- Introducing the Youth Compendium of Physical Activities: A Breakthrough Resource for Childhood Obesity Research
PUBLICATIONS & TOOLS
- CDC releases real world examples to the Community Preventive Services Task Force’s (CSPTF) built environment recommendation to increase physical activity
- Beyond Nutrition and Organic Labels—30 Years of Experience With Intervening in Food Label, USDA Economic Research Services report
- New Nutrition, Physical Activity, and Obesity infographic from Healthy People 2020
- Healthy Eating, Active Play, Screen Time Best Practices maps
CHILDHOOD OBESITY RESEARCH & NEWS
- Stigma experienced by children and adolescents with obesity
- Like a baby: The vicious cycle of childhood obesity and snoring
- Trends in beverage consumption among children and adults, 2003-2014
- In new 18-year master plan, physical-activity levels significantly increase, sparked by healthcare
- TOS Scientific Position Statement: Breastfeeding and obesity
Introducing the Youth Compendium of Physical Activities: A Breakthrough Resource for Childhood Obesity Research
November 30, 2017, NCCOR
The National Collaborative on Childhood Obesity Research (NCCOR) launched the Youth Compendium of Physical Activities to help researchers and practitioners estimate the energy expended for a variety of activities in which youth participate. The Compendium provides measures of energy expenditure for 196 common youth activities including sitting, standing, playing games, walking and running. This new compendium represents a great advancement in the field of youth energy expenditure as it is the first compendium to be based entirely on youth data, and includes METy values separated into four different age groups.
On December 6, NCCOR is hosting a Connect & Explore webinar, “Introducing the Youth Compendium of Physical Activities: A Breakthrough Resource for Childhood Obesity Research.” The webinar will provide information on energy costs and their dependency on age. Presenters will discuss the development of the Youth Compendium and ways to use this new tool.
Join us on Wednesday, December 6, at 3:00 p.m. ET, for the one-hour webinar. Guest speakers include the following researchers:
- Karin Pfeiffer, PhD, an Associate Professor of Kinesiology at Michigan State University. Dr. Pfeiffer will define appropriate metrics for youth energy expenditure and age-dependency.
- Nancy Butte, PhD, a Distinguished Emeritus Professor at Baylor College of Medicine. Dr. Butte will share background on the development of the Compendium.
- Scott Crouter, PhD, an Associate Professor of Exercise Physiology at the University of Tennessee, Knoxville. Dr. Crouter will share how the Compendium can be used by a variety of audiences to measure youth physical activity.
The webinar is free, but space is limited, so register today!
Invite a colleague, and please consider sharing this information on your social networks using the hashtag #ConnectExplore. We will be tweeting during the event, so follow the conversation at @NCCOR. For those who cannot attend, the webinar will be recorded and archived on www.nccor.org.
Publications & Tools
CDC releases real world examples to the Community Preventive Services Task Force’s (CSPTF) built environment recommendation to increase physical activity
Based on the CPSTF’s built environment recommendation to increase physical activity, CDC released an infographic including a chart of real-world examples of combined built environment approaches. These examples illustrate how activity-friendly routes have been linked with everyday destinations in communities across the nation.
Access the infographic: https://www.cdc.gov/physicalactivity/downloads/built-environment-recommendation.pdf
Beyond Nutrition and Organic Labels—30 Years of Experience With Intervening in Food Label, USDA Economic Research Services report
Consumers are increasingly interested in farming methods and the nutritional quality of food. Manufacturers, in turn, are adding more information to food labels. In 1990, Congress passed two watershed laws on food labeling, one requiring nutrition labels to be included on most processed foods and the other requiring organic foods to meet a national uniform standard. This report examines the economic issues involved in five labels for which the Federal Government has played different roles in securing the information and making it transparent to consumers. In addition to the nutrition and organic labels, the report scrutinizes three other labels—one advertising foods made without genetically engineered ingredients, another advertising products made from animals raised without antibiotics, and the Federal country-of-origin label, which is now required for fresh and frozen fruits and vegetables, some nuts, fish and shellfish, ginseng, and certain meats. As interest grows in process-based and other types of food labeling, findings from these five case studies illustrate the economic effects and tradeoffs in setting product standards, verifying claims, and enforcing truthfulness.
Access the full report: https://www.ers.usda.gov/webdocs/publications/85687/err-239.pdf?v=43053
New Nutrition, Physical Activity, and Obesity infographic from Healthy People 2020
Healthy People 2020 releases a new infographic each month with the latest data related to a Leading Health Indicator (LHI) topic. This month’s featured LHI topic is Nutrition, Physical Activity, and Obesity.
