The US Department of Health and Human Services currently promotes Breastfeeding as A Strategy for Reducing the Risk of Obesity in Later Life.
They advise mothers that breastfeeding results in babies that are “less overweight” and who will “tend to gain less unnecessary weight.”
New research shows that this may not be the case and that there is no relationship between babies who were breastfed and later obesity in adulthood. Is it time to reassess the advice offered to mothers to help curb the obesity epidemic?
A review of research conducted during the last few years shows contradictory findings. Supporting the US Department of Health and Human Services point of view , studies from 2004 have claimed to show that breastfeeding children had a direct effect in the reduction of obesity rates. A meta-analysis by Rüdiger von Kries and colleagues compared nine studies looking at over 69,000 participants and concluded that breastfeeding had a “consistent effect against obesity in children”.
As well, in 2005 Andreas Plagemann and colleagues reviewed 17 studies to reveal a “dose-dependent association” between duration of breastfeeding and a decreased risk of obesity.
However, the latest study to show no link between breastfeeding and obesity was published in the International Journal of Obesity in April, 2007. Michele Forman and colleagues evaluated the weight of more than 35,000 nurses over twelve years by monitoring their Body Mass Index (BMI), a measure of weight relative to height. The authors then retrospectively assessed their diets in infancy by asking their mothers to fill out a four-page questionnaire detailing the type of milk their children were fed and the duration of breast and bottle feeding.
The study finds that, once socio-economic factors were removed from the analysis, breastfeeding was not associated with BMI after adolescence. The factors considered were those affecting both mother and nurse: maternal smoking during pregnancy, ownership of a home, the level of the mother’s and father’s education and the occupations of the nurse’s parents during her infancy and childhood were recorded and the results were adjusted to remove any effect they could have.
Furthermore, socio-economic factors affecting the nurse that were considered included her age at menarche – when she had her first period, how many children she has, whether she smokes, amount of physical activity, alcohol consumption, energy intake, menopausal status, her husband’s education and her household income.
Previous studies showing a link between breastfeeding and reduced rates of obesity in later life, and that support the advice of the US Department of Health and Human Services, often neglected to remove these confounding factors.
The debate on the value of breastfeeding in preventing obesity is almost certain to continue, with different studies reaching a range of conclusions. Dr Beckie Lang of the Obesity Resource Information Centre said: “The data on breastfeeding and later obesity is not clear cut, with some papers showing protection, and others not.” “As obesity is a multifactorial problem, it may be one small aspect in a much larger problem. Thankfully, nothing has shown that breastfeeding may cause obesity. The health messages are still to promote breastfeeding, but at this stage I don't think we can claim it protects infants from becoming obese later in life.”
Janet Calvert, Northern Ireland Regional Breastfeeding Coordinator for the Health Protection Agency, agrees and also questions the value of the recent results. Calvert said: “It is possible that these individuals may have had difficulty recalling details of how they fed their nurse daughters. Also as they were the mothers of nurses, they may not have wanted to admit to poor infant feeding practices.” “Perhaps the obesity and breastfeeding debate will continue until we have substantial populations breastfeeding exclusively and for longer. In the meantime there is a plethora of other evidence about why breastfeeding is such a significant public health issue.”
The World Health Organisation (WHO) 2002 Global Strategy for infant and young child feeding recommends exclusive breastfeeding until 6 months with continued breastfeeding until the age of 2 and beyond due to the many benefits of breastfeeding.
The 2007 WHO document “Evidence on the long-term effects of breastfeeding'” presents data that breastfeeding can protect against high blood pressure, high cholesterol and type-2 diabetes. The document also shows a correlation between breastfeeding and higher performance in intelligence tests.
Although there is no evidence to suggest breastfeeding increases the risk of obesity, there is a growing body of research to suggest it has no significant protective effect. Is it therefore right for government health authorities to promote breastfeeding as a protective tool in the battle against obesity? Promoting breastfeeding as a preventative measure may not be damaging to mother or baby, but presenting this uncertain information as scientific fact may be damaging to the value of science in society.
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