Vol.1, No.3, 88-93 (2011)
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
Open Journal of Preventive Medicine
Breastfeeding and obesity: a meta-analysis
Jeanne M. Stolzer
University of Nebraska-Kearney, Kearney, USA; stolzerjm@unk.edu
Received 3 September 2011; revised 15 October 2011; accepted 24 October 2011.
Over the last decade, obesit y rates have reached
epidemic proportions in the United States of A-
merica. Comorbidities associated with overweight
and obesity include, but are not limited to, hy-
pertension, type 2 diabetes, cardiovascular di-
sease, and elevated cholesterol levels. As a di-
rect result of obesity, data indicates that these
diseases are now being detected in an unpre-
cedented number of American children, ado-
lescents, and adults. Although the major cause
of the obesity epidemic in America has thus far
been attributed to excessive caloric intake and
lack of physical activity, this paper will explore
the pivotal role that breastfeeding plays in the
prevention of overweight and obesity through-
out the life course. Epide miological data demo n-
strates that breastfeeding significantly reduces
the incidence of overweight and obesity and
that exclusive and long term breastfeeding has
been strongly correlated with a reduction in LDL
cholesterol, blood pressure related disorders,
type 2 diabetes, and cardiovascular dysfunction.
While it is certain that diet and exercise are in-
tegral factors associated with overweight and
obesity, the time has come for a collective re-
cognition of the protective effects associated
with breastfeeding if we are serious in our en-
deavor to eradicate the overweight and obesity
epidemic in America.
Keywords: Obesity; Breastfeeding and Obesity;
Breastfeeding; Lactation and Obesity
Over the last 40 - 50 years, much attention has been
given to the role of diet and exercise with regard to the
prevention of obesity. It is certainly a fact that the
American diet has been altered dramatically in a rela-
tively short time. Portion sizes in food outlets have more
than doubled over the last two decades, and Americans
have significantly increased their consumption of fatty
fast foods [1]. In addition, trans-fats are now a common
ingredient in a variety of foods and natural home pre-
pared meals are becoming increasingly rare.
In addition, Americans are now more sedentary than
at any time in recorded history. Walking, which has been
an integral feature of hominid existence throughout evo-
lutionary time, has now been replaced by riding in cars,
elevators, and other automated means of transportation
[2]. Children no longer spend their days engaged in rig-
orous physical outdoor activity, but instead rely on high-
tech gadgetry to occupy their time [3]. Physical educa-
tion classes have been systematically reduced or elimi-
nated, and recess is no longer considered a necessary
component of the American public school curriculum
According to the American Academy of Pediatrics [5],
preventio n of obesity in children must be the first line of
defense. The American Academy of Pediatrics [5] re-
leased a policy statement that recommended that pedia-
tricians should become adept at recognizing children at
risk of overweight and obesity. In addition, pediatricians
should calculate and plot Body Mass Index (BMI) at
every visit, use changes in BMI to identify excessive
weight gain, and monitor for comorbidities associated
with obesity. The American Academy of Pediatrics [5]
also states that pediatricians should encourage, support,
and protect breastfeeding in order to significantly de-
crease overweight an d obesity in child pop ulations [2,5].
It is interesting to note that at the same time the
American Academy of Pediatrics (AAP) [5] is promot-
ing the multifarious benefits of breastfeeding, they are
also aligned economically with the formula industry.
The AAP [5] routinely advertises formula in the presti-
geious medical journal “Pediatrics,” was granted three
million dollars by the manufacturers of formula to build
the AAP headquarters in Illinois, and is funded in part
by block grants provided by the formula industry [6,7].
If the AAP [5] is sincere in its efforts to promote
breastfeeding as a means to combat overweight and obe-
sity, perhaps the time has come to sever its economic
ties with the formula industry. Margolis [8] forcefully
J. M. Stolzer / Open Journal of Preventive Medicine 1 (2011) 88-93
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
reiterates this position by stating “The acceptance of
gifts in virtually any form violates the fundamental du-
ties of the physician of nonmaleficence, fidelity, justice,
and self improvement; the medical community must
articulate this position clearly, and it should act accord-
ingly” (p. 51).
