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 *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. 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