Early Childhood: Breastfeeding,“Solving the Problem of Childhood Obesity Within a Generation,” an Excerpt from the White House Task Force on Childhood Obesity: Report to the President,May 2010

Children who are breastfed are at reduced risk of obesity. ¹ Studies have found that the likelihood of obesity is 22% lower among children who were breastfed. ² The strongest effects were observed among adolescents, meaning that the obesity-reducing benefits of breastfeeding extend many years into a child's life. Another study determined that the risk of becoming overweight was reduced by 4% for each month of breastfeeding. ³ This effect plateaued after 9 months of breastfeeding.

Despite these health benefits, although most (74%) babies start out breastfeeding, within 3 months, two-thirds (67%) have already received formula or other supplements. By 6 months of age, only 43% are still breastfeeding at all, and less than one-quarter (23%) are breastfed at least 12 months. ⁴ In addition, there is a disparity between the prevalence of breastfeeding among non-Hispanic black infants and those in other racial or ethnic groups. For instance, a recent CDC study showed a difference of greater than 20 percentage points in 13 states. ⁵

The protective effect of breastfeeding likely results from a combination of factors. First, infant formula contains nearly twice as much protein per serving as breastmilk. This excess protein may stimulate insulin secretion in an unhealthy way. ⁶ Second, the biological response to breastmilk differs from that of formula. When feeding a baby, the mother's milk prompts the baby's liver to release a protein that helps regulate metabolism. ⁷ Feeding formula instead of breastmilk increases the baby's concentrations of insulin in his or her blood, prolongs insulin response, ⁸ and, even into childhood, is associated with unfavorable concentrations of leptin, a hormone that inhibits appetite and controls body fatness. ⁹ Despite the well-known health benefits of breastfeeding and the preference of most pregnant women to breastfeed, ¹⁰ numerous barriers make breastfeeding difficult. For first-time mothers, breastfeeding can be challenging, even for those who intend to breastfeed. For those who have less clear intent to breastfeed, cultural, social, or structural challenges can prevent breastfeeding initiation or continuation. For example, immediately after birth, many babies are unnecessarily given formula and separated from their mothers, making it harder to start and practice breastfeeding. Also, hospital staff are often insufficiently trained in breastfeeding support.

The Joint Commission on the Accreditation of Hospitals, the body that accredits hospitals and healthcare organizations for most State Medicaid and Medicare reimbursement, now expects hospitals to track and improve their rates of exclusive breastfeeding. Hospitals that meet specific criteria for optimal breastfeeding-related maternity care are designated as “Baby Friendly” by Baby-Friendly U.S.A. This non-governmental organization has been named by the U.S. Committee for UNICEF as the designating authority for UNICEF/WHO standards in the United States. Currently only 3% of births in America occur in Baby-Friendly facilities.^11–13

While breastfeeding could be far more widespread than it is today, it is not a viable alternative for all mothers and babies. Specific guidance and support options should also be made available for those who cannot breastfeed. Parents and caregivers of babies also may benefit from guidance about when to start feeding them solid foods, since early introduction of solids (prior to 6 months) increases the risk for childhood obesity. ¹⁴