>>The problem with making generalizations about gastric by-passes is
that so often these surgeries are done on morbidly obese patients who
may have other issues that may be more key to the bfg issues than the
surgery itself. Often these women have some sort of insulin resistence
problem, or have the obsesity secondarily to conditions such as PCOS.
Both insulin resistence and PCOS have been implicated in primary low
milk production. Additionally, some morbidly obese patients have eating
disorders.  Too often the by-pass is done without addressing (through
behavioral therapy, 12 step programs or additional treatment of some
kind) the underlying psychological disorder.<<

I want to agree with what Barbara wrote and comment a little further
that these issues are often viewed two-dimensionally when they can have
three dimensions. Recent articles on the correlation between obesity and
breastfeeding problems have examined the presenting physiology without
considering the underlying causes of the obesity. For example, one
theory focuses on the difficulty of breastfeeding with the large breasts
that often (though not always!) accompany obesity, noting that it may be
mechanically difficult for the infant to reach and adequately milk the
ducts/sinuses, thus resulting in poor transfer and poor stimulation of
supply. Looking at the inability to easily assimilate necessary
nutrients due to gastric by-pass is another obvious possibility.

However, as Barbara pointed out, there can be issues underlying the
obesity that may also influence lactation-- a third dimension to the
problem. While obesity may be the result of overeating (a
psychologically based issue), it can also be the result of a metabolic
disorder, including but not limited to PCOS and insulin resistance. When
working with such mothers, it is important to examine not only the more
obvious surface issues, but the underlying ones as well. Ask lots of
questions about mother's and her family of origin's health and
reproductive history; though not definitive, this information can be
helpful to understanding the big picture.

~Lisa Marasco

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