01 Aug 2020 Blog: Is there a link between low breastfeeding rates and childhood obesity in the UK?
To mark this year’s World Breastfeeding Week (1st-7th August), our student placement Chloé Higham-Smith discusses whether there is an association between low breastfeeding in the UK and childhood obesity rates, in a blog for Food Active.
Breastfeeding rates in the UK may have increased in recent years, but it still has one of the lowest rates in Europe [1]. Although 81% of mothers in the UK begin to breastfeed, the majority do not continue beyond 3 months, with just 1% of UK infants exclusively breastfed to 6 months – notably low compared to 62% in Sweden [2]. But why are breastfeeding rates in Britain so low, and why is it such a pressing public health issue?
‘Breast is best’
The World Health Organisation currently recommends exclusive breastfeeding for 6 months [3] due to the endless benefits breast milk provides to both baby and mother. Breast milk contains a powerhouse of nutrients required for a baby in a form that is hygienic and easy to digest, acts as baby’s first vaccine, and reduces risks for respiratory infections [1]. There is also a large body of evidence to suggest that infants breastfed for a longer period of time are less likely to be obese in childhood and adolescence. Research by World Health Organisation on 16 European countries found that breastfeeding can cut the chances of a child becoming obese by up to 25% [4] with another study concluding that each additional month of breastfeeding was associated with a 4% reduction in the prevalence of overweight [5]. This can be partially explained by the fact that breastfeeding delays the introduction of solid food which may be high in energy as well as infant formula spiking insulin levels, leading to fat deposition [6]. In addition, children who are breastfed seem to have more favourable food preferences, eating more fruits and vegetables compared to those who are formula fed [7].
Why do so few women continue to breastfeed in the UK?
Breastfeeding in the West is often promoted as being ‘natural,’ which can lead to misconceptions that it is an instinctive and easy behaviour – when in fact many women find breastfeeding challenging [8]. Poverty, difficulty in accessing health services, social marginalisation and marketing of breast-milk substitutes are just some of the reasons for low breast feeding rates in the UK [9]. Lack of breastfeeding knowledge combined with the shortage of support due to Government cuts in 2015 has left many mothers vulnerable to breastfeeding demands [10], with some women reporting having to travel up to two hours to access their nearest support group [11]. Research from the 2010 Infant Feeding Survey revealed that 20% of mothers did not like the idea of breastfeeding, 21% had fed earlier children on infant formula and 19% reported infant formula was more convenient than breastfeeding. Perhaps more startling, 10% of mothers were embarrassed to breastfeed, despite women in the UK having the right to breastfeed anywhere. However, the main reason women were not exclusively breastfeeding to 6 months was because they thought their baby wasn’t receiving enough [12].
Additional support in the first ten days after birth, particularly for first time mothers, has a significant positive effect on breastfeeding rates as the sharpest drop-off in breastfeeding occurs during the first two days [13].
Protection against childhood obesity?
The UK has one of the highest childhood and adult obesity rates, with 1 in 5 children aged 4-5 years affected by overweight or obesity and 1 in 3 children aged 10-11 years experiencing overweight or obesity [14]. Multiple studies suggest that a longer duration of breastfeeding is associated with a larger decrease in the risk of childhood obesity [5,6] yet there is no mention of this in the Government’s 2018 childhood obesity plan which instead focuses on sugar reduction, healthier food and drink and unhealthy food advertising – albeit staggered progress, see Food Active’s analysis of the Government’s progress in its submission to the Health and Social Care Select Committee Childhood Obesity Follow Up Inquiry [15].
More recently, in a bid to beat Covid-19 and protect the NHS, the Government unveiled a new obesity strategy to “help the country lose weight” last week. The measures included a much-anticipated ban on TV and online adverts for less healthy foods before 9pm, end of ‘buy one get one free’ deals and location-based promotions (i.e checkouts/end of aisles) and calories displayed on menus in large restaurants, cafés and takeaways. Whilst these measures are a step in the right direction, acknowledging the need for a whole systems approach and makes progress in three of Food Active’s policy priority areas, the strategy misses the mark by neglecting to recognise the importance of early years intervention – which is also a policy priority for Food Active. The first 1,000 days of life from conception to childhood offer a unique window of opportunity to contribute to obesity prevention and influence the child’s future health [16].
