This document summarizes evidence that breastfeeding can help combat childhood obesity. It finds that exclusive breastfeeding for at least one year is associated with lower rates of childhood obesity compared to formula feeding. This is because breastmilk regulates appetite and promotes healthy weight through hormones. While breastfeeding rates have increased in the US, rates of exclusive breastfeeding at 6 and 12 months have remained low. Increasing exclusive breastfeeding could help address the epidemic of childhood obesity and subsequent risks of adult obesity and related diseases.

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Breastfeeding: An approach to combat
childhood obesity
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2. 13Agro FOOD Industry Hi Tech - vol. 26(6) - November/December 2015
KEYWORDS: Breastfeeding, infant nutrition, childhood obesity, adulthood obesity, appetite-controlling hormones.
Abstract The global rise of childhood obesity has become a major public health concern due to surmounting
evidence of associated health issues, including hypertension, type 2 diabetes, cardiovascular diseases,
and some cancers. This requires a multifaceted approach to find solutions that can effectively control the epidemic. One major
approach is breastfeeding, which is considered to be the preferred form of infant nutrition. Our review of literature finds substantive
evidence that exclusive breastfeeding for at least one year after birth could possibly help prevent childhood obesity. One of the many
documented benefits is its role in weight control, with breast-fed infants being leaner than their formula-fed counterparts through
adulthood. Breastmilk is rich in many different biochemicals, including hormones that regulate appetite and promote healthy weight.
Optimal nutrition should start early in infancy with exclusive and sustained breastfeeding if we are to make any headway against
childhood obesity.
Breastfeeding:
An approach to combat childhood obesity
INTRODUCTION
Over the last two decades, childhood obesity has continued
to climb at an alarming rate. The purpose of our paper is to
provide evidence from literature reviews supporting exclusive
breastfeeding to help combat childhood obesity. From
1999-2010 the prevalence of obesity among children and
adolescents aged 2–17 years increased from 15.4% to
18.6% among boys and from 13.8% to 15.1% among girls
(1, 2). During that same period of time, the prevalence of
obesity among children aged 2 to 5 years actually decreased
from 13.9% to 8.4% (3). This data suggests that while some
previous interventions have worked, other risk factors have
contributed to the uptrend in obesity post adolescence. We
suggest that more education be provided to new mothers,
regardless of gravidity, about the benefits of exclusive
breastfeeding for at least one year post-birth.
One method used by professionals to screen for overweight
and obesity is the Body Mass Index (BMI). BMI is calculated by
dividing the weight (kilograms) by the height squared (meters)
and the American Association for Pediatrics uses the BMI in
children to define overweight as being a value falling in the
85th percentile and obesity falling in the 95th percentile for
age and gender (4). Although there are many factors that
contribute to obesity in childhood and adulthood, the main
causes of childhood obesity include excessive caloric intake,
inactivity, and certain demographic and socioeconomic
factors (5). The purpose of this review is to provide evidence in
support of breastfeeding as a practical method for lowering
childhood obesity by evaluating evidence for and against
breastfeeding as an approach to combat obesity in children.
Statistics And Causes Of Childhood Obesity
A study by Fryar and colleagues in 2012 mapped the trends
in childhood obesity over the previous four decades, from
the early 1970’s through 2010, and discovered that the
percentage of obese children and adolescents aged 2-19
years increased by more than threefold (6). This extreme
rate of growth in obesity for children and adolescents
far outpaces the growth of obesity among adults during
this time, which only grew by 25% (7). Based on extant
knowledge regarding childhood obesity and its direct
correlation with obesity in adulthood, a rise in the childhood
epidemic could subsequently promote an increase in the
adult epidemic. Furthermore, estimations from the Finkelstein
et al. predict that 51% of adults will be obese by the year
2030 (8), so the importance of decreasing the rate of growth
in childhood obesity is paramount.
