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The contribution  of high fat, high sugar, high calorie foods alongside reduced levels of physical exercise to rising levels of obesity is well established and acknowledged. The role of optimal infant and young child feeding (exclusive breastfeeding for six months, followed by continued breastfeeding alongside appropriate complementary foods) is less well acknowledged.

When considering ways to tackle this problem its important that the focus is moved away from individual ‘choice’ to providing an environment that supports good healthy decision making. Schemes that seek promote breastfeeding but fail to ensure that women receive adequate and  consistent and objective  support and advice at the time they need it and allow conflicting commercial messages to continue,  are likely to back fire and create hostility.

See Protecting breastfeeding -Protecting babies fed on formula Why the UK government should fulfil its obligation to implement the International Code of Marketing of Breastmilk Substitutes and other papers:

http://www.babymilkaction.org/shop/publications01.html#bflgsubmission

http://www.babyfeedinglawgroup.org.uk/monitoring.html  http://www.babymilkaction.org/policy/policyindex.html

Although the vast majority of women in the UK want to breastfeed, most are failed by the system and stop breastfeeding long before they wanted to because of problems that could have been avoided with proper support and care.  Most give up long before they have to return to work.

Indeed the UK has one of the lowest breastfeeding rates in Europe – with less than 1 per cent of mothers in the UK exclusively breastfeeding at six months. The UK infant feeding survey 2005 (Bolling et al. 2007) showed that 78% of women in England breastfed their babies after birth but, by 6 weeks, the number had dropped to 50%. Only 26% of babies were breastfed at 6 months. Exclusive breastfeeding was practised by only 45% of women one week after birth and 21% at 6 weeks (Bolling et al. 2007). 

As new formulas are promoted with lower protein levels, it is important to recognize that rapid early weight gain and later obesity is not only  the result of the extra  calories in  formulas and baby foods.  Breastfeeding and baby-led feeding is likely to influence the development of a taste receptors, fostering a preference for lower energy diets later on in life,  and may help  in developing appetite control mechanisms.

Evidence regarding breastfeeding

Epidemiological evidence strongly suggests that breastfeeding represents an ideal window of opportunity for obesity prevention. Systematic reviews on the association between breastfeeding and obesity show that breastfeeding acts as a protective factor in a dose-dependent and causal fashion Scientific research shows that many biological  factors associated with obesity and chronic diseases may be programmed very early in life or even during pregnancy.   Once a child becomes obese, it is quite likely that s/he will remain obese as an adult.

The report of the BMA Board of Science on Early life nutrition and lifelong health, February 2009 states that: “Breastfed infants have more control over the flow of milk than bottle-fed infants. Breastfeeding is therefore often described as an ideal ‘supply and demand’ regulation system. The feeding behaviour of the baby and the quality of the breast milk change with time in a way that may prevent overfeeding, teach the infant how to recognise satiety signals, and regulate energy intake differently from formula-fed infants. The role of leptin in breast milk may be of particular importance in the early development of both adipose tissue and appetite regulatory systems in the infant, and ultimately on propensity to obesity in later life. A recent study showed that administration of physiological levels of leptin to suckling rats caused a significantly lower body weight in adulthood.¹²⁹ Observational studies have shown that breastfeeding is associated with lower rates of childhood obesity.¹³⁰ Bearing in mind the absence of leptin in formula milk, this may have important implications for the prevention of obesity in children and in adults.”

The USA Centre for Disease Control and Prevention  (CDC) considers that there are only two potential, cost-effective interventions that can be put into place immediately to deal with the childhood obesity epidemic: decreased television viewing and breastfeeding  promotion. (Dietz  WH. Breastfeeding may help prevent childhood overweight. JAMA. 2001; 285:2506

Excerpts from: Recommended Community Strategies and Measurements to Prevent Obesity in the United States  Morbidity and Mortality Weekly Report

www.cdc.gov/mmwr July 24, 2009 / Vol. 58 / No. RR-7

This report describes the expert panel process that was used to identify 24 recommended strategies for obesity prevention and a sug­gested measurement for each strategy that communities can use to assess performance and track progress over time. The 24 strategies are divided into six categories including  strategies to promote the availability of affordable healthy food and beverages;  to support healthy food and beverage choices, and to encourage breastfeeding,

Strategy to Encourage Breastfeeding

Breastfeeding has been linked to decreased risk of pediatric overweight in multiple epidemiologic studies. Despite this evidence, many mothers never initiate breastfeeding and others discontinue breastfeeding earlier than needed. The following strategy aims to increase overall support for breastfeeding so that mothers are able to initiate and continue optimal breast­feeding practices. systematic reviews of epidemiologic studies indicate that breastfeeding helps prevent pediatric obesity: breastfed infants were 13%–22% less likely to be obese than formula-fed infants (77,78), and each additional month of breastfeeding was associated with a 4% decrease in the risk of obesity (79). Furthermore, one study demonstrated that infants fed with low (<20% of feedings from breastmilk) and medium (20%–80% of feedings from breastmilk) breastfeeding intensity were at least twice as likely to have excess weight from 6 to 12 months of infancy compared with infants who were breastfed at high intensity (>80% of feedings from breastmilk) (80).

Systematic reviews indicate that support programs in health-care settings are effective in increasing rates of breastfeeding initiation and in preventing early cessation of breastfeeding. Training medical personnel and lay volunteers to promote breastfeeding decreases the risk for early cessation of breast­feeding by 10% (81) and that education programs increase the likelihood of the initiation of breastfeeding among low-income women in the United States by approximately twofold (75).

Age of introduction of complementary foods and drinks

Many baby foods and drinks in the UK are promoted as suitable from 4-months – (some even younger).  This encourages the introduction of solid foods before the vast majority of babies are developmentally ready to eat family foods, and conflicts with the UK Government  and WHO recommendations: Practices encouraging puree as first weaning foods also encourage parents to overfeed infants at too early an age.

WHA Resolution 54.2, adopted in 2001 URGES Member State: to improve complementary foods and feeding practices by ensuring sound and culture-specific nutrition counselling to mothers of young children, recommending the widest possible use of indigenous nutrient-rich foodstuffs.

It requests  the Director-General to provide support to Member States in the identification, implementation and evaluation of innovative approaches to improving infant and young child feeding, emphasizing exclusive breastfeeding for six months as a global public health recommendation, taking into account the findings of the WHO expert consultation on optimal duration of exclusive breastfeeding (note 1), the provision of safe and appropriate complementary foods, with continued breastfeeding up to two years of age or beyond, and community-based and cross-sector activities.[1]

According to the 2009 BMA Board of Science report,   Early life nutrition and lifelong health,  “The influence of the timing and nutritional content of complementary feeding and the specific effects of variations in quality of complementary feeding on current and later health in countries such as the UK are still to be determined. There are wide variations in infant size, weight gain, linear growth and body composition. There is increasing evidence that these influence the risk of developing obesity, diabetes, cardiovascular disease and other health outcomes in later life. The optimal pattern(s) of infant growth to minimise the risk of obesity, cardiovascular disease and diabetes need(s) to be determined…

Nutrition during infancy also determines later risk of obesity. Rates of overweight and obesity are lower in people who were breastfed, although there is debate as to whether this is a causal relationship. Rapid weight gain in infancy also predicts an increased risk of obesity.

According to a study in the American Journal of Clinical Nutrition, the age at which parents introduce foods to infants may influence his/her body mass indexes (BMI) in adulthood.  Babies who are breastfed for longer seem to have lower BMIs in adulthood, and delaying the introduction of complementary foods reduces the risk of becoming overweight in the long run by 5 to 10 percent.