The increasing incidence of childhood obesity has garnered significant attention from policy makers, researcher and concerned parties. Globally, the WHO estimates that 42 million children aged below 5 years are obese or overweight (World Health Organization, 2014). This figure shows an increase in the cases of childhood obesity up from 32million in 1990 (World Health Organization, 2014). In the UK, about a third of children aged 2-15 are overweight or obese (Conolly, 2016). Obesity in children predisposes them to medical conditions, such as type 2 diabetes, high blood pressure, congestive heart failure, respiratory problems, hepatic steatosis and sleep apnea (Sahoo et al., 2015). According to Rakel & Rakel (2011), Childhood obesity arises from the interplay between genetic constitution, environment and lifestyle. This means that either the genetic makeup or dietary habit can predispose a child to obesity. There are several interventions that can be used to prevent childhood obesity. Breastfeeding is an example of such interventions. Notably, it has been linked to a reduced incidence of childhood obesity and conveys other benefits for the mother as it lowers their chances of getting breast and ovarian cancers (Moreno et al., 2011). While a number of studies have shown that breastfeeding lowers the risk of childhood obesity in the first six months, other studies have demonstrated conflicting evidence. This research paper will, therefore, investigate whether breastfeeding in the first six months prevents obesity in children.
The benefits of breast to infants cannot be underestimated as it has been shown to provide nutrients, bioactive factors and immunity support for infants in their developmental stages (Woo & Martin, 2015). This means that children who are breastfed receive an optimal nutrition that contains a perfect mix of proteins, fat, and vitamins which are essential in an infant’s growth and development. Notably, breast milk contains leptin, an amino acid that plays a role in the regulation of bodyweight (Zibadi et al., 2013). Mechanistically, leptin induces a feeling of satiety by sending signals to the brain. It has been established that exclusive breastfeeding for the first six months protects infants against bouts of diarrhoea, respiratory illness and minimizes chances of ear infections (WebMD, 2015). Thus, breastfeeding can decrease the number of hospital admission among the infants (Kramer & Kakuma, 2004). Based on the components of breast milk, various studies have recommended that breast milk has a protective against childhood obesity as it reduces the odds of developing it (Hess & Ofei, 2015). Healthcare workers especially nurses should, therefore, address the benefits of breastfeeding to nursing mothers across the continuum of care as has been suggested by research.
Research into the benefits of breastfeeding in childhood obesity was first carried out in 1981 (Kramer, 1981). This research noted that breastfeeding led to a substantial decrease in the risks of obesity in children (Kramer, 1981). Owing to his research, various studies have been carried out to prove his conclusions. In a study carried out in Canada, Rossiter et al., (2015), established that infants who were exclusively breastfed for the first six months had the least likelihood of developing obesity as compared to infants who were formula fed or mixed fed. This means that infants who were formula fed had a higher probability of being obese than their peers who were exclusively breastfed (OR 1.57, 95% CI 1.10-2.25) (Rossiter et al., 2015). Mixed feeding, on the other hand, was found to confer a better benefit as compared to formula feeding (Rossiter et al., 2015). Therefore, breastfeeding has a stronger impact than formula and mixed feeding (combined breast and formula). A similar study was carried out in Germany by Grube et al., (2015), where it was established that infants who were breastfed for more than four months had a major reduction in the likelihoods of being obese. The result of these studies shows that breastfeeding in the first six months has protects against childhood obesity and, therefore, strategies and social policies need to be instituted to promote exclusive breastfeeding for a longer duration. The benefits of this will be the reduction of incidences of childhood obesity and a subsequent long-term reduction of the burden of chronic illness. Moreover, in their meta- analysis study involving 25 studies and 226508 participants, Jing et al., (2014), established that breastfeeding led to slight decrease in the risk of obesity in children (AOR= 0.78; 95% CI: 0.74, 0.81). Based on this statistics, children breastfed as babies had 22% chances of not being obese. The study also explored the relationship between the duration of breastfeeding and the reduced risk of breastfeeding (Jing et al., 2014). Conclusively, the two studies propose that breastfeeding offers a key defensive factor against childhood obesity. According to Arenz et al., (2004), breastfeeding has a slight but a reliable protective action against obesity in children. Notably, the duration of breastfeeding is directly related to the degree of reduction in obesity risk (Jing et al., 2014); therefore, shorter duration of breastfeeding is a predisposing factor to obesity.
