Overweight and Obesity
Infant health research
Breastfeeding has been found to generally reduce a child’s current and future risk of overweight and obesity. Some of the latest studies are below. Find out about the impact of breastfeeding on maternal overweight and obesity in our maternal health research section.
Enabling children to be a healthy weight – what we need to do better in the first 1,000 days
A new report from First Steps Nutrition Trust identifies key actions needed to protect children from overweight and obesity in the first 1,000 days of life, including requiring services to become Baby Friendly accredited. The report outlines 18 key actions needed to promote a healthy weight in the early years, including increasing investment in universal breastfeeding support, regulating the misleading commercial influence of food and drinks for infants and young children, and offering greater support for families to practise age-appropriate introduction of solids and responsive feeding.
Read more on this report here.
Infant feeding and growth trajectories in early childhood: the application and comparison of two longitudinal modelling approaches
Two longitudinal approaches revealed similar findings that infant feeding mode (breastfeeding, mixed feeding, formula feeding) and breastfeeding duration, but not the timing of solid foods introduction, were associated with BMI z-score trajectory in early childhood. The findings provide robust longitudinal evidence to encourage and support extended breastfeeding for childhood obesity prevention.
Barriers and enablers to caregivers’ responsive feeding behaviour: A systematic review to inform childhood obesity prevention
Responsive infant feeding is a critical component of childhood obesity prevention. This review identifies the barriers and enablers to caregiver responsive feeding. Findings indicated that parents’ recognition of a child’s feeding and safety cues are key to the development of responsive feeding, and that caregivers and infants learning to signal to each other is highly important. Therefore, the provision of timely information and education to support caregivers is critical.
Longer term breastfeeding and later introduction of solids associated with lower BMI in children up to five years of age
This Australian study examined the relative impact of breastfeeding duration and timing of solids introduction on BMI score in early childhood. Results demonstrated that children who were breastfed for ≥ 6 versus < 6 months had a lower BMI at all ages from three to 60 months and children who received solids before versus after six months of age had a higher BMI at 18 and 42 months.
Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017
This study of 16 countries across Europe has found that breastfeeding can cut the chances of a child becoming obese by up to 25%. In absolute terms, 16.8% of children who were never breastfed were obese, compared with 13.2% who had been breastfed at some time and 9.3% of children breastfed for six months or more. After adjustment for demographics, children who were never breastfed were 22% more likely to be obese and those who had been breastfed for less than six months were 12% more likely to be obese than children who were breastfed for six months. The protection for children who were exclusively breastfed for six months – with no formula or weaning foods involved – was even higher, at 25%. The data came from nearly 30,000 children monitored as part of the WHO Childhood Obesity Surveillance initiative (Cosi).
Find out more about the study.
Effects of infant feeding on growth and childhood obesity
This evidence review explores the impact of interventions designed to prevent childhood obesity. The review highlights the importance of early years interventions for obesity prevention, and considers the importance of supporting a responsive feeding approach in order to prevent rapid weight gain.
https://www.cedar.iph.cam.ac.uk/resources/evidence/eb-17-infant-feeding-growth-obesity/
Effects of opaque, weighted bottles on maternal sensitivity and infant intake
This study explored whether use of opaque, weighted bottles (as compared with conventional, clear bottles) improves feeding outcomes by supporting responsive bottle feeding and reducing over feeding. The researchers found that when using the opaque bottles, mothers exhibited significantly greater sensitivity during feeding, fed their infants fewer millilitres per kilogram body weight, and fed their infants at a significantly slower rate. They note that infant clarity of cues was a significant moderator of effects of bottle type on intake per kilogram body weight, and that effects of bottle type were not moderated by bottle contents (expressed breast milk vs. formula). They concluded that promotion of opaque, weighted bottles for infant feeding may be a pragmatic approach to improve the quality and outcome of bottle‐feeding interactions.