Healthy Eating, Active Play, Screen Time Best Practices maps
Funded by Healthy Eating Research, a program of the Robert Wood Johnson Foundation, the Public Heath Law Center at Mitchell Hamlin School of Law developed interactive maps that show healthy eating, active play, and screen time policies, separated by child care setting, for each state. Child care facilities were classified as a home or a center by reviewing the definitions in the child care licensing regulations. Researchers selected the nutrition, physical activity, and screen time practices for obesity prevention in child care settings that either had demonstrated evidence for effectiveness in the published literature or were determined to be key promising practices by a national group of expert stakeholders.
Access the maps: http://www.publichealthlawcenter.org/heal/ChildCareMaps.html
Childhood Obesity Research & News
Stigma experienced by children and adolescents with obesity
November 20, 2017, American Academy of Pediatrics
The stigmatization of people with obesity is widespread and causes harm. Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivating positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change. Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youth. Health care professionals continue to seek effective strategies and resources to address the obesity epidemic; however, they also frequently exhibit weight bias and stigmatizing behaviors. This policy statement seeks to raise awareness regarding the prevalence and negative effects of weight stigma on pediatric patients and their families and provides 6 clinical practice and 4 advocacy recommendations regarding the role of pediatricians in addressing weight stigma. In summary, these recommendations include improving the clinical setting by modeling best practices for nonbiased behaviors and language; using empathetic and empowering counseling techniques, such as motivational interviewing, and addressing weight stigma and bullying in the clinic visit; advocating for inclusion of training and education about weight stigma in medical schools, residency programs, and continuing medical education programs; and empowering families to be advocates to address weight stigma in the home environment and school setting.
More children in the United States suffer from obesity than from any other chronic condition, with one-third of US children and youth having overweight or obesity and 17% of children 2 to 19 years of age having obesity. In some pediatric populations, such as children living in economically challenged communities, as many as two-thirds of children have overweight or obesity. Although some promising signs suggest the prevalence of obesity may be stabilizing, rates remain unacceptably high, and some studies suggest that the rate of children with severe obesity (BMI ≥120% of the 95th percentile) continues to increase.
Although numerous efforts are underway to help children and adults reach and maintain a healthy weight, many such efforts do not address the social consequences of obesity, specifically weight stigmatization and discrimination. Weight stigma refers to the societal devaluation of a person because he or she has overweight or obesity and often includes stereotypes that individuals with obesity are lazy, unmotivated, or lacking in willpower and discipline. These stereotypes manifest in different ways, leading to prejudice, social rejection, and overt unfair treatment and discrimination. For children and adolescents with overweight or obesity, weight stigma is primarily expressed as weight-based victimization, teasing, and bullying.
Weight stigmatization is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivate positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain over time, which worsen obesity and create barriers to healthy behavior change. Experiences of weight stigma also dramatically impair quality of life, especially for youth. A landmark study by Schwimmer et al revealed that children and adolescents with severe obesity had quality-of-life scores that were worse than age-matched children who had cancer. Furthermore, the manifestation of weight stigma is not isolated to older adolescents with severe levels of obesity, because negative weight-based stereotypes toward children with overweight emerge as young as 3 years old. Importantly, peers are not the only sources of weight stigma. Research documents weight stigma by parents and other family members, teachers, health care professionals, and society at large, including the popular media. Thus, children are vulnerable to stigma and its negative consequences in school, at home, and in clinical settings.
Pediatricians and pediatric health care professionals strive to improve the health of patients through direct clinical care and through advocating for systemic and environmental change to support the health and success of patients in homes, schools, and communities. Weight stigma is prevalent through numerous settings and negatively affects the health and success of patients across several domains, including personal and social development, education, and the workplace. Many examples throughout the history of public health demonstrate that disease stigma is a legitimate barrier to prevention, intervention, and treatment. Conditions such as HIV/AIDS, various forms of cancer, alcoholism, and drug use were initially stigmatized and required considerable efforts by the medical field to reduce stigma-induced barriers that impaired effective treatment. Weight stigma is no exception but unfortunately remains an ongoing omission in approaches to address obesity. To best support patients’ healthy changes, it is important to recognize, address, and advocate against weight stigma in all settings.
