1. Breastfeedin g and obesity Dr. Amy Brown Swansea University

2. 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.’

3. Content of breast and formula milk

5. “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)

6. 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…

7. Breastfeeding and weight

8. 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

9. 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

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

12. Why?

13. 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

14. 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)

15. Content of breast milk: the role of protein

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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