Link between childhood obesity and adulthood obesity
Evidence from epidemiological studies, animal models,
and experimental interventions have shown that nutrition-
-good or bad-- early in life could affect health later in
adulthood. It has been hypothesized that infants who
grow too rapidly have an increased risk of developing
components of metabolic syndrome and indicators of
cardiovascular disease, insisting on the need to begin
interventions during infancy to prevent obesity related
complications in adulthood (9). There is also evidence
that suggests there are correlations between higher birth
weights and higher adult BMI, proposing that birthweight
is a predictive indicator of lean mass later in life, implying
that babies who weigh more tend to become obese as
adults (10). In addition to childhood obesity presaging
INFANT NUTRITION
CHAD BURLESON1, SHANNON M. CEARLEY2*, PADMINI SHANKAR1, SUMAN AHUJA3
*Corresponding author
1. Georgia Southern University, Statesboro, GA, USA
2. Independent Researcher, Augusta, Evans, GA, USA
3. Lincoln University, MO, USA
Shannon M. Cearley

3. breastfeeding extend much farther than just obesity. A
systematic review by Owen et al. found that breastfeeding
in infancy was associated with a lowered risk of diabetes
and lowered insulin concentrations in infancy and adulthood
(18). Since childhood obesity predisposes adult obesity, the
general consensus among health professionals is to prevent
this occurrence among children as early as possible. Although
some studies have concluded there are no significant
associations between prevalence of overweight among
breastfed children compared to formula-fed or both, more
evidence suggests the benefits are in favor of exclusively
breastfeeding infants to promote healthy body composition
among children (19), yet in 2012, the percentage of exclusive
breastfeeding or breastfeeding in combination with other
foods and liquids, the rates significantly declined even before
one month of age (see Figure 3).
These charts (Figures 1-3) represent the breastfeeding rates in
2013 and 2014 from phone surveys (cell and landline) from the
National Immunization Survey.
adulthood obesity, other consequences include
psychosocial, neurological, pulmonary, cardiovascular,
gastrointestinal, renal, musculoskeletal and endocrine
malfunctions and disorders (11). Biro and colleagues
concluded that metabolic syndrome and type 2 diabetes
in adulthood were consequences of childhood and
adolescent obesity (12), and more current research
continues to provide evidence suggesting a strong
association between a high childhood BMI and diseases
in adulthood including obesity, coronary heart disease,
diabetes, and some cancers (13).
Some studies suggest that since many obese adults were at
a healthy weight during adolescence, childhood BMI should
not be considered as a predictive mechanism for adulthood
obesity; however, evidence based on using childhood BMI
is indicative that 1) childhood obesity leads to adulthood
obesity and 2) adolescent obesity progresses into adult
obesity. Although there are studies providing evidence that
many individuals who were overweight as children matured
into adults who lived lean, healthy lives (13), it has been
documented that adipocyte (fat cells) numbers remain
constant throughout a person’s life (13). This means that
as adipocytes die, the cumulative number remains the
same because each death is replaced by a proportionate
number of new adipocytes. The importance in childhood
obesity was reported by Spalding et al. who concluded
that the adipocyte number is set during childhood and
adolescence, regardless of weight. These adipocyte
numbers undergo very little variation in adulthood, even
after a significant weight loss (14). The significance lies in the
possibility of exposing children to large caloric quantities
early in life, increasing adipocyte volume and number,
thus making weight gain later in life much more rapid
and weight loss much more difficult for adults who were
overweight as children (14).
Supporting evidence that breastfeeding prevents childhood
obesity
The global epidemic of childhood obesity calls for a multi-
pronged approach to find effective solutions. One approach
has been the promotion of breastfeeding, initiation and
exclusivity, as the most effective means of maintaining
healthier body weight among children (15). Breastfeeding
has been advocated as a possible and effective method
for reducing the prevalence of childhood obesity, since
breastfeeding in the first months of life exposes the child
to necessary and beneficial nutrients. Also, it is possible
that “metabolic imprinting” takes place as a result of
breastfeeding, which can have a lifelong effect on the
child’s metabolic pathways (16). The American Academy
of Pediatrics (4) recommends mothers exclusively breastfeed
their infants until six months of age, then continue
breastfeeding in combination with complementary foods
until the baby reaches 12 months of age. In addition to
these guidelines, the AAP also recommends breastfeeding
for as long as both the mother and the baby desire. (17).
Despite these recommended guidelines, (see Figures 1 and 2)
breastfeeding in 2012 only slightly increased from 2003, and
during the same time frame, exclusive breastfeeding was
much lower than breastfeeding combined with other foods
and liquids.
