need it, whether for the expectant mother and her baby or for someone in the last moments of life.”

Editor’s note: This paragraph is rather hard to discern. On the one hand, it seems to be an blank check for prevention programs which are, overwhelmingly, governmental programs. Yet, then it shifts to personal responsibility. Then, a neck-whipsawing shift to Medicare and Medicaid participants getting every service they need when they need it. So, what exactly does this mean? Do you get bariatric surgery, for example, when you need it? Or is it denied because you did not take “personal responsibility?”

Regarding Medicare, the platform calls for making the program into a “premium support” program for those age 55 and younger. For these individuals, Medicare would provide a voucher to go out and purchase private health insurance coverage. Currently, Medicare covers bariatric surgery and intensive behavioral counseling for both those over age 65 and those disabled and receiving Social Security disability. Frankly, I am skeptical that private insurance companies (which did not insure elderly persons before Medicare was enacted) would cover such persons and such services without prohibitively high premiums.

For Medicaid, the platform proposes “alternatives to hospitalization for chronic health problems. Patients should be rewarded for participating in disease prevention activities. Excessive mandates on coverage should be eliminated. Patients with long-term care needs might fare better in a separately designed program.”

Editor’s note: The platform does not describe what an “alternative to hospitalization” would be. The reference to “patients with long-term care needs” refers to millions of elderly Americans whose nursing home costs are paid for by Medicaid, after their own assets are exhausted. It has been a politically charged issue to make the spouse’s assets at risk for the patient’s nursing home costs. This was proposed in the Ryan Budget. What a “separately-designed” program would be was not specified.

Of course, the platform calls for  the repeal Obamacare or the Affordable Care Act “in its entirety.” This would include free intensive behavioral  counseling for adults with obesity under plans which were not grandfathered, grants for healthier communities, access to breastfeeding sites at work, access to health insurance by persons whose obesity has prevented them from getting insurance due to a “pre-existing condition, and greater rights for individuals to fight denials of claims.

Of course, also repealed would be the regressive provisions for “workplace wellness” programs which penalize overweight workers for not meeting weight targets set by their employers.

In 2008, The Republican Party Platform, adopted in St. Paul, Minnesota, provided:

“Prevent Disease and End the “Sick Care” System. Chronic diseases – in many cases, preventable conditions – are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital.  To reduce the incidence of diabetes, cancer, heart disease and stroke we call for a national grassroots campaign against obesity, especially among children”.

 

Failure of anti-obesity legislation

August 21st, 2012

Christopher Still and I have a new article out, “Survey of antiobesity legislation: are these laws working?” Unfortunately, the answer is no. This finding is consistent with a paper earlier this year by Dr. Jeffrey Mechanick and last year’s Cochrane Review but contrary to the somewhat rose-tainted view of the Institute of Medicine’s recent report. Here is the abstract:

Obesity is well recognized as a major public health crisis throughout the USA. In recent years,governmental bodies at the federal, state and local levels have enacted policies intended to preventthe transition to obesity. Researchers have had the opportunity to study these policies and evaluate theirimpact on prevention of obesity.

Recent findings Most public policies have been directed principally, but not exclusively, to the prevention of obesity inschool-age children. Interventions have been directed to encouraging breast-feeding, to changing school lunches, limiting access to sugar-sweetened beverages, encouraging physical activity, changing thecomposition of competitive foods and affecting food advertising directed at children as well as collectingBMI information. Efforts more directed at adults include encouraging workplace wellness programs andimproving the nutrition label on packaged foods with front-of-package labels and caloric information on restaurant menus.

Summary  For the most part, evaluations of the interventions reveal weak or modest benefits. The actual picture mightbe less positive due to the poor quality of research and publication bias. Push back by industry and otherswill require higher quality experimental and real world studies. All interventions fail to accommodate themultifactorial aspects of obesity.

See PubMed: http://www.ncbi.nlm.nih.gov/pubmed/22895357