Like a baby: The vicious cycle of childhood obesity and snoring
November 17, 2017, Beth Israel Deaconess Medical Center
Poor nutrition and lack of exercise lead to the increasing prevalence of obesity which, in turn, is the major predictor of diabetes and future risk of cardiovascular disease in western societies. Excess weight is also closely associated with obstructive sleep apnea (OSA), the increasingly common and potentially serious sleep disorder that is often marked by loud snoring. OSA affects about 5 to 10 percent of children 8 to 11 years old. While evidence suggests that OSA appears to exacerbate obesity and its comorbidities such as diabetes and cardiovascular disease, its effects on children have not yet been studied in detail.
In a new longitudinal observational study, scientists at Beth Israel Deaconess Medical Center (BIDMC) looked at the relationships among maternal snoring, childhood snoring and children’s metabolic characteristics – including body mass index (BMI) and insulin resistance, which reflects future risk for developing diabetes and cardiovascular disease – in approximately 1,100 children followed from gestation through early adolescence. Led by endocrinologist Christos S. Mantzoros, MD, DSc, the team was the first to demonstrate a bidirectional relationship between snoring and body weight in children, meaning each condition increases risk of the other over time. Their findings were published today in the journal Metabolism.
“Excess body weight and child snoring were each predictive of the other among the children and adolescence in this cohort, creating a vicious metabolic cycle,” said Mantzoros, Director of the Human Nutrition Unit in the Division of Endocrinology, Diabetes, and Metabolism at BIDMC. “Our findings confirm the existence of a physiologic loop between worsening obesity and worsening sleep apnea, which in turn leads to worsening obesity and higher risk for diabetes and cardiovascular disease later in life.”
To the best of their knowledge, Mantzoros and colleagues were the first to examine the relationships among maternal snoring, child snoring and child metabolic outcomes in humans. Their findings build on animal data suggesting maternal sleep may affect metabolic outcomes in the next generation. In rodent studies, female rats were exposed to intermittent hypoxia late in pregnancy to mimic maternal sleep apnea. Their male offspring weighed more and ate more, and blood work revealed they had higher fasting levels of insulin, triglycerides and cholesterol levels – the major metabolic biomarkers risk for developing diabetes and cardiovascular disease later in life.
The team analyzed data from Project Viva, a study that recruited expectant mothers from Atrius Harvard Vanguard Medical Associates – a network of 34 medical clinics in eastern Massachusetts – between 1999 and 2002. Mothers filled out annual questionnaires sent in the mail or via email. In combination with blood samples and measurements obtained at in-person research visits at roughly 7 and 13 years of age, the data provided scientists with a trove of information. Data points included but were not limited to: participants’ sleep schedules, television watching habits, fast food and sugar-sweetened beverage consumption, body composition, body mass, blood glucose and cholesterol levels, insulin resistance and overall metabolic risk score.
“We found strong associations between body weight measures and cardiometabolic biomarkers with the later development of sleep apnea in early adolescence,” said Mantzoros, who is also a Professor of Medicine at Harvard Medical School, and chief of the Endocrinology Section at the VA Boston Healthcare System. “These results suggest that in children, early interventions including both targeted weight loss and appropriate treatments for OSA are critical to breaking this vicious cycle between poor sleep and obesity in order to prevent chronic disease later in life.”
The team found that, although maternal snoring had no major effect on children, children who snored were at much higher risk of developing higher body fat mass and obesity late in childhood or adolescence. Biomarkers indicated they were also more likely to develop diabetes and cardiovascular disease later in life.
Mantzoros and colleagues also found that children who snored were more likely to become heavier teenagers and that parent-reported child snoring in early adolescence was strongly correlated to body weight measures such as BMI and measures of central body fat deposition in the body trunk – metabolically the most dangerous fat – as well as to blood levels of the hunger hormone leptin, HDL cholesterol levels and overall metabolic risk scores. Loud snoring showed even more pronounced associations.
Revealing the bi-directional relationship between obesity and OSA in children has major public health implications given that the earlier obesity appears in life, the greater the risk of developing diabetes and its comorbidities earlier in adult life.
To follow up, Mantzoros and his BIDMC colleagues plan to collaborate with metabolism and sleep experts from major Harvard institutions, including BIDMC, Brigham and Women’s Hospital and Massachusetts General Hospital, to test the effects of weight loss and OSA treatment in preventing diabetes and other metabolic complications.