This lack of Government recognition, coupled with a society that struggles to accept breastfeeding as the universal norm, means it is crucial that effective support systems regarding sustained breastfeeding are in place to assist mothers. Childhood obesity is a multifactorial issue, but the large body of evidence displaying the protective factors of breastfeeding must be centre stage in tackling this issue, not to mention the plethora of other benefits that come from breastfeeding for both baby and mother.
Chloé, has been volunteering at Food Active for a number of months, having recently graduated from Liverpool John Moores University and is due to start a Public Health Nutrition Masters at the University of Chester this September. Chloé assists Food Active on a variety of resources, including the development and writing of position statements, blogs, toolkits and reports.
Email: chloe.higham-smith@foodactive.org.uk
Linkedin: https://www.linkedin.com/in/chloe-higham-smith-a27310180/
Twitter: https://twitter.com/higham_smith
References
[1] Buttriss J.L., Welch A.A., Kearney M.J. and Lanham-New A.S., (2018). Public Health Nutrition, Second Edition. The Nutrition Society. Wiley Blackwell, p. 138-145.
[3] Infant and young child feeding: World Health Organisation (2020) [online] Available at: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
[4] Rito, A.I., Buoncristiano, M., Spinelli, A., Salanave, B., Kunešová, M., Hejgaard, T., Solano, M.G., Fijałkowska, A., Sturua, L., Hyska, J. and Kelleher, C., (2019). Association between characteristics at birth, breastfeeding and obesity in 22 countries: The WHO European Childhood Obesity Surveillance Initiative–COSI 2015/2017. Obesity facts, 12(2), pp.226-243.
[5] Harder, T., Bergmann, R., Kallischnigg, G. and Plagemann, A., (2005). Duration of breastfeeding and risk of overweight: a meta-analysis. American journal of epidemiology, 162(5), pp.397-403.
[6] Horta, B.L. and Victora, C.G., (2013). Long-term effects of breastfeeding. Geneva: World Health Organization, 74.
[7] Bosi, A.t.B., Eriksen, K.G., Sobko, T., Wijnhoven, T.M. and Breda, J., (2016). Breastfeeding practices and policies in WHO European region member states. Public health nutrition, 19(4), pp.753-764.
[8] Taylor, A.M., Van Teijlingen, E., Ryan, K.M. and Alexander, J., (2019). ‘Scrutinised, judged and sabotaged’: A qualitative video diary study of first-time breastfeeding mothers. Midwifery, 75, pp.16-23.
[10] Fox, R., McMullen, S. and Newburn, M., (2015). UK women’s experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services. BMC pregnancy and childbirth, 15(1), p.147.
[11] World Health Organisation (2015) Global breastfeeding rates [online] Available at: https://www.independent.co.uk/life-style/breastfeeding-rates-britain-lowest-world-channel-4-dispatches-kate-quilton-a8468416.html
[12] Infant Feeding Survey (2012) [online] Available at: https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010
[13] National Prenatal Epidemiology Unit (2006) Recorded delivery: a national survey of women’s experience of maternity care [online] Available at:https://www.npeu.ox.ac.uk/assets/downloads/reports/Maternity-Survey-Report.pdf
[14] Public Health England (2020) Childhood Obesity: Patterns and Trends [online] Available at: https://www.gov.uk/government/publications/child-obesity-patterns-and-trends/patterns-and-trends-in-child-obesity-national-and-regional-data
[16] Rivkees, S.A., (2019). Protecting the First 1000 Days of a Child’s Life and the 280 Days before. In Fla. L. Rev. Forum(Vol. 71, p. 113).