Infant feeding and weight gain: Separating breast milk from breastfeeding and formula from food
This study explored the link between feeding method and weight, using feeding reports from mothers and hospital documents, and measuring weight and BMIz scores at 12 months. Compared with exclusive direct breastfeeding at 3 months, all other feeding styles were associated with higher BMIzs. Formula supplementation by 6 months was associated with higher BMIzs, whereas supplementation with solid foods was not. Results were similar for weight gain velocity. The authors concluded that breastfeeding is inversely associated with weight gain velocity and BMI. These associations are dose dependent, partially diminished when breast milk is fed from a bottle, and substantially weakened by formula supplementation after the neonatal period.
Effect of a responsive parenting educational intervention on childhood weight outcomes at 3 years of age
This study examined effects of a responsive parenting intervention designed to promote developmentally appropriate, prompt, and contingent responses to a child’s needs on weight outcomes at 3 years. Researchers found that, among primiparous mother-child dyads, a responsive parenting intervention initiated in early infancy compared with a control intervention resulted in a modest reduction in BMIz scores at age 3 years, but no significant difference in BMI percentile. Further research is needed to determine the long-term effect of the intervention and assess its efficacy in other settings.
Early infant feeding of formula or solid foods and risk of childhood overweight or obesity in a socioeconomically disadvantaged region of Australia: A longitudinal cohort analysis
This Australian study of 346 singleton, full term and normal weight infants measured the outcome risk of overweight or obesity at every two-year interval of children aged 0 or 1 year at baseline until they reached age 10 or 11, defined by body mass index (BMI) ≥ 85th percentile. Researchers found that the odds of overweight or obesity were significantly higher among infants introduced to formula or solids at ≤4 months compared to those introduced at >4 months. The odds of overweight or obesity when age at formula or solids introduction was held fixed at ≤4 months, increased significantly for children stopping breastfeeding at age ≤4 months compared to >4 months. The authors concluded that increasing the prevalence of breastfeeding without any formula or solids to 4–6 months in southwest Sydney should be a worthwhile public health measure.
Association of exposure to formula in the hospital and subsequent infant feeding practices with gut microbiota and risk of overweight in the first year of life
This study found that among 1,087 infants from the Canadian Healthy Infant Longitudinal Development (CHILD) cohort, earlier cessation of breastfeeding and supplementation with formula (more so than complementary foods) were associated with a dose-dependent increase in risk of overweight by age 12 months; this association was partially explained by specific gut microbiota features at 3 to 4 months. Subtle but significant microbiota differences were observed after brief exposure to formula limited to the birth hospital stay, but these differences were not associated with overweight.
One in five UK infants are obese at age 14 – but children who were breastfed are less likely to be obese
A new study from the Centre for Longitudinal Studies (CLS) at the UCL Institute of Education has found that one in five young people born in the UK at the turn of the century was obese by the age of 14, and a further 15 per cent were found to be overweight. Researchers analysed information on more than 10,000 teenagers who are taking part in the Millennium Cohort Study. Rates of excess weight varied by country, with almost 40 per cent of young people in Northern Ireland overweight or obese, compared to 38 per cent in Wales, and 35 per cent in both Scotland and England. As well as mother’s education and parents’ home ownership being factors impacting the likelihood of children becoming obese, researchers found that children who were breastfed as infants had lower odds of being overweight and obese at age 14.
Relationship between breastfeeding and early childhood obesity
This Swedish Prospective Longitudinal study of 30,508 infants explored the potential link between breastfeeding in infancy and obesity at age four. It found that any breastfeeding up to 9 months was linked to a reduced risk of childhood obesity at four years. Other factors influencing child obesity were child sex, maternal education, maternal body mass index, and maternal smoking.
The effects of breastfeeding on childhood BMI: a propensity score matching approach
A study of the impact of breastfeeding on childhood BMI found that breastfeeding had a particularly strong effect on BMI in older children, when breastfeeding was prolonged and exclusive. At 7 years, children who were exclusively breastfed for 16 weeks had a BMI 0.28 kg/m2 lower than those who were never breastfed, a 2% reduction from the mean BMI of 16.6 kg/m2. The authors suggested that breastfeeding should be encouraged as part of a wider lifestyle intervention to reduce childhood BMI.
