Wednesday, January 19, 2011

Fighting the obesity epidemic - kids are not doomed in the womb...

Breastfeeding's role

Raleigh News and Observer
Modified/Published Tue, Jan 18, 2011 02:00 AM

Thank you for the wonderful series on how to address the obesity epidemic.

Concerning "Doomed from the womb?", certainly obesity during pregnancy is associated with many risks for a mother's health. However, it is important for moms who are fighting the battle of the bulge to know that they are not dooming their children from birth.

While the rate of height increase is indeed pretty much set in the womb, this is not so with the rate of weight increase. We have a window of opportunity to modify this at birth and to set the new baby on the path to proper weight gain. An important step on the path is supporting every mom in considering and succeeding in early and exclusive breastfeeding. Those dangerous overfeeding behavior habits are just not possible with breastfeeding. The breastfeeding baby will take only what it needs for good growth.

Exclusive breastfeeding is good for mothers and infant health, and it is an available intervention to help prevent a continuing cycle of obesity. Obese moms who exclusively breastfeed their babies can set the next generation on a path to a healthier rate of weight gain.

Friday, January 14, 2011

Some of my academic friends in the UK seem to think that we should return to 4 months of exclusive breastfeeding....

Dear Readers of the BMJ, or the article "Six months of exclusive breast feeding: how good is the evidence?" BMJ, 2011; 342 by Mary Fewtrell, David C Wilson, Ian Booth, and Alan Lucas:

With thanks to my friends and respected colleagues for addressing the importance of six months of exclusive breastfeeding, it would seems that their argument considers breastfeeding primarily as a replacement for formula feeding. The health benefits for the mother, both short and long term, are not explored, and the risks and expense of formula feeding, even in industrialized settings, are brushed aside.

For the most part, this article actually presents substantial additional data supporting six months for the infant and child health outcomes while noting the few findings that might speak against it. One possibly new issue raised, based on a single Swedish study, is coeliac disease; the article itself notes that gluten load, rather than timing, might well be the culprit. Concerning iron stores, we know that much of this problem could be addressed with proper delay of cord clamping, giving infants greater iron stores from birth, or if still needed, later micronutrient supplementation might be considered. This birth-related issue and other maternal issues are disregarded: six months (vs. four) exclusive breastfeeding has many advantages for maternal health and birth spacing in less developed and industrialized countries alike. Also, the large body of published research on later maternal and child obesity, cancer and related diseases is barely considered. In sum, there is little here to argue against the definition of optimal feeding practice, for mother and child, to remain exclusive breastfeeding for six months.

As to the research from developed countries, such research on exclusive breastfeeding in developed countries is very difficult to interpret in part due to small self-selected numbers and in part due to inadequate definitions of breastfeeding practices. The WHO nutrition section and other nutrition groups tend to define the term exclusive breastfeeding only in its role as a food, and therefore the definition of exclusive breastfeeding generally includes the feeding of expressed milk and/or pasteurized donor milk. Such milk feeding may not be creating the same physiological, hormonal and gut floral/fauna responses in the mother and child as is created by direct breastfeeding, and, in situations where there may be considerable separation of mother and child, the immune composition of the milk may no not address the child's environmental exposures. We are far from understanding the differences in health outcomes for mother and child with the use of pumps and expressed milk, a very common practice in the US. Other concerns, such as delayed exposure to food flavors, would not appear significant, given recent research that has confirmed that breastfed infants are already exposed to the flavors of foods ingested by mother through her milk.

On a different issue, it may also be important to correctly the statement on US government support. USG policy has noted the importance of six months, rather than 4-6, since the preparation of the US DHHS Blueprint for Action on Breastfeeding, published in 2000, and has been supporting six months exclusive breastfeeding for more than 5 years with the Healthy People goal for the Nation to increase exclusive breastfeeding through six months.

Finally, it might be noted that three of the four authors declare receiving funding from the infant food industry, which would benefit from policy that dictated a significant increase in the need for infant formula.

Rather than calling for truncation of exclusive breastfeeding, limiting its myriad of positive immediate health, child spacing and long-term health effects, let us instead call for 1) delayed cord clamping for iron stores, with iron supplements as needed in later infancy, 2) research on the impact of exclusive breastfeeding vs. expressed milk feeding on the health of both mothers and their children, and, most of all, 3) unbiased, informed, and mother-centered support - clinical, social and economic - so that women may make an unbiased, informed infant feeding choice, and succeed in six months of exclusive breastfeeding.


Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM, The Carolina Breastfeeding Institute (CGBI) Professor, and Director, CGBI
Note: Labbok is on the Board of the Academy of Breastfeeding Medicine and North America Representative on the Board of Directors, World Alliance for Breastfeeding Action