It is important to understand that the health benefits of
Figure 1. Percentage of U.S. Children Who Were Breastfed, by
Birth Year: Any Breastfeeding.
Used with permission from the CDC.
Figure 2. Percentage of U.S. Children Who Were Breastfed, by
Birth Year: Exclusive Breastfeeding.
Used with permission from the CDC.
14 Agro FOOD Industry Hi Tech - vol. 26(6) - November/December 2015

4. months or longer had lower rates of being overweight, and
the protective factor even included children up to two
years of age. Being overweight in infancy increases the
chances of becoming overweight in childhood, increasing
the chances of becoming obese in adulthood. In nine
studies consisting of 69,000 participants and in 28 other
studies, evidence was found suggesting consistency
between exclusive breastfeeding and lower rates of
childhood obesity (19). Hopkins et al, found that infants
who were fed higher volumes of formula were heavier,
longer, and taller than breastfed children (22). Furthermore,
infants at 8 months of age who were fed higher amounts
of cow milk (≤600 mL of cow milk or formula) consumed
more protein (19%-72%), more energy (600-740 kJ),
and more fat than the infants the same age who were
breastfed. Additionally, those infants had higher BMIs in
childhood than their breastfed counterparts (22). Also,
infants who were fed cow milk, insulin like growth factor
(IGF-I) concentrations were higher, and in children at 7
years of age who drank cow milk the IGF-I concentration
and growth hormone were elevated, which may explain
their rapid growth (22). It is hypothesized that infants who
drank primarily breast milk were leaner than those who
were fed cow milk or some formulas because of lower
protein levels in breast milk. Evidence suggests infants who
are fed higher volumes of formula not only gain weight
more rapidly than their breastfed counterparts, but the
rapid increase in weight increases the risk of childhood
obesity and increases the chances of developing coronary
heart disease in adulthood (22).
Exclusive breastfeeding means solely breastmilk was given
and does not include solid foods, water, or other liquids.
In 2013, about 77% of U.S. infants were breastfed, up from
74.6% in 2008. Of infants born in 2010, approximately 49% were
breastfeeding at 6 months, which is an increase from 35% in
2000. The breastfeeding rate at 12 months increased from 16%
to 27% during that same time period (1,3). The prevalence of
breastfed infants has increased; however, when extending
the period of time (6 and 12 months) the percentages drop
drastically. Figure 4 shows that between the years 2000 and
2008 there was an increase in the percentage of breastfeeding
in infants across white, black, and Hispanic infants, but the
increase was no more than 11%. This suggests that mothers may
either need more encouragement to continue breastfeeding,
or they need more education informing them of the
recommended 12 month breastfeeding period established by
the AAP. A systematic review by Horta and Victora for the World
Health Organization (WHO) concluded that, “breastfeeding
may provide some protection against overweight or obesity,
but residual confounding cannot be ruled out,” after findings
suggested that breastfeeding was associated with a 24%
reduction in obesity. However only a 12% reduction was found
in the higher quality studies (studies that included larger sample
sizes and adjustment for confounding variables) (20).
Many studies have reported on the influence of childhood
obesity leading to adult obesity, yet there are only a limited
number of studies that have followed obese children through
to adolescence. One such study is by Yin et al, 2012 who
investigated a birth cohort of 415 pregnant women and
their children up to the age of 16 years. It was found that the
mother’s caloric, fat, and protein intakes during pregnancy
had positive correlations with increased fat mass in their
children, especially when the protein source was from
meat (21). Examination of maternal breastfeeding patterns
revealed that those infants exclusively breastfed for more
than 25 days had decreased levels of fat mass (21). This study
verifies the premise that breastfeeding may exert a beneficial
effect on the prevention of obesity among children even until
their teen years (21).
Even more, there are several studies that have
documented the protective effects of breastfeeding on
the pediatric population. A Brazilian study sampling more
than 2200 children between the ages of 12 and 24 months
showed children who were exclusively breastfed for six
Figure 3. Rates of Any and Exclusive Breastfeeding by Age
Among Children Born in 2012, United States
Used with permission from the CDC.
Figure 4. Percentage of infants breastfed, by breastfeeding
duration and race/ethnicity* — National Immunization Survey,
United States, 2000 and 2008 births†.
