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Leigh Anne O’Connor, IBCLC, New York City, USA
Photo: Michèlle Du Toit
Obesity & breastfeeding
According to the National Center for Biotechnology Information nearly one in two American women of childbearing age is overweight or obese. About 24% of women 20–44 years of age are overweight and 23% are obese. (1)
Can breastfeeding prevent obesity? Does not breastfeeding increase the risk of obesity? Does being overweight make it more challenging to breastfeed? There is an inherent discrimination against obese women in today’s culture. There is an assumption that overweight women cannot breastfeed or do not want to breastfeed. This is simply not true!
Breastfeeding may be challenging for many mothers. Obese mothers have their own unique challenges in meeting their breastfeeding goals. This does not mean that breastfeeding is impossible for plus size moms.
While not everyone who is heavy is unhealthy, obesity has been associated with both short and long-term health problems for women as well as for their children.
Obese women are at an increased risk for gestational diabetes and when giving birth are at an increased risk for medical interventions, including induction, epidural, and cesarean section. These birth interventions can make breastfeeding more challenging for both mother and baby. (2)
For the mom recovering from surgery: her body is holding on to extra intravenous fluids that will make her uncomfortable and may make her breasts painfully swollen, making it difficult for her baby to latch on well. Narcotic medications used during birth interventions can make a baby sleepy so he may not rouse enough to nurse. Babies whose births were induced or who arrived too early are often sleepy when they have not been “fully cooked.”
More common in obese women are PCOS (polycystic ovarian syndrome), metabolic syndrome, and thyroid disease. Each of these conditions can lead to problems for mothers making milk.
If breastfeeding is so challenging, why should a mom bother?
Breastfeeding is important to the health and wellbeing of all babies and parents but can be particularly important for obese mothers. Breastfeeding improves a mother’s blood sugar and insulin levels postpartum. Not breastfeeding precludes the normal resolution of maternal pregnancy-based physiological changes.
Mothers who breastfeed are less likely to develop Type 2 diabetes. Mothers with gestational diabetes who breastfeed have improved lipids and glucose metabolism in the first three months postpartum. Women with gestational diabetes who breastfeed have lower rates of abnormal blood sugar at their postpartum six-week follow-up glucose tolerance test.
Mothers who have never lactated had more visceral (belly) fat while those who lactated for three or more months had the same amounts as women who had never been pregnant. Seven years postpartum, visceral fat deposits were significantly greater among mothers who lactated for fewer than three months after the birth of each of their children. (3)
Breastfeeding has been shown to reduce the risk of childhood obesity. The onset of breast development begins at an earlier age in girls with a higher BMI (Body Mass Index) and this may increase the child’s risk of breast cancer later in life. Obese children are at an increased risk of cardiovascular disease, type 2 diabetes, breathing problems, and low self-esteem. (4)
What can an overweight mom do to prepare?
It’s the same for anyone planning to breastfeed: education and planning are key. Breastfeeding is a learned behavior for parents. Attending La Leche League meetings can help educate expectant parents.
Birth practices have an impact on how breastfeeding gets started. Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start. Write a birth plan: this is a template that empowers parents to make informed decisions about their birth. Another way to take charge of your birth is to hire a labor support doula. A doula supported birth lowers the risk of interventions.
Once the baby is born, skin to skin with mom is where the baby expects to be. The baby knows his mother, knows her scent and her voice. In mother’s arms the baby can instinctively find his way to the breast.
Overweight women tend to have larger breasts. This can be challenging in the early days. Some strategies that can help include having a support pillow for the baby, or moms can roll up a cloth diaper or wash cloth and place it under the breast to give a “lift,” making it easier for baby to latch and for mom to see where her baby is in relation to her body.
In some cases the baby may be very small and have trouble latching on to the breast and maintaining suction. If the baby cannot latch on to the breast, the mom can hand express her milk in the first few days. If the baby is still not latching and getting milk, she can continue hand expressing or use a pump to stimulate milk production so she can give her milk to her baby.
Julia Kaplan Schilling, who weaned her child a couple of years ago, said:
“I weighed 298 lb the day Eli was born. I never did get an accurate bra size. I think 42GG was about right while I was nursing. Obesity made it harder to breastfeed overall. I was thrilled, though, when at four months I realized I could leave my baby in his car seat when we stopped briefly on our eight-hour journey and lean over him to nurse, without lifting him out every time. One of the best ways we have of solving our chronic obesity as a nation is to promote breastfeeding.”
Vanessa in NYC said:
“I’ve been quite curvy my whole life. I am Latina and natural body fullness is more prevalent in my culture. Before I got pregnant I did yoga daily, ate healthily, and rode my bike everywhere. I was fit and healthy. I’m fine with my body but am reminded at every doctor’s visit that I am overweight. I did not experience any pregnancy complications due to my weight, but I wasn’t taken seriously about my morning sickness when I tried to get medical attention and ended up in the hospital dehydrated two times. Thankfully, I didn’t have breastfeeding issues related to my weight. Once we got the hang of it, nursing became one of the best parts of motherhood. I was able to nurse my son until he was almost three and my daughter has just turned one. I could definitely lose a few pounds and am technically obese. Some moms seem to be able to get weight off easily while they nurse, but it’s harder for me. I’m just trying to love myself and my child and I’ll deal with it later when my daughter weans.”
It is possible to have healthy weight loss while nursing. See Eat Well Lose Weight While Breastfeeding. It is not recommended to use fad diets or liquid diets, but losing a couple of pounds a week is safe. A dramatic weight loss can reduce milk supply. (5)
Eating healthily sets a good example for your family: The Breastfeeding Mother’s Diet. Be mindful of what you are eating. Eat nutrient dense whole foods. Watch your fluid intake: drink water and herbal teas, avoid sodas and other sugary drinks. Be aware that children will model their behavior on yours.
Set yourself up to have a good support system and if the people around you want to help, have them prepare healthy meals and sensibly proportioned snacks for you while you nurse.
Obesity does not need to be an obstacle to nursing your baby.
- Vahratian, A. Prevalence of Overweight and Obesity among Women of Childbearing Age. Results from the 2002 National Survey of Family Growth Matern Child Health J. 2009; 13(2): 268–273.
- Lothian, J. The Birth of a Breastfeeding Baby and Mother J. Perinat Educ. 2005; 14(1): 42–45.
- McClure, C. et al. Maternal Visceral Adiposity by Consistency of Lactation Matern Child Health J. 2012; 16(2):10.
- Armstrong, J.et al. Breastfeeding and lowering the risk of childhood obesity The Lancet 2002; 359 (9322):2003–2004.
- Dewey, K. Effects of maternal caloric restriction and exercise during lactation, J. Nutr. 1998 Feb;128(2 Suppl):386S-389S.
Leigh Anne O’Connor is a La Leche League Leader and a private practice lactation consultant. She and her husband Rob live in New York City with their three beautiful children.