Breastfeeding and Pediatric Obesity in America

Introduction: Rates of breastfeeding have recently increased in America, but still remain low in reference to empirical and US government recommendations. Women are both initiating breastfeeding less frequently than is ideal, and continuing to breastfeed their children for shorter periods of time than that which is clinically recommended. Meanwhile, rates of pediatric obesity in America are at an ever-increasing and perilous high, leading to short- and long-term adverse health effects in developing infants and children. This is especially significant as body composition seen in early childhood has recently been shown to remain stable through adulthood. Obese infants and children are much more likely to be obese as adults than healthy-weight peers. Excessive adiposity is associated with many adverse sequelae, a few of which include cardiovascular and cerebrovascular disease, diabetes, some cancers, and musculoskeletal difficulties. Preventing pediatric adiposity is an important step in promoting lifelong wellness.

Objectives: Many studies have been conducted on the relationship between breastfeeding and pediatric obesity. The purpose of this review is to summarize and synthesize findings of the current body of research on breastfeeding, pediatric obesity, and relationships found therein to form a comprehensive picture of the protective effects of breastfeeding on rates of pediatric obesity. This includes various specific factors which confer protection from obesity, their functions, and limitations.

Methods: Articles were obtained through MEDLINE and CINAHL databases between December 2016 and June 2018. Criteria for inclusion in this review comprised empirical studies with peer-reviewed status, publication in the English language, a publication date within the last ten years unless seminal in nature, and relevant content addressing breastfeeding, pediatric obesity, or both as interrelated. Twenty-eight studies which met these criteria were initially identified and synthesized to develop the content of this project.

Results: Breastfeeding, especially when prolonged and exclusive, is negatively correlated with the incidence of pediatric and lifelong obesity. The more predominant breast milk is in an infant’s diet, and the longer an infant is breastfed (up to nine months), the more pronounced this protective effect is. Factors that mediate and interfere with the protective effect of breastfeeding on excess adiposity include maternal microbial transmissions, the biochemical profile of breast milk versus formula, infant feeding practices, and maternal characteristics such as race and socioeconomic status. Breast milk contains hormones which help infants to develop appetite regulation, and bacteria which comprise an infant’s early gut microbiota; both are implicated in reduced adiposity compared to formula-fed peers. Breastfed babies and their caregivers learn natural intake regulation, whereas bottle-fed babies learn a caregiver-led pattern of intake which leads to overconsumption. Patterns of appetite and intake are established early in life and remain stable thereafter. Notably, the protective effects of breastfeeding against obesity are best preserved in non-Hispanic white women of middle-to-high socioeconomic status (SES). While this partial exclusivity is incompletely understood, possible contributors include maternal BMI and related fatty acid breast milk transmissions which are mediated by race, as well as bottle and formula use which are heavily mediated by both race and SES.

Conclusion: Exclusive breastfeeding for at least nine months is an effective means by which to reduce an infant’s likelihood of developing pediatric and related lifelong obesity. This review supports the importance of excellent breastfeeding education and support on the clinical level. Nursing professionals should both encourage and educate regarding prolonged, exclusive breastfeeding among clients to assist in preventing adverse health outcomes for children in early and later life. Future research is needed to more clearly identify the etiology of the disparities seen in the correlation between breastfeeding and pediatric obesity among various racial and socioeconomic groups.