Clearly, the prevention of this epidemic should be our
focus as data confirms that a high body mass index (BMI)
in childhood is a strong predictor of overweight and
obesity during adolescence and adulthood [9]. Increasing
breastfeeding initiation and duration will, according to
published data, significantly decrease overweight and
obesity, thus decreasing morbidity and mortality rates
across the life span [10,11]. Obesity related diseases
such as cardiovascular disease, high blood pressure, ele-
vated cholesterol, and type 2 diabetes are manifested in
both children and adults, therefore, early intervention is
critical [5,12].
In keeping with the guidelines set forth by the Sur-
geon General of the United States [13] and the World
Health Organization [11], infants should be exclusively
breastfed for the first six months of life, with continued
breastfeeding for two years or longer. According to
decades of empirical, epidemiological data, breastfeed-
ing has been associated with significant decreases in
morbidity and mortality rates across the life course [13].
Breastfeeding has also been correlated with a reduction
of infectious and noninfectious diseases, diarrhea, respi-
ratory illness, ear infection, type 1 and 2 diabetes, celiac
disease, inflammatory bowel disease, childhood cancer,
allergies, asthma, overweight, and obesity [14,15].
Numerous scientific studies have confirmed that chil-
dren who are breastfed exclusively and long term are
less likely to develop botulism, bacterial meningitis,
urinary tract infection, liver disease, and sudden infant
death syndrome (SIDS) [14,16]. Furthermore, research-
ers have found that breastfeeding significantly decreases
hospital admission rates and prescription drug use in
pediatric populations [14,1 7] .
For over forty years, epidemiological studies have
demonstrated that breastfeeding significantly reduces
both overweight and obesity in child, adolescent, and
adult populations [18-20]. In addition , empirical data h as
confirmed that nutritional intake in infancy is highly
correlated with later predisposition to diseases such as
obesity, high blood pressure, heart disease, and type 2
diabetes [21,22].
It has been established that cow milk contains signify-
cantly higher levels of protein and fat than human milk.
The high fat and protein levels found in bovine based
formula lead to an increased secretion of IGF-1 (insulin
growth factor type 1 and in turn stimulates the over-
production of adipocytes which has been associated with
overweight and obesity in human populations [23]. Hu-
man milk is compositionally distinct from all other
mammalian milk as milk from a particular mammal is
species specific (i.e., ensures the optimal development of
that particular mammal). Cow milk contains three times
the amount of protein that human milk contains, as the
survival of most mammals is dependent on the rapid
acceleration of physical growth. However, humans are
distinct from most mammals in this respect [24].
Human milk is quantitatively different than formula
regardless if it is soy or bovine based. Numerous bioac-
tive factors are exclusive to human milk, including spe-
cific human growth hormones and growth factors which
impact differentiation, growth, and fu nctional maturation
of the human organism [25,26].
The concept that early nutritional intake influences
adult onset overweight and obesity was first developed
by McCance [20] in the 1960’s. Kramer [18] continued
on with McCance’s seminal work and demonstrated with
empirical case-controlled studies that formula feeding in
infancy was significantly linked to obesity in adoles-
cence and adulthood. Animal studies have also been va-
luable as they show the particular mechanisms that link
early nutrition with accelerated growth, appetite regula-
tion, and the underlying hormonal factors which have
been correlated with overweight and obesity in human
subjects [27].
It has been suggested that one of the reasons that for-
mula-fed infants are more likely to develop overweight
and obesity later in life is that there are predetermined
amounts of formula that a baby is supposed to drink.
Physicians and/or the manufacturers of formula recom-
mend specific dosages which often times leads to over-
eating and the inability to determine satiety [25]. Con-
versely, a breastfed baby has no predetermined amount
they are supposed to drink at each feeding. Across mam-
malian species, the exclusively breastfed baby suckles
until satisfied. There is no overfeeding and the infant
learns appetite regulation beginning immediately after
birth [28].
Longitudinal data demonstrates that breastfeed ing acts
as a buffer against overweight and obesity even when
controlling for confounding variables such as socioeco-
nomic status, education of parents, race, number of sib-
lings, and maternal BMI [29,30]. Gillman and Collea-
gues [31] found that the effects of breastfeeding are
dose-response specific, as their data indicates that the
J. M. Stolzer / Open Journal of Preventive