Used with permission from the CDC.
Abbreviation: CI = confidence interval.
* The child's race and ethnicity were reported by the respondent and
categorized into one of three mutually exclusive racial/ethnic groups: white,
black, and Hispanic. Persons identified as Hispanic might be of any race.
Persons identified as white or black are non-Hispanic.
† Data for 2000 and 2008 births were collected from survey years 2002, 2003
and 2010, 2011, 2012, respectively.
§ The overall values include data from all racial/ethnic groups, not just the
three included in this analysis.
¶ Increase was not significant; all other increases presented in table were
significant (p<0.05), based on trend analysis using polynomial contrasts.
15Agro FOOD Industry Hi Tech - vol. 26(6) - November/December 2015

5. REFERENCES
1. Centers for Disease Control and Prevention. Obesity--United States
1999-2010. (2013). http://www.cdc.gov/mmwr/preview/mmwrhtml/
su6203a20.htm
2. Centers for Disease Control and Prevention. Childhood Obesity Facts
(2014). http://www.cdc.gov/obesity/data/childhood.html
3. Centers for Disease Control and Prevention. Breastfeeding Report
Card. (2013).
1. http://www.cdc.gov/breastfeeding/
pdf/2013breastfeedingreportcard.pdf
4. American Academy of Pediatrics. Obesity and BMI. (2014). https://
www.aap.org
5. Anderson, P.M., Butcher K.F. “Childhood Obesity: Trends and Potential
Causes”, The Future of Children, 16(1):19-45 (2006).
6. Fryar, C., Carroll, M., Ogden, C. “Prevalence of overweight, obesity,
and extreme obesity among adults: United States, trends 1960–1962
through 2009–2010”, National Center of Health Statistics, 1–8 (2012).
7. United States Department of Health and Human Services. Overweight
and Obesity Statistics. (2012). http://www.niddk.nih.gov/health-
information/health-statistics/documents/stat904z.pdf
8. Finkelstein, E.A., Khaviou, O.A., Thompson, H., et al. “Obesity and
severe obesity forecasts though 2030,” American Journal of
Preventative Medicine, 42 (6) 563-70 (2011).
9. Lanigan, J., Singhal, A. “Early nutrition and long-term health: a practical
approach,” Proceedings Of The Nutrition Society, 68(4), 422-9 (2009).
10. Wells, J.C., Chomtho, S., Fewtrell, M.S. “Programming of body
composition by early growth and nutrition”, Proceedings Of The
Nutrition Society, 66(3),423-34 (2007).
11. Ebbeling, C.B., Pawlak, D.B., Ludwig, D.S. “Childhood obesity: public-health
crisis, common sense cure”,The Lancet, 360(9331),473-82 (2002).
12. Biro, F.M., Wien, M. “Childhood obesity and adult morbidities,” The
American Journal of Clinical Nutrition, 91(5), 1499S–1505S (2010).
13. Simmonds, M., Burch, J., Llewellyn, A., et al. “The use of measures of
obesity in childhood for predicting obesity and the development of
obesity-related diseases in adulthood: a systematic review and meta-
analysis”, Health Technology Assessment, 19 (43),1-336 (2015).
14. Spalding, K. L., Arner, E., Westermark, P. O., et al, “Dynamics of fat cell
turnover in humans”, Nature, 453(7196), 783–787, (2008).
15. Vafa, M., Moslehi N., Afshari, S., et al. “Relationship between
breastfeeding and obesity in childhood”, Journal of Health
Population and Nutrition, 30(3), 303-310 (2012).
16. Waterland , R.A., Garza, C. “Potential mechanisms of metabolic
imprinting that lead to chronic disease”, The American Journal Of
Clinical Nutrition, 69(2), 179-97 (1999).
17. American Academy of Pediatrics Breastfeeding and the use of
human milk. Journal of Pediatrics, 115 (2), 496 (2012).
18. Owen, C. G., Martin, R. M., Whincup, P. H., et al. “Does breastfeeding
influence risk of type 2 diabetes in later life? A quantitative analysis of
published evidence”, American Journal of Clinical Nutrition, 84(5),
1043–54 (2006).
