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Subject:
From:
Nikki Lee <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 23 Jul 2009 14:20:59 -0400
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Dear Friends:

Nice to see breastfeeding listed as one of many strategies to reduce
obesity!


 Strategy to Encourage Breastfeeding

Breastfeeding has been linked to decreased risk of pediatric overweight in
multiple epidemiologic studies. Despite this evidence, many mothers never
initiate breastfeeding and others discontinue breastfeeding earlier than
needed. The following strategy aims to increase overall support for
breastfeeding so that mothers are able to initiate and continue optimal
breastfeeding practices.
11. Communities Should Increase Support for Breastfeeding

Overview

Exclusive breastfeeding is recommended for the first 4--6 months of life,
and breastfeeding together with the age-appropriate introduction of
complementary foods is encouraged for the first year of life. Epidemiologic
data suggest that breastfeeding provides a limited degree of protection
against childhood obesity, although the reasons for this association are not
clear (*11*). Breastfeeding is thought to promote an infant's ability to
self regulate energy intake, thereby allowing him or her to eat in response
to internal hunger and satiety cues (*73*). Some research suggests that the
metabolic/hormonal cues provided by breastmilk contribute to the protective
association between breastfeeding and childhood obesity (*74*). Despite the
many advantages of breastfeeding, many women choose to bottle-feed their
babies for a variety of reasons, including social and structural barriers to
breastfeeding, such as attitudes and policies regarding breastfeeding in
health-care settings and public and work places (*75*).

Breastfeeding support programs aim to increase the initiation and
exclusivity rate of breastfeeding and to extend the duration of
breastfeeding. Such programs include a variety of interventions in hospitals
and workplaces (e.g., setting up breastfeeding facilities, creating a
flexible work environment that allows breastfed infants to be brought to
work, providing onsite child care services, and providing paid maternity
leaves), and maternity care (e.g., polices and staff training programs that
promote early breastfeeding initiation, restricting the availability of
supplements or pacifiers, and providing facilities that accommodate mothers
and babies). The CDC Guide to Breastfeeding Interventions identifies the
following general areas of interventions and programs as effective in
supporting breastfeeding: 1) maternity care practices, 2) support for
breastfeeding in the workplace, 3) peer support, 4) educating mothers, 5)
professional support, and 6) media and community-wide campaigns (*76*).

Evidence

Evidence directly linking environmental interventions that support
breastfeeding with obesity-related outcomes is lacking. However, systematic
reviews of epidemiologic studies indicate that breastfeeding helps prevent
pediatric obesity: breastfed infants were 13%--22% less likely to be obese
than formula-fed infants (*77,78*), and each additional month of
breastfeeding was associated with a 4% decrease in the risk of obesity (*79*).
Furthermore, one study demonstrated that infants fed with low (<20% of
feedings from breastmilk) and medium (20%--80% of feedings from breastmilk)
breastfeeding intensity were at least twice as likely to have excess weight
from 6 to 12 months of infancy compared with infants who were breastfed at
high intensity (>80% of feedings from breastmilk) (*80*).

Systematic reviews indicate that support programs in health-care settings
are effective in increasing rates of breastfeeding initiation and in
preventing early cessation of breastfeeding. Training medical personnel and
lay volunteers to promote breastfeeding decreases the risk for early
cessation of breastfeeding by 10% (*81*) and that education programs
increase the likelihood of the initiation of breastfeeding among low-income
women in the United States by approximately twofold (*75*).

One systematic review did not identify any randomized control trials that
have tested the effectiveness of workplace-wide interventions promoting
breastfeeding among women returning to paid employment (*82*). However, one
study demonstrated that women who directly breastfed their infant at work
and/or pumped breast milk at work breastfed at a higher intensity than women
who did not breastfeed or pump breast milk at work (*83*). Furthermore,
evaluations of individual interventions aimed at supporting breastfeeding in
the workplace demonstrate increased initiation rates and duration of
breastfeeding compared with national averages (*76*).

Suggested measurement

Local government has a policy requiring local government facilities to
provide breastfeeding accommodations for employees that include both time
and private space for breastfeeding during working hours.

This measurement captures local policies that support breastfeeding among
women who work for local government. Although in most cases infants are not
present in the women's place of employment, the policy would require
employers to designate time and private space for women to express and store
breast milk for later use.

<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm?s_cid=rr5807a1_e>

warmly,

-- 
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

             ***********************************************

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