In addition to Mantzoros, study authors include, first author Oliva M. Farr, PhD of the Department of Neurology at BIDMC; Sheryl L. Rifas-Shiman and Emily Oken of the Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School and the Department of Nutrition, Harvard School of Public Health; and Elsie M. Taveras, MD, of the Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children.
This work is supported by grants from the National Institutes of Health (K24 HD069408, P30 DK092924, P30 DK040561, 2K24DK081913.) Project Viva is also supported by grants from the National Institutes of Health (R01 HD034568, UG3OD023286, 1U54CA155626). This research is the result of work supported with resources and the use of facilities at the VA Boston Healthcare System at Jamaica Plain, MA.
Original source: http://www.bidmc.org/News/PRLandingPage/2017/November/Farr.aspx
Trends in beverage consumption among children and adults, 2003-2014
November 14, 2017, Obesity Journal
This study aimed to provide the most recent national estimates for beverage consumption among children and adults in the United States.
Dietary data were collected from 18,600 children aged 2 to 19 years and from 27,652 adults aged ≥ 20 years in the 2003 to 2014 National Health and Nutrition Examination Survey. Total beverage and sugar-sweetened beverage (SSB) consumption was measured by 24-hour dietary recall.
From 2003 to 2014, per capita consumption of all beverages declined significantly among children (473.8-312.6 calories; P < 0.001) and adults (425.0-341.1 calories; P < 0.001). In the 2013-2014 survey, 60.7% of children and 50.0% of adults drank SSBs on a given day, which is significantly lower than 2003-2004, when 79.7% of children and 61.5% of adults reported drinking SSBs. From 2003 to 2014, per capita consumption of SSBs declined from 224.6 calories to 132.5 calories (P < 0.001) for children and from 190.4 calories to 137.6 calories (P < 0.001) for adults. The absolute levels for the percentage of SSB drinkers and per capita consumption of SSBs were highest among black, Mexican American, and non-Mexican Hispanic children, adolescents, and young adults for all years of the study.
Overall, beverage and SSB consumption declined for children and adults from 2003 to 2014. The levels of consumption are highest among black, Mexican American, and non-Mexican Hispanic participants.
Original source: http://onlinelibrary.wiley.com/doi/10.1002/oby.22056/full
In new 18-year master plan, physical-activity levels significantly increase, sparked by healthcare
November 6, 2017, Prescription for Physical Activity
The Prescription for Activity Task Force had a question: How can the healthcare sector be mobilized to work in greater concert with communities across the U.S. to increase physical-activity levels—with a focus on those populations at greatest need?
Today, the Task Force releases its answer: a systems-change map that charts a course to a U.S. culture transformed to prioritize and celebrate physical activity and thus reduce the prevalence of inactivity-related diseases. Published by a volunteer team of more than 60 national experts in healthcare, academia, business, nonprofit, government and more, the comprehensive plan maps how to get 50 percent of Americans to recommended levels of physical activity by 2035. The desired outcome will be achieved through the pursuit and achievement of a series of necessary incremental outcomes over the next 18 years in key subsectors of healthcare and in the communities where care is delivered.
“The Prescription for Activity systems-change map represents a fundamental rethink of investment in health by healthcare and will result in high collaboration between the clinical care and community,” said Eduardo Sanchez, MD, MPH, FAAFP, Chief Medical Officer for Prevention and Chief of the Center for Health Metrics and Evaluation for the American Heart Association, which officially endorsed the white paper. “By using the Theory of Change approach to strategic planning, the Task Force was able to start with what’s possible – 50 percent or more of all Americans across all demographics achieving recommended physical-activity levels — rather than be constrained by the limitations of the binding present. As a result, we now have a blueprint for how healthcare and its various systems and the communities that surround healthcare work in concert to measurably increase physical activity among all individuals and the adoption of healthier lifestyles across the full diversity of the U.S. population.”
The Prescription for Activity Task Force’s plan features three core paths to achieve its goal:
- Care delivery: Assessing, prescribing, and tracking physical activity as a path to enhanced patient outcomes
- Community: Recruiting communities to make physical activity a priority and a source of fun, enjoyment and socialization
- Clinic-Community Integration: Building a bridge of trust and collaboration between healthcare providers and community resources to encourage physical activity
If the outcomes that constitute these paths are achieved as the Task Force recommends, healthcare providers would routinely assess physical-activity levels, encourage physical activity among their patients, counsel on its necessity and then refer patients to community partners to help them become physically active. Trusted by clinicians and healthcare consumers, the community programs would provide effective, affordable and community-based and science-based physical activity. The health and fitness providers would track and assess how their clients did with their goals and adjust care plans accordingly.
