[Obesity Discussion]

Wow, thanks Yuliya! That's a great article. Amazing on the differences between those who breastfed and those who did not.




Here's the article:


Submission by the Australian Breastfeeding Association to the National Health and Medical Research Council - 2003
Recent research in breastfeeding has produced important information concerning the reduction of obesity in children and adolescents. A brief consideration of some of these findings clearly points to the significance of breastfeeding in reducing the incidence of overweight and obesity in our society.

In 1995-1996 a study of 2106 nine and ten year olds in Dresden and Munich, found a "markedly lower overweight prevalence among breastfed than non breastfed children in both cities." The researchers also noted that, "a longer overall duration and duration of exclusive breastfeeding was associated significantly with decreasing prevalence of overweight." (Liese, et al 2001)
In the United States of America, a 1996-1997 study of 15,341 nine to fourteen year olds (8,186 girls and 7,155 boys) found "that infants who were predominantly fed breastmilk in the first 6 months of life had a lower incidence of overweight 9 to 14 years later" - this lower incidence of overweight or obesity was approximately 22%. As well, the longer the infants were breastfed, the greater the protection against obesity. (Gillman, et al. 2001)
In Germany, a study of 9,206 Bavarian children at school entry in 1997 showed that the prevalence of obesity in children who had never been breastfed was 4.5%, as compared to 2.8% in children who had ever been breastfed. There was a clear reduction in obesity dependent on the length of time these children had been breastfed i.e. 3.8%, 2.3%, 1.7% and 0.8% for breastfeeding for up to 2 months, 3 to 5 months, 6 - 12 months, and over 12 months respectively. Children who had ever been breastfed had a reduction of 20% in their risk of being overweight; if they had been breastfed for six months, this figure was over 35%; and there were even more pronounced effects regarding obesity, 25% and 43% respectively. (von Kries, et al. 1999)
A very large population of 32,200 Scottish children studied at 39 - 42 months in 1998 and 1999, showed that "the prevalence of obesity was significantly lower in breastfed children." This association persisted after adjustment for socio-economic status, birthweight and sex. (Armstrong et al 2002)
A study of 33 768 Czech children using data collected in 1991 found that "a reduced prevalence of overweight/obesity was associated with breastfeeding in a setting where socio-economic status was homogenous." (Tocschke et al 2002)

WHY DOES BREASTFEEDING PLAY A ROLE IN REDUCTION OF RISK OF OVERWEIGHT, AND OBESITY?
There are several factors to be considered:-

Breastmilk is the physiological standard for normal human infant growth and development. All mammals produce milk, and each milk is specifically nutritionally composed to meet the needs of that animal. Humans are designed to grow at a certain rate, to develop in certain ways. The use of infant formula is still in its "infancy" - two maybe three generations? We are still finding out about the long-term effects that this radical change in infants' diet has had on the health of our population.
It is now considered that exposure to excessive calories in infancy can lead the human infant's metabolism to respond by increasing the number of fat cells it lays down in the infant's body. Thus in the future, extra fat can be stored in more cells than otherwise would have been available.
Breast-milk is a living fluid, impossible to replicate, full of activity, taste and with subtle differences in composition from feed to feed.
A recently found protein in human milk, leptin, serves to regulate energy expenditure, and may act as a counter-regulatory hormone to insulin. It may also act as a circulating satiety factor. (Lyle et al, 2001)
The amount of milk a baby takes in is not mediated by the parent or caregiver, who is tempted to get the baby to "drink it all up", or "eat everything on the plate". Leptin, then, and the baby's reactions to his intake, function to ensure that only what is needed is drunk.
Breastfeeding is an adjustable process - babies' feeding intakes vary according to individual needs (Mitoulis et al 2001), and the mothers' supply adjusts automatically to meet these needs, provided the baby has easy and at-need access to the breast.
Mothers of breastfed babies have a more relaxed attitude to their toddlers' intake of solid food and their toddlers consequently eat a wider range of solids and are taller and leaner than their bottlefed counterparts (Fisher et al 2000). The Toowoomba Childrens Nutrition Study (Boulton et al 1999) showed that breastfed infants consumed significantly less full-cream milk, soft drink cordial and soft drinks at 12 months of age.

Conclusion:
The promotion of breastfeeding in these guidelines is essential, and should be viewed as a starting-point in any discussion on dealing with the problems of overweight and obesity in our population. This is something that mothers can do, regardless of income, language-barriers or geographic situation. Government health bills are dramatically reduced when infants are breastfed with fewer visits to doctors, and fewer hospital stays. In 2000 81.1% of Australian babies left hospital breastfeeding, but by 6 months, this figure was only 46.2%, far short of national government targets for that year of 80% of babies exclusively or partially breastfed at 6 months (Donath and Amir, 2000). The problems of obesity in children and adolescents would be reduced if more babies in Australia were breastfed and breastfed for longer.