While the above studies demonstrate the benefits of breastfeeding in reducing childhood obesity, they have varied results attributed to the varied research method used in each. Grube et al (2015), while demonstrating the benefits of breastfeeding in the reduction of childhood obesity cites ethical concerns in randomizing the test subjects into cohorts. Randomizing subjects into “exclusively breastfed” and “Not breastfed” groups would mean that the test subjects in the “not breastfed” group would have to cope without breast milk and this can endanger their lives. Therefore, this means that the study’s deductions cannot be fully relied upon as they might have been influenced by confounding variables. Statistically, the meta- analyses are also subject to bias and do not give the actual representation a general population (Jing et al., 2014). Moreover, meta-analyses are likely to combine studies utilizing cross-sectional, longitudinal and observational studies have limiting their accuracy. Such studies are likely to be influenced by confounding variables such as socioeconomic status since the studies were carried out in high income countries. The lack of studies in low and middle income areas, therefore, means that the areas do not have an evidence of protective action of breastfeeding. Arguably, various studies have questioned the protective action of breastfeeding on obesity in childhood. Miao & Foster (2013) argues that there is lacks a correlation between the length of breastfeeding and the risk of childhood obesity. This is because there is no direct association between children’s BMI and the extent of breastfeeding (Miao & Foster, 2013). In their study, they concluded that breastfeeding has numerous health benefits but does not cure childhood obesity (Miao & Foster, 2013), hence there is the need to focus on addressing the causes of childhood obesity.
Some scholars have found out that breastfeeding does not have protective actions against childhood obesity (Ryan, 2007). In this study, it is shown that despite breastfeeding being a preventive strategy in childhood obesity, their lacks evidence that breastfed children will not develop obesity later in life (Ryan, 2007). This research was based on 14 studies that were based on the correlation between childhood obesity and breastfeeding. Ryan (2007), determined that six of the studies established that breastfeeding did not confer a protective effect against childhood obesity, three studies testified a protective effect and four noted a partial protective effect in children. Furthermore, one study showed that there was a protective effect in children but not adults (Ryan, 2007). While breast feeding has been shown to have some preventive action against childhood obesity, it cannot be relied upon as the sole preventive measure against childhood obesity. This can be explained by the fact that though there has been an increase in breastfeeding rate in the UK, childhood obesity rates have also increased exponentially (Unicef UNITED KINGDOM, n.d.). This suggests that a number of dynamics are critical in the maintenance of a healthy body weight in children. The existence of possible protective action of breastfeeding against obesity seems to be possible though difficult to prove as there is no relationship between breastfeeding promotions of the body mass index (BMI) (Beyerlein & Von Kries, 2011). Previous studies on the outcome of breastfeeding on the BMI have shown that the BMI is in most cases lower among the breastfed subjects and this is usually attributed to confounding variables and publishing bias (Owen et al., 2005). Though these studies to a larger extent show that breastfeeding has minimal or no protective action against childhood obesity, they acknowledge the importance of breast feeding for the infants.
Based on the studies discussed, it can be agreed that the first six months of breastfeeding does not prevent childhood obesity, but reduces its risk. Various literatures demonstrates that breastfeeding significantly lessens the risk of childhood obesity and the duration of breastfeeding directly correlates to the degree of protection from obesity (Jing et al., 2014). The literature shows that breastfeeding reduces the risks of childhood obesity but not preventing obesity. The benefits of breastfeeding in the first six months of life have been emphasized by the World Health Organization (WHO) in their nutritional guidelines for the infants (World Health Organization, 2017). The WHO endorses an exclusive breastfeeding up to six months of age after which the mother should introduce the child to mixed feeding (combining breast milk with necessary complementary foods) up to two years of age (World Health Organization, 2017). Moreover, the benefits of breast milk in reducing chances of childhood obesity can be attributed to its component, leptin- which is instrumental in regulating body weight and energy consumption (Zibadi et al., 2013). Perhaps, the reduction in chances of obesity in breastfed children can be attributed to leptin and other hormones (Zibadi et al., 2013). Moreover, breastfed children have lower plasma insulin concentrations as compared to formula fed children who have a higher plasma concentration which converts to a prolonged insulin response (Lucas et al., 1981). Increased amounts on insulin would promote the deposition of fats in the body thus leading to weight gain. Conversely, children who are exclusively fed on formula are likely to be obese because their bodies do not have a proper mechanism to regulate fat deposition. The possible mechanism through which breastfeeding reduces chances of childhood obesity could be that breastfeeding mothers tend to choose healthy lifestyles and healthy diets. Thus, the healthier lifestyle can lead to a direct association between breastfeeding and the decreased risk of childhood obesity.
Though a number of scholars note that breastfeeding have protective action against childhood obesity, others have demonstrated a contrary opinion. Analytically, breastfeeding plays a part in reducing chances of childhood obesity but does not prevent its development. This position has been demonstrated by the literature review of various studies showing the potential of breastfeeding in reducing childhood obesity. Though breastfeeding in the first six months of life reduces chances of childhood obesity, there lacks sufficient research that proves whether it can prevent childhood obesity. Researchers’ holding onto the position that breastfeeding does not have a protective role against childhood obesity maintain that breastfeeding has some benefits hence should be promoted in the first six months of life. Moreover, it has been demonstrated that prolonged duration of breastfeeding confers more protective benefits against childhood obesity. Owing to the health complications associated with childhood obesity, the discovery of the association between childhood obesity and breastfeeding is crucial in the management of the condition. Breastfeeding reduces chances of childhood obesity by three different mechanisms. Breast milk has leptin that regulates body weight and energy utilization. Moreover, breastfed infants have a self-regulatory mechanism for energy intake. Finally, breastfed infants have lower insulin levels as compared to their formula fed counterparts whose higher insulin levels lead to increased fast deposition, hence weight gain.