“What’s so compelling about what the Prescription for Activity Task Force has created is that it’s implementable,” said Jenny Bogard, Director of Healthcare Strategies at Alliance for a Healthier Generation, which officially endorsed the white paper. “The Task Force isn’t just presenting recommendations. It is presenting what amounts to a highly invitational, inclusive, and fairly detailed plan of attack for bringing communities and healthcare into alignment in the name of evolving U.S. culture to one that puts physical activity first. It’s that goal that animated the task force’s work, so much so that the Task Force now turns its attention to sustained, orchestrated implementation.”
With today’s release of the plan, the Prescription for Activity Task Force turns its focus toward implementation. The first steps of implementation mandate recruitment of critical healthcare stakeholders at the local, state and national levels to build nationwide initiatives and national, state and local pilot programs. Simultaneously, the Task Force has assembled a leadership council to coordinate, communicate, facilitate, measure and evaluate the work specified in the report through 2035.
“When the American Council on Exercise humbly convened the Task Force more than two years ago, we could not have imagined the power of the work that would unfold,” says American Council on Exercise Chief Science Officer Cedric X. Bryant, Ph.D., who facilitated the Task Force. “Within the Task Force was the palpable sense that healthcare has almost limitless capacity to influence the adoption of physically active lifestyles and facilitate a new understanding of the degree to which regular physical activity can enrich lives. What the Task Force presents today is a systems-change map for exactly how to unlock healthcare’s full potential to spark that transformation in understanding, culture, and ultimately measurable health outcomes in communities and populations across the country.”
Physical activity, which encompasses all activities that require bodily movement, such as play, work and exercise, is associated with improved quality of life and a reduced risk of developing chronic disease. However, only one in four adults globally is considered sufficiently physically active, with physical inactivity identified as the fourth leading cause of death worldwide. According to the National Physical Activity Plan, the integration of physical-activity into healthcare is a promising strategy to increase physical activity across communities of all demographics, achieve improved population health and lower the cost of care. And advice from health professionals has been shown to significantly influence the adoption of healthy lifestyle behaviors, including regular physical activity, and can increase patient satisfaction with medical care.
TOS Scientific Position Statement: Breastfeeding and obesity
October 30, 2017, The Obesity Society
In accordance with the World Health Organization (WHO) recommendation of optimal infant feeding practices, and as interpreted in policy documents of the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, Academy of Breastfeeding Medicine, Academy of Nutrition and Dietetics and many other national groups, it is the position of The Obesity Society (TOS) that women should be encouraged and supported to exclusively breastfeed for approximately the first 6 months of an infant’s life with continued breastfeeding through the infant’s first year and beyond as age-appropriate complementary foods are introduced and as mutually desired by the mother and child.
Breastfeeding rates in the U.S. have steadily increased over the past decade but still remain well below targets. The 2016 report of the National Immunization Survey indicated that 21.9% of mothers were exclusively breastfeeding at 6 months postpartum and 29.2% were breastfeeding at 1 year. National objectives for Healthy People 2020 call for increasing the rate of exclusive breastfeeding for 6 months to 25% which remains substantially below the 50% goal established by the WHO Global Nutrition Targets for 2025. Breastfeeding rates are associated with sociodemographic characteristics of mothers including race/ethnicity, level of education, and age, as well as maternal BMI. In comparison to normal weight women, breastfeeding is 14% less likely to be initiated in overweight women and 46% less likely in women with obesity.
The health benefits of breastfeeding for mothers and children not related to obesity are well established. In mothers who breastfeed, immediate health effects include a more rapid recovery from child birth (e.g., reduced postpartum bleeding and involution of the uterus) and protection from postpartum depression. Breastfeeding may also provide longer-term benefits for mothers including protection from breast and ovarian cancers. For children, the benefits include reduced mortality and morbidity due to infectious, allergic, and gastrointestinal diseases, fewer hospital admissions due to diarrhea and lower respiratory tract infections, lower risk for sudden infant death syndrome, and improved cognition.
Does Breastfeeding Benefit Mothers for Obesity-Related Outcomes?
