Weighing in on the obesity epidemic and breastfeeding

Let’s face it. Americans are plump and we’re getting heavier all the time. Some reasons for this are fairly straightforward. First of all, we like to eat and “value-sized” food is available everywhere. We are often sedentary and have high levels of stress. When we combine these elements, we have the makings of a public-health disaster. Obesity is weighing heavily on our national consciousness. In response, national health campaigns have been launched to curtail our growing girth.¹ In the midst of the discussion, there is one preventive measure we can all applaud: breastfeeding.

Babies don’t overeat

We know that breastfeeding is great for babies and substantially lowers their lifetime risk of obesity. This salutary effect is likely because breastfeeding babies tend to take in what they need without overfeeding, so they learn early on to heed their own satiety cues. We have also recognized that breastfeeding is great for mothers as well, and substantially lowers both their short and long-term risk of overweight and obesity.

Mothers lose weight and gain protection

Breastfeeding helps women lose weight postpartum. But more important is what breastfeeding does for women’s lifetime risk of metabolic syndrome, diabetes, and heart disease.

Metabolic syndrome is the cluster of symptoms that includes:

• insulin resistance (a lowered level of response to insulin, the hormone secreted by the pancreas that helps to regulate the level of glucose (sugar) in the body)
• high triglycerides (a type of fat in the blood)
• high LDL (low-density lipoprotein) “bad” cholesterol—too much cholesterol in the blood can increase the risk of heart and circulatory diseases
• VLDL (very low density lipoprotein) cholesterol
• visceral fat (fat stored in the abdominal cavity)

Metabolic syndrome is the precursor syndrome to both heart disease and diabetes (Haffner & Taegtmeyer, 2003).

During pregnancy, there is a rise in levels of:

• triglycerides 
• LDL cholesterol
• visceral fat accumulation
• insulin resistance.

Basically, pregnancy induces a state of temporary metabolic syndrome.

Breastfeeding specifically resets women’s levels of triglycerides, LDL cholesterol, and lowers levels of insulin resistance and visceral fat to pre-pregnancy levels (Stuebe & Rich-Edwards, 2009). When women do not breastfeed, these levels remain elevated, thus increasing their disease risk. This mechanism likely explains the results of several studies that have found that breastfeeding lowers women’s risk of heart disease and diabetes throughout their lives (Schwartz et al., 2009; Stuebe, Rich-Edwards, Willett, Manson, & Michels, 2005).

A study just published has found a link between longer duration of breastfeeding and a lower risk of metabolic syndrome.

The problem in looking for problems

So it makes sense to encourage all women to breastfeed, right? Unfortunately, there may be a problem. Some recent studies have found that heavier women may have trouble breastfeeding. Seeing these potential difficulties, some researchers have proposed special interventions for women who fall within the “overweight or obese” range of the scale (please note that this is over 60% of the U.S. population). These interventions are offered with the best of intentions, but I am concerned about their potential for discouraging heavier women from trying to breastfeed.

Erica Anstey and Cecilia Jevitt reviewed the research in Clinical Lactation on maternal obesity and breastfeeding and outlined some of the challenges heavy women may face and Lou Lamb described the impact of weight loss surgery on breastfeeding women, creating another potential problem over which to pause when assessing whether lactation intervention is warranted. Lamaze International’s Science & Sensibility blog has described how heavier women are discriminated against in perinatal health settings. 

Heavy women may have problems—or they may not. Mothers who have flat nipples may also have problems—and it’s good to be aware of these potential problems, to  recognize where they exist, and be ready with help if needed. But assuming heavy women will have problems is to undermine them with a lack of confidence in their ability to breastfeed solely through the anticipation of problems because of weight.

Women come in all shapes and sizes. It would be rash to assume that a mother is heavy because she eats too much. The abundance of available food is certainly a factor in our culture’s weight problem—but it doesn’t explain all obesity.

Not just overeating

Studies have revealed that there are other factors, such as sleep problems, depression, and history of psychological trauma, that all increase the risk of obesity (Cappuccio, Strazzullo, D’Ella, & Miller, 2010; Cappuccio et al., 2008; Kendall-Tackett, 2009; Pulkki-Raback et al., 2009). Yes, depression, trauma, and sleep problems) can make you fat! And if these issues are not addressed, they will torpedo weight-loss efforts as surely as a bucket of extra crispy. Fortunately, breastfeeding helps with depression, sleep problems, and trauma, so it really is our best possible tool for improving the population’s health.

Breastfeed

Breastfeeding is unique in its impact on mothers’ health in that it addresses the whole range of factors that put women at risk for diseases.

While breastfeeding may not make all mothers thin, it will improve their health and lower their lifetime risk of disease. And this will be true for women of all shapes and sizes.

¹ Although some of these efforts have been a bit misguided. I attended a national meeting on obesity, where they served cake at the break—without a hint of irony. Full disclosure: I did have a slice.

Recommended reading

Your Plus-Size Pregnancy and Beyond: Positive Information, Advice and Support

References

Cappuccio, F. P., Strazzullo, P., D’Ella, L., & Miller, M. A. (2010). Quantity and quality of sleep and incidence of type 2 diabetes. Diabetes Care, 33, 414-420.

Cappuccio, F. P., Taggart, F. M., Kandala, N. B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008). Meta-analysis of short sleep duration and obesity in children and adults. Sleep, 31(5), 19-26.

Haffner, S., & Taegtmeyer, H. (2003). Epidemic obesity and the metabolic syndrome. Circulation, 108, 1541-1545.

Kendall-Tackett, K. A. (2009). Psychological trauma and physical health: A psychoneuroimmunology approach to etiology of negative heatlh effects and possible interventions. Psychological Trauma, 1(1), 35-48.

Pulkki-Raback, L., Elovainio, M., Kivimaki, M., Mattsson, N., Raitakari, O. T., Puttonen, S., . . . KetikangasJarvinen, L. (2009). Depressive symptoms and the metabolic syndrome in childhood and adulthood: A prospective cohort study. Health Psychology, 28(1), 108-116.

Schwartz, E. B., Ray, R. M., Stuebe, A. M., Allison, M. A., Ness, R. B., Freiberg, M. S., & Cauley, J. A. (2009). Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics & Gynecology, 113(5), 974-982.

Stuebe, A. M., & Rich-Edwards, J. W. (2009). The reset hypothesis: Lactation and maternal metabolism. American Journal of Perinatology, 26(1), 81-88.

Stuebe, A. M., Rich-Edwards, J. W., Willett, W. C., Manson, J. E., & Michels, K. B. (2005). Duration of lactation and incidence of type 2 diabetes. Journal of the American Medical Association, 294(20), 2601-2610.