Recommendations:
In the current Draft Clinical Guidelines, breastfeeding is listed as a risk factor. This is clearly not the case. We recommend that "artificial infant feeding", or "formula feeding" be listed as a risk factor.
We recommend that, as breastfeeding is the physiological norm for infant feeding, language be changed throughout the guidelines to reflect this; ie the risks of artificial feeding, rather than the benefits breastfeeding.
The evidence for formula feeding being a risk factor for obesity is similar to the evidence regarding television watching (111-2). Yet recommendations regarding TV watching carry a Level B recommendation, whereas recommendations regarding infant feeding carry a level C recommendation. Language surrounding the discussion of infant feeding is much weaker, for instance, than language surrounding television watching. We feel that the recommendations regarding infant feeding carry a level B recommendation.
In the commentary, there seems to be a general assumption that infant feeding is not modifiable. Whilst this is the case after a child has been weaned, there is evidence to suggest that many factors influence a mother's decision to breastfeed or not, such as social acceptability of breastfeeding, and the quality of clinical or medical advice they receive.
We recommend that artificial infant feeding be placed in 3.1 Risk Factors.
We challenge the implications of the statement "However, in a time when obesity has increased, breastfeeding rates have also increased" (3.4). This is an extremely simplified analysis of the complicated relationships between infant feeding and overweight, and ignores the cumulative intergenerational effect of artificial infant feeding. (Prentice 2002)
The commentary on measuring and assessing obesity says nothing about the use of infant growth charts and the use of weight as clinical indicators of health. Artificially fed babies follow a different growth pattern to breastfed babies. The World Health Organisation (WHO) iscurrently producing a set of growth charts which more accurately take into account normal infant growth and ethnicity. This should be noted in the guidelines.

REFERENCES:
Armstrong J, Reilly JJ, and the Child Health Information Team 2002, Breastfeeding and lowering the risk of childhood obesity. Lancet 359: 2003-2004.

Boulton J, Landers M 1999, The Toowoomba Children's Nutrition Study 1993-1997. Darling Downs Public Health Unit, Toowoomba.

Dietz WH 2001, Breastfeeding may help prevent childhood overweight. JAMA 285(19): 2506-2507.

Donath S, Amir LH 2000, Rates of breastfeeding in Australia by State and socio- economic status: Evidence from the1995 National Health Survey. J Paediatr Child Health 36: 164 -168

Fisher JO, Birch LL, Smiciklas-Wright H, Picciano MF 2000 Breastfeeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes. J Am Diet Assoc 100(64): 641-646.

Gillman MW, Rifas-Shiman SL,Camargo CA Jr., Berkey CS, Rockett HRH, Field AE, Colditz GA 2001, Risk of overweight among adolescents who were breastfed as infants. JAMA 285: 2461-2467.

Hediger ML, Overpeck MD, Kuzmarski RJ, Ruan WJ 2001, Association between infant breastfeeding and overweight in young children. JAMA 285: 2453-2460.

Kries R von, Koletzko B, Sauerwald T, Mutius E von 2000, Adv Exp Med Biol 478: 29-39.

Liese AD, HirschT, Mutius E von, Keil U, Leupold W, Weiland SK 2001, Inverse association of overweight and breastfeeding in 9 to 10-y-old children in Germany. Int J Obesity 25(11): 1644-1650.

Lightdale JR, Oken E 2002, Breastfeeding and food choices, restrictive diets and nutritional fads. Curr Opin Pediatr 14(3): 3444-349.

Lyle RE, Kincaid SC, Bryant JC, Prince AM, McGhee RE Jr 2001, Human milk contains detectable levels of immunoreactive leptin. Adv Exp Med Biol 501: 87-92.

Mitoulas LR, Sherriff JL, Hartmann PE 2001, Short-and long term variation in the production, content, and composition of human milk fat. Adv Exp Med Biol 478: 401-402.

Prentice, AM Early Life Programming of Adult Disease Conference Papers Breastfeeding: Ancient Art; Modern Miracle September 2001

Toschke AM, Vignerova J, Lhotska L, Oscanova K, Koletzko, B, Von Kries, R. Overweight and obesity in 6-14-year-old Czech children in 1991: Protective effects of breastfeeding. Journal of Paediatrics 2002, Dec; 141(6): 764-9