Exclusive breastfeeding expends approximately 500 kcal/day, which may influence energy balance and promote weight loss, although women may compensate with reduced activity or greater energy intake. Many but not all studies have found that a longer duration of breastfeeding is associated with less postpartum maternal weight retention, although some suggest that the beneficial association varies by BMI category. Women who have breastfed are observed to have lower risks of visceral adiposity, hypertension, hyperlipidemia, diabetes, and subclinical cardiovascular disease, as well as cardiovascular morbidity and mortality, perhaps through mechanisms independent of any effect on adiposity. Greater intensity of breastfeeding (greater proportion of breastfeeding as compared to formula feeding) has also been associated with lower risk for type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes.
Does Breastfeeding Provide Benefit to Children for Obesity-Related Outcomes?
Compared to infants never breastfed, breastfed infants have a 12% to 24% reduction in the future risk of overweight/obesity. Because information on duration and intensity of breastfeeding is not always reported, it is unclear if there is an optimal duration and/or intensity of breastfeeding that is necessary to confer a reduced risk in offspring adiposity. Furthermore, differences in overweight/obesity risk in breastfed versus non-breastfed infants are also likely influenced by differences in parental feeding styles, patterns of feeding self-regulation, maternal sociodemographic factors such as race/ethnicity and education, and maternal health (e.g., adiposity, inflammation, insulin resistance) that have been seldom reported or controlled for in published studies. Breast milk is a dynamic, nonuniform substance, and aside from its nutritional properties, breast milk comprises multiple compounds including growth factors, cytokines, immunoglobulins, metabolic hormones, oligosaccharides, and microbiota. Associations between these nonnutritive compounds in human breast milk (e.g., insulin, leptin, adiponectin, IL-6, TNF-α) and alterations in infant growth (e.g., length, weight, BMI-z and ΔBMI-z, fat and lean mass) have been reported and are the subject of emerging research.
The primary limitation of the body of evidence linking breastfeeding with postpartum maternal and child health outcomes is that observational studies cannot fully account for differences in sociodemographic factors, physiology, and behaviors between women (and infants) who do and do not breastfeed or between those who breastfeed for shorter or longer durations. Although many studies have attempted to statistically adjust for measured maternal characteristics including education and prepregnancy BMI, substantial differences likely remain in not only measured but also typically unmeasured factors that strongly predict weight gain. For example, women who have more abdominal obesity before pregnancy or exhibit adverse eating behaviors such as excessive dietary restraint are less likely to breastfeed. A large cluster randomized intervention to promote longer duration and greater exclusivity of breastfeeding did not show significant or meaningful improvements in offspring or maternal weight, adiposity, or blood pressure at approximately 11 years after birth. This intervention was conducted among women who all initiated breastfeeding and so cannot provide information about the comparison of breastfeeding with formula feeding.
Are There Specific Considerations for Women with Obesity and Breastfeeding?
Mothers with obesity are less likely to initiate and maintain breastfeeding, even after adjusting for psychosocial and demographic factors. Higher rates of cesarean delivery and difficulty in positioning the infant at the breast may contribute to this risk; however, defects in maternal physiology are also suggested [28, 29]. Obesity is a strong risk factor for hyperinsulinemia and prediabetes, yet the role of insulin during breastfeeding is still emerging. Similarly, obesity-induced inflammation has recently been shown to compromise breastfeeding by promoting premature involution of the mammary cell. There is concern among some clinicians that energy restriction may impair breastfeeding performance; however, studies have indicated that weight loss can be safe during breastfeeding. An energy deficit achieved by a combination of calorie restriction and increased physical activity to promote a 1-pound per week weight loss (i.e., approximately 500-kcal/day deficit), beginning after breastfeeding has been established, can safely be pursued without affecting breast milk composition or infant growth.
Adequately powered randomized controlled trials do not exist comparing no breastfeeding versus partial or exclusive breastfeeding; however, such trials are likely not ethical or feasible.
Mechanisms by which maternal obesity, inflammation, and insulin resistance influence breast milk composition as well as breastfeeding initiation and duration warrant investigation in order to develop interventions to improve maternal and childhood health and to support breastfeeding success in women with obesity.
There is insufficient evidence to confirm that interventions to promote breastfeeding will result in meaningful improvements for maternal and childhood obesity risk at a population level. However, breastfeeding is not associated with adverse outcomes for women or children and may confer obesity-related health benefits for individuals who choose to breastfeed.
Social and health care support should be provided for women with overweight and obesity who desire to breastfeed their infants. Once breastfeeding is established, women with overweight or obesity can be supported to reduce energy intake and increase energy expenditure with a goal weight loss rate of 1 pound per week until the desired weight is achieved.
Original source: http://onlinelibrary.wiley.com/doi/10.1002/oby.22024/full