19. Assuncao, M.L., Ferreira, H.S., Countinh, S.B., et al. “Protective effect of
breastfeeding against overweight can be detected as early as the second
year of life: a study of children from one of the most socially-deprived areas
of Brazil”, Journal of Health Population and Nutrition, 33(1), 85-91, (2015).
20. Horta, B. L., Victora, C. G. (Long-term health effects of
breastfeeding), World Health Organization (Vol. 129) (2013).
21. Yin, J., Quin, S., Dwyer, T., et al. “Maternal diet, breastfeeding and
adolescent body composition: a 16-year prospective study”,
European Journal of Clinical Nutrition, 66, 1329-1334 (2012).
22. Hopkins D., Steer C.D., Northstone K., et al. “Effects on childhood
body habitus of feeding large volumes of cow or formula milk
compared with breastfeeding in the latter part of infancy”, American
Journal of Clinical Nutrition, (2015).
23. Victora, C. G., Barros, F., Lima, R. C., et al. “Anthropometry and body
composition of 18 year old men according to duration of breast
feeding: birth cohort study from Brazil”, BMJ (Clinical Research Ed.),
327(7420), 901 (2003).
24. Parsons, T. J., Power, C., Manor, O. “Infant feeding and obesity through
the life course”, Archives of Disease in Childhood, 88, 793–794 (2003).
Metabolic hormones and imprinting
One theory about how breastfeeding helps prevent childhood
obesity suggests “leptin (satiety regulation), adiponectin (glucose
regulation), ghrelin (hunger regulation), resistin (insulin resistance),
and obestatin (satiety regulation) play a physiological role in
human milk” (19). A second theory suggests that adipokines
in human milk are responsible for regulating metabolic
pathways, and help control food intake, utilizing nutrients, and
“potential neuroendocrine modulation of body-weight control”
(19). Metabolic imprinting is an important benefit of breast milk
exposure because it helps program body weight and energy
balance regulation. Diets of non-breastfed children consist of
higher amounts of protein and higher calorie foods (19).
Conflicting evidence
One study by Victora and colleagues followed all males born in
the city of Pelotas, Brazil from 1982-2000. When the boys enrolled
in the national army at 18 years of age, 2250 (78.8%) were
located. Weight, height, and body compositions were recorded,
finding no significant correlation between breastfeeding
duration and exclusive breastfeeding as a factor impacting
anthropometric measures (23). Many studies that try to examine
a potential protective benefit of breastfeeding on BMI later in life
have loss of significance when adjusted for confounders. Age,
sex, socioeconomic status, parental education level, and other
factors have also been shown to greatly affect the overall BMI
of the individual. Parsons et al discovered a protective benefit of
breastfeeding against overweight and obesity in girls at 16 years
of age and 33 years of age and 33 years for boys; however, “this
significance became non-existent in men, and reduced to non-
significance in females (p>.05)” when adjusted for social class,
mother’s BMI and mother is smoking during pregnancy (24).
CONCLUSION
Researchers agree that the prevalence of childhood obesity
is a global public health concern. Although the majority of
evidence points to breastfeeding as a principal intervention
to prevent overweight and obesity among children and
adolescents, there are reports suggesting otherwise. Some
evidence even suggests that there is no correlation between
childhood obesity and adulthood obesity. In this article,
we have included information supporting the need for
breastfeeding to prevent childhood obesity and its associated
health issues. This information supports the premise that
breastfeeding is the best form of infant nutrition and should
continue until at least the first year of life. Although not all
breastfed children are at healthy weight later in life and infants
who are not breastfed often times transition into adulthood
with a healthy weight, there is still evidence to support that
infants who are breastfed are leaner and healthier later in life
than their formula and cow-milk fed counterparts. Moreover,
breastfeeding may aid in the metabolic imprinting that can
shape the infant’s metabolism by preventing overproduction of
adipocytes, thus promoting healthy weight during adulthood.
The American Academy of Pediatrics recommends
breastfeeding for one year to promote optimal health in
children. But, as per current trends, the average duration is still
below these recommendations. In a nation that is striving for
preventative care to battle the childhood obesity epidemic,
advocating for breastfeeding should continue to be a priority
for professionals when counseling new mothers.
16 Agro FOOD Industry Hi Tech - vol. 26(6) - November/December 2015

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