September 2, 2022
Obesity and Barriers to Breastfeeding
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World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) Baby Friendly Initiative work has promoted breastfeeding globally and brought it once again to the forefront. However, certain groups, such as mothers with overweight and clinical obesity, are often unable to experience the benefits of breastfeeding. A 2014 study demonstrated that only 82.2% (vs 86.4%) of women with obesity are likely to start breastfeeding, and only 44.4 % (vs 53.8%) are likely to breastfeed for at least six months (1). Overall, women who have clinical obesity have “lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight” (2).
These women are thus unable to experience the numerous benefits of breastfeeding, which not only include cost savings but preventative health benefits such as a decreased risk of common infections, protection against certain cancers and diabetes, and the development of the maternal-child bond, which promotes closeness and connection (3). From the obesity perspective, breastfeeding has benefits for both the mother and the child. Breastfeeding mothers tend to lose their pregnancy weight quicker (3). Early research indicates that breastfeeding can promote a healthy weight in children and that breastfed children tend to have a lower BMI later in childhood (3) (4).
Why are mothers with obesity less likely to breastfeed?
Several important links are being researched, but the two most significant factors are delayed lactation and a stressful labor & birth experience. Obesity was found to be an independent factor in delayed lactogenesis, with “delayed” defined as breasts being “noticeably fuller” after 72-hr postpartum” (2). Complicated labor and especially cesarean birth prevented the crucial first skin-to-skin contact, a proven strategy with numerous benefits, which posed as a barrier to initiating breastfeeding for obese mothers (2). These women also described facing practical obstacles, such as challenges in choosing the right nursing top and “social barriers due to their body size and shape, which reinforced the idea that breastfeeding was not for them” (1). Due to the medicalized nature of some women’s pregnancies, being deemed “high risk” by their providers can create a sense of a lack of control and can further impact breastfeeding initiation (1).
What can be done to promote and sustain breastfeeding for this group of women?
Strategies that sustain breastfeeding in this group are twofold – ensuring support networks during pregnancy and after birth and promoting a sense of control. Professional support from physicians and care providers can go a long way. One study found a definite link between healthcare professionals’ support of breastfeeding and subsequent breastfeeding initiation and duration (2).
Many women also reported “that they had needed a ‘cheerleader’ and that seeking professional support had provided encouragement and reassurance that breastfeeding was for them” (1). So, what does this kind of support look like? Starting early with conversations about optimal prenatal weight gain and periodic weight checks can be beneficial in preventing excessive weight gain (5). Having regular check-ins can also help reduce the risk of complications that can be linked to stressful labor & birth. Furthermore, providers should seek to increase their knowledge of how to support women with obesity to breastfeed (2). One such way is to promote a breastfeeding-friendly environment in both clinics and the hospital, limit maternal-newborn separation as much as possible, and create breastfeeding plans attuned to the individual women’s needs (2).
Lastly, addressing the social stigma around breastfeeding is essential. One way to achieve this is to be aware of the obesity stigma and to provide sensitive care by using gentle and inclusive language (2). It is well-demonstrated that women with a higher BMI tend to face numerous challenges in their breastfeeding journey. Ultimately, we as healthcare providers have a responsibility to support these women to achieve their breastfeeding goals, tackle obesity as a medical issue, and create environments that promote breastfeeding for all women.
For more information regarding pediatric obesity, visit OMA’s pediatric resources page.
1) Lyons S, Currie S, Smith DM. Learning from Women with a Body Mass Index (Bmi) ≥ 0 g/m2 who have Breastfed and/or are Breastfeeding: a Qualitative Interview Study. Matern hild Health J. 2019 May;23(5):648-656. doi: 10.1007/s10995-018-2679-7. PMID: 30610528; PMCID: PMC6459079.
2) Chang YS, Glaria AA, Davie P, Beake S, Bick D. Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review. Matern Child Nutr. 2020 Jan;16(1):e12865. doi: 10.1111/mcn.12865. Epub 2019 Aug 6. PMID: 31240826; PMCID: PMC7038894.
3) Moreno MA. Advice for patients. Breastfeeding as obesity prevention. Arch Pediatr Adolesc Med. 2011 Aug;165(8):772. doi: 10.1001/archpediatrics.2011.140. PMID: 21810641.
4) Jwa SC, Fujiwara T, Kondo N. Latent protective effects of breastfeeding on late childhood overweight and obesity: a nationwide prospective study. Obesity (Silver Spring). 2014 Jun;22(6):1527-37. doi: 10.1002/oby.20735. Epub 2014 Mar 17. PMID: 24591416.
5) Yashi Kanica, Rising Obesity Rates in America – A Public Health Crisis, Obesity Medical Association blog, 2022 July 15th. https://obesitymedicine.org/rising-obesity-rates-in-america-a-public-health-crisis/
6) Yashi Kanica, Obesity care in college students in the US, Obesity Medical Association blog, 2022 July 22nd. https://obesitymedicine.org/obesity-care-in-college-students-in-the-us/
Article written by:
Kanica Yashi, MD, MPH, DABOM
Kanica Yashi, MD, MPH, DABOM is an American board-certified Internal Medicine and Obesity Medicine expert, practicing in Cooperstown, New York. Dr. Yashi is also certified in medication-assisted- treatment helping patients with opioid addiction. She is a skilled educator and researcher involved with multiple studies as well as holds important leadership positions with the Obesity Medicine Association and the New York chapter of the American College of Physicians. She also serves as an associate editor for the journal Obesity Pillars. Dr. Yashi is passionate about her practice of obesity medicine and her hobby of “cooking” and is in process of combining the two by making a page for “whole-some” Asian meals especially keeping in mind the nutrients and calories. She also loves swimming, traveling, and spending time with her daughter and husband.