Effect of Exclusive Breastfeeding Among Overweight and Obese Mothers on Infant Weight-for-Length Percentile at 1 Year
This study found that exclusive breastfeeding for 4 months among overweight and obese mothers resulted in less increase in W/L percentiles in the first year. Authors noted the need for concerted efforts to support breastfeeding among obese and overweight mothers, who often have difficulties initiating and maintaining breastfeeding.
Systematic review of interventions to reduce early overweight and obesity
This review identified interventions designed to reduce the risk of overweight/obesity that were delivered before birth or during the first two years of life, with outcomes reported from birth to seven years of age. It was found that nutritional and/or responsive feeding interventions targeted at parents improved feeding practices and had some impact on child weight, while breastfeeding promotion and lactation support for mothers had a positive effect on breastfeeding but not child weight. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change.
Breastfeeding and obesity
This study examined the relationship between >4 months of full breastfeeding and overweight/obesity in children living in Germany. The authors conclude that breastfeeding does have a beneficial effect on childhood overweight and obesity, with the effect strongest in children of primary school age.
The association between breastfeeding and childhood obesity
The authors systematically searched PubMed, EMBASE and CINAHL Plus with Full Text databases. Twenty-five studies with a total of 226,508 participants were included in this meta-analysis. Results showed that breastfeeding was associated with a significantly reduced risk of obesity in children. Categorical analysis of 17 studies revealed a dose-response effect between breastfeeding duration and reduced risk of childhood obesity.
Breastfeeding duration and weight gain trajectory in infancy
This prospective, observational study tested the hypothesis that infants at higher risk for obesity were more likely to be members of a rising weight-for-length (WFL) z score trajectory if breastfed for shorter durations. The authors found that infants at the highest risk for rising weight patterns appeared to benefit the most from longer breastfeeding duration. They suggest that targeting mothers of high-risk infants for breastfeeding promotion and support may be protective against overweight and obesity during a critical window of development.
Epigenetic changes in early life and future risk of obesity
This study reviews evidence for the impact of fetal and early postnatal environments on the risk of developing obesity in later life, with a focus on how particular environments can alter epigenetic regulation of specific genes. The researchers suggest that understanding the role of epigenetics in risk of obesity opens the possibility of new interventions to modify long-term obesity risk and combat the rapid rise in obesity that has been occurring over the last two decades.
Timing of solid food introduction and the risk of obesity
This study examined the association between timing of introduction of solid foods during infancy and obesity at 3 years of age. This research studied 847 children in Project Viva, a prospective pre-birth cohort study. Among formula-fed infants or infants weaned from breastmilk before the age of 4 months, introduction of solid foods before the age of 4 months was associated with increased odds of obesity at age 3 years.
Early bottle-feeding impacts on ability to self-regulate
A study was carried out to investigate whether infants’ self-regulation of milk intake is affected by feeding mode (bottle versus breast) and the type of milk in the bottle (formula versus expressed breast milk). Participants in a large study received monthly questionnaires during their infant’s first year, and complete data were available for 1,250 infants. The authors concluded that infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are fed directly at the breast. Bottle-feeding, regardless of the type of milk, is distinct from feeding at the breast in its effect on infants’ self-regulation of milk intake.
Meta-analyses
Three good and moderate meta-analyses of methodological quality which infer that the risk of obesity is reduced in later life by breastfeeding have been published. Harder (2005) reviewed 17 studies including over 120,000 babies. They concluded that every month of breastfeeding was found to be associated with a 4% decrease in risk. Arenz (2004) reviewed 9 studies, 69,000 babies and concluded that breastfeeding appears to have a small (odds ratio 0.78, 95% CI (0.71, 0.85) but consistent protective effective against obesity. Owen (2005) reviewed 61 studies, 29,800 babies again found a reduced risk of obesity in later life even when confounding variables such as parental obesity, maternal smoking and social class were taken into account.
Breastfeeding and lower BMI
This study of 2,347 Dutch children found that children who were breastfed for more than 16 weeks had a lower BMI at one year compared with children who hadn’t breastfed. A high BMI at one year of age was strongly associated with a high BMI from age one to seven.