Introducing solid foods to your baby can be an exciting adventure.  I know that it was for me, the spit out food, screwed up faces, and the eventual gusto with which my son ate. When to introduce solids appears to be very important, according to a recent study in the journal Pediatrics that explored the relationship between the early introduction of solid foods (four months or earlier) and early childhood obesity. Interestingly, the results differed according to if and for how long the children were breastfed as infants.

Huh and colleagues (2011) used data collected on 847 infants at birth, six months, and one, two, and three years of age. Information on feeding practices was gathered at each of these points in time and at three years, information on obesity was also collected. The researchers adjusted for a variety of factors, such as maternal education, household income, parent BMI, and child age, gender, and race/ethnicity. They also controlled for early infant growth so none of the results are explained by rapid growth during the early months of life.

The authors found that obesity was associated with introducing solids too early (before four months), but this was the case only for formula-fed infants.  For infants who were breastfed for four months or longer, introducing solids before four months of age did not increase the rate of obesity. However, for the formula-fed* infants, eating solids before four months increased the odds of obesity six-fold when compared to eating solids after four months. In other words, the highest rate of obesity was found among formula-fed infants who were also given solid foods before they were four months old. *Formula-fed infants included those infants that were exclusively fed formula as well as those that were breast-fed for fewer than four months.

Why did the formula-fed infants with early solid food introduction end up being obese more frequently than their breastfed counterparts? The authors suggest that mothers of breastfed infants may be able to recognize hunger and satiety cues more easily for starters. They go on to say that breastfed infants may not add caloric intake when introduced to solids. Rather, they may be able to self-regulate their breastfeeding and take in less breastmilk to adjust for the food intake. For formula-fed infants, the authors state that they perhaps add the solid food calories on to the same amount of formula that they are accustomed to drinking and, therefore, increase their overall calories consumed.

The American Academy of Pediatrics gives the green light for solid foods to be introduced between four and six months of age, preferably six months. The current study suggests that following these guidelines is especially critical for parents of formula-fed infants so that the odds of developing early childhood obesity decline.  Keeping these recommendations in mind, enjoy the solid food experience and keep lots of towels on hand!

Source: Huh, S., Rifas-Shiman, S., Taveras, E., Oken, E., & Gillman, M. (2011). Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children PEDIATRICS, 127 (3) DOI: 10.1542/peds.2010-0740

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6 Responses to Breastfeeding versus Formula-Feeding and the Rate of Early Childhood Obesity

  1. Giliell says:

    As a personal guess:
    Parents of formula-fed babies are often used to “feed until empty” which might also lead to a loss of satiety recognition in the infants.
    We know how we are all trained to clean the plate.
    Breastfeeding you just kind of wait until they stop/fall asleep

    • John says:

      That’s a reasonable guess I’d say

    • Anita M. Schimizzi, Ph.D. says:

      Giliell, Thank you for your response. That makes a lot of sense. I remember being told by a lovely lactation consultant that breast-feeding is like a dance between mom and baby where the two figure out a rhythm whereby the baby gets all he/she needs. We do live in such a clean plate culture where we learn from an early age to over-ride satiety cues. It is interesting to ponder how bottle-fed babies emit their satiety cues so care providers can pick up on when the whole bottle may be more than is what is needed for a particular feeding.

  2. Giliell says:

    I remember being told by a lovely lactation consultant that breast-feeding is like a dance between mom and baby where the two figure out a rhythm whereby the baby gets all he/she needs.

    I remember crying my eyes out because my baby was starving at my breast. Really didn’t get enough and having read/heard this “they get all they need” a thousand times before I felt like the worst mother on earth ever.
    Such phrases are really a trigger to me. I got myself together (with the aid of a fantastic midwife), bought some formula, rented a milk-pump and worked ahrd and when the babe was 2 months old we were a wonderful breastfeeding team.
    I know that breastfeeding needs more postive propaganda, but I’m very much against mystifying it or demonizing bottle-feeding. I think that one of the biggest woes in early childcare nowadays is that young parents are made to feel so insecure and not adequate.
    What I’d love to see is that babies and parents are treated as individuals again, with individual needs and problems and stuff. Everything nowadays is charts and models and checklists and standards.
    The providers may very well pick up the cues but they may not dare to stop out of fear that the baby would “fail” the next check-up. Don’t get me wrong, check-ups are great, but I think I’ve had one nurse too many telling me that my firstborn is underweight and I’ve answered the question what the kid was eating once too many and I’ve wondered too often whether they shouldn’t have spent that time acually looking at the child instead of the charts to see that there’s a skinny but healthy and bright as the sun kid.
    Sorry about the rant, but it really makes my blood boil.

    • Anita M. Schimizzi, Ph.D. says:

      Dear Giliell,

      I hope that you received my direct email. I am going to include some of it here so that our readers may be part of the dialogue as well.

      As I stated in our off-site email, I do apologize for having triggered you. It sounds like you had a really rough road with breast-feeding. I do agree with you that there is far too much pressure and emphasis put on moms to do it all and to do it all well. I, too, had all of the charts presented to me for my son. And I had all the mommies bragging about the weight of their babies while mine remained one skinny guy. Figuring out breast-feeding was an extremely challenging experience for me and I had to hold onto what the lactation consultant said to keep me going. Very fortunately, we were able to figure it out when I had everyone else telling me to call it quits. I was also able to find a pediatrician that recognized that parents’ body types make a difference for the baby’s body type.

      I know that breast-feeding doesn’t always work out for everyone. For many, it simply needs to be the bottle (whether out of necessity or choice). I certainly did not mean to demonize bottle-feeding. Plenty of healthy babies are bottle-fed. I really just wanted to ponder the dynamics of how we get to a place where we override our own satiety cues and how early feeding may be where it begins.

      Again, I do apologize for upsetting you. I thank you for speaking out about it, too.

  3. Jennifer Donovan says:

    Just wanted to point out the the rates of “obesity” were as follows:

    Breastfed kids, regardless of when they started solids: 1 in 14, or just over 7%
    Formula-fed kids who started solids between four and six months: 1 in 20, or 5%
    Formula-fed kids who started solids before four months: 1 in 4, or 25%

    Now, they defined “obese” as at or above the 95th percentile on the height/weight charts. So, by definition, one would expect 5% of children to be “obese.” 5% of kids should be in the top 5%, right?

    Well, for breastfed kids and most formula-fed kids, that’s what they found. 5-7% of kids were in the top 5%.

    The real issue here is not formula. What is going on with the formula-fed kids who start solids early that is causing a quarter of them to be in the top 5% of weight-for-height? Obviously they are eating more calories than they are burning. But why? My guess (and it’s just a guess) is that many are being fed more to encourage them to sleep longer or to calm them down when they are fussy but not necessarily hungry. Maybe they are also being weaned onto a higher calorie diet. Or they are eating a higher calorie diet in general as they get older. My guess (again, just a guess) is that the parents who are going to overfeed their kids are going to start doing it in infancy, and that it just so happens that they’re also going to be more likely to formula-feed rather than breastfeed.

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