Breastfeedin g and obesity Dr. Amy Brown Swansea University

WHO (2012) ‘Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Review of evidence has shown that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.’

Content of breast and formula milk

“Research in the United States, Canada, Europe, and other countries, among predominantly middle-class populations, provides strong evidence that human milk feeding decreases the incidence and/or severity of diarrhea, lower respiratory infection, otitis media, bacteremia, bacterial meningitis, botulism, urinary tract infection, and necrotizing enterocolitis…sudden infant death syndrome, insulin-dependent diabetes mellitus, Crohn's disease, ulcerative colitis, lymphoma, allergic diseases, and other chronic digestive diseases. Breastfeeding has also been related to possible enhancement of cognitive development.” (AAP Policy Statement on Breastfeeding and the Use of Human Milk, 1997)

If 45% of babies were exclusively breastfed for four months there would be… Gastroenteritis 3,285 fewer babies admitted to hospital 10,637 fewer GP consultations Respiratory Infections 5,916 fewer babies admitted to hospital 22,248 fewer GP consultations 21,045 fewer GP visits for ear infection 361 fewer cases of necrotising enterocolitis NHS would save over £40 million per year…

Breastfeeding and weight

Early Growth Slower weight gain Lower weight at 9 and 12 months (but not shorter or head circumference) Formula fed infants more likely to have rapid early growth This led to introduction of growth charts based on breastfed babies

Obesity Breastfeeding reduces chances of childhood overweight by around 15 – 30% Breastfeeding is associated with a 4% decrease in the risk of childhood obesity for each month of breastfeeding until nine months of age. Some studies show a link into later childhood, adolescence and even adulthood

Eating behaviour Breastfed infants are: Less likely to overeat Less likely to eat when not hungry Less likely to be fussy eaters

Why?

Amount of milk Formula fed babies consume more milk throughout the first year – as early as 2 days old Dolberg et al (2001) Day 1: BF: 9.6 ml/kg/day v FF 18.5 ml/kg/day Day 2: BF: 13.0 ml/kg/day v FF 42.2 ml/kg/day Feed more quickly (8ml v 25 ml per minute) Breastfed infants have more sucking pauses

Which means that by 8 months old… A formula fed baby has consumed over 30,000 more calories than a breastfed baby Jones & Bartlett (1999)

Content of breast milk: the role of protein

Breast milk also has Lower plasma insulin Optimal leptin and grehlin levels (appetite) Bio active properties not found in formula milk that help with appetite control

Breastfed babies regulate their intake of milk better If mothers express milk, baby will initially drink more but quickly reduce again Infants of mothers who produce higher energy dense milk consume less If a baby feeds more frequently, they consume less at each feed Have noticeable variations in hunger Reduce milk intake in line with solid foods

Feeding mechanisms Sucking from a bottle is different to feeding from a nipple A formula fed baby is easier to encourage to consume more milk A breast fed baby has to actively latch onto the breast

Maternal feeding patterns Breastfed babies tend to be fed more irregularly whereas formula fed babies to a schedule BF mothers manipulate feeding patterns less – allowing appetite control More aware of subtle hunger and satiety cues Do BF mothers need to be more baby-led? Or do mothers choose to FF to allow more control? Tied to attitudes and experiences

Future eating patterns Breastfed infants: Receive solids later Move to solids more gradually Reduce milk intake in line with solid intake Are more likely to be BLW Less likely to be fussy eaters Accept new foods more readily Healthier diet as children

Maternal factors Mothers who formula feed are: More likely to be overweight Have a negative body image More likely to have negative eating behaviours Be more introverted and anxious Lower SES

Solutions? Supporting all women to breastfeed Importance of responsive feeding Supporting later weaning Continuing to support parents with later diet Exploring body image and diet with women Lower protein formulas