Anna Zamora-Kapoor, PhD, a researcher with Partnerships for Native Health, recently reported a link between breastfeeding and body weight later in life among Native people. In an article published in the Journal of the Academy of Nutrition & Dietetics, she demonstrated that longer periods of breastfeeding in infancy are associated with lower body mass index (BMI) among American Indian and Alaska Native adolescents and young adults.
“The more breastfeeding, the better,” says Dr. Zamora-Kapoor. “Babies who breastfeed longer are more likely to avoid excess weight gain in adolescence and beyond. This is important for Native families, because Native youth have the highest rates of obesity among young people of all races. Obesity is associated with many health problems that are prevalent in Native communities, such as type 2 diabetes and cardiovascular disease.”
Dr. Zamora-Kapoor’s research offers the first compelling evidence of a connection between breastfeeding and body weight in a large sample of Native people. Only one previous study addressed the potential link between breastfeeding and Native BMI, and it was limited to three tribes in Wisconsin. This is first study to take a national perspective on the issue. To conduct her analysis, Dr. Zamora-Kapoor used data from the National Longitudinal Study of Adolescent to Adult Health, commonly known as Add Health (Website at http://www.cpc.unc.edu/projects/addhealth). This is a multi-decade survey of young Americans of all races. Data collection began in 1994 and has continued until the present.
Current guidelines from the American Academy of Pediatrics call for at least 6 months of exclusive breastfeeding and then 6 more months of breastfeeding in combination with solid food. Dr. Zamora-Kapoor found that the benefits of breast milk continued to increase with increasingly longer periods of breastfeeding, even in excess of one year. However, many new mothers can’t breastfeed for so long because of work and other responsibilities.
“Women should never feel guilty for not breastfeeding enough,” says Dr. Zamora-Kapoor. She emphasizes that breastfeeding can be challenging for a multitude of reasons. Apart from physical and logistical considerations, many social factors present barriers. These include an absence of maternity leave in the jobs held by many new mothers, a lack of facilities at the workplace (“mother’s rooms”) for pumping breast milk, and a lack of cultural and social support for breastfeeding in public. For example, laws in Idaho characterize public breastfeeding as a form of public indecency.
“That’s why we need policies that encourage and facilitate breastfeeding everywhere – at home, in the workplace, and in public space,” says Dr. Zamora-Kapoor. “Such policies are likely to have a positive influence on BMI in the long term.”
Ideally, new mothers should confer with a lactation consultant on the best way to approach breastfeeding, but many women – especially women with low income – have no access to these resources.
Many long-term benefits are associated with breastfeeding, other than simply nourishing infants. In addition to avoiding excess weight gain, potential benefits include preventing allergies and inflammatory conditions. However, not all women know about these positive outcomes. For that reason, more widespread health insurance coverage and better quality healthcare, including education and consultation on breastfeeding, can contribute to higher rates of breastfeeding.
As Dr. Zamora-Kapoor emphasizes, “Obesity and diabetes are serious problems for Native people. Unfortunately, we lack knowledge of specific behaviors that can help prevent these conditions. Everybody knows some behaviors associated with weight loss, but this isn’t about weight loss – it’s about preventing weight gain in the first place. If we can identify specific behaviors that are associated with maintaining a healthy weight and avoiding weight gain, we can design interventions that will reduce the prevalence of obesity. Breastfeeding is clearly one of those behaviors.”
Dr. Zamora-Kapoor is committed to conducting health research that will yield tangible benefits for Native people. In less than two years she has published a half-dozen scientific articles on her findings. As a sociologist by training, she focuses on understanding the social factors that might be able to reduce or eliminate health disparities in Native communities. Right now she is in the middle of a study funded by the New Connections program of the Robert Wood Johnson Foundation. Her ongoing work also uses Add Health data, this time to examine a broad range of risk factors for type 2 diabetes in Native youth and young adults. Sadly, type 2 diabetes develops earlier in life for Native people. Younger age at onset is associated with earlier development of other health conditions, including kidney disease, cardiovascular disease, and blindness.
“It’s important to identify risk factors for disease early in life, especially during adolescence, says Dr. Zamora-Kapoor. “Adolescence is an ideal time for interventions to prevent illness and support good health.”
Resources
Eckhardt CL, Lutz T, Karanja N, Jobe JB, Maupomé G, Ritenbaugh C. (2014) Knowledge, attitudes and beliefs that may influence infant feeding practices in American Indian mothers. J Acad Nutr Diet. 2014. 114(10): 1587-1593. (Full text available here: https://www.ncbi.nlm.nih.gov/pubmed/24951434)
Horta BL, Victora CB. (2013) Long-term effects of breastfeeding: A systematic review. World Health Organization. (Full text available here: http://www.who.int/maternal_child_adolescent/documents/breastfeeding_long_term_effects/en/)
Lindberg SM, Adams AK, Prince RJ. (2012) Early predictors of obesity and cardiovascular risk among American Indian children. Matern Child Health J. 16(9): 1879–1886. (Full text available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438386/)
Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. (2005) Effect of infant feeding on the risk of obesity across the life course: A quantitative review of published evidence. Pediatrics. 115(5):1367-77.
Zamora-Kapoor A, Omidpanah A, Nelson LA, Kuo AA, Harris R, Buchwald DS. (2017) Breastfeeding in infancy is associated with body mass index in adolescence: A retrospective cohort study comparing American Indians/Alaska Natives and non-Hispanic Whites. J Acad Nutr Diet. S2212-2672(16)31448-4. (Abstract: http://www.andjrnl.org/article/S2212-2672(16)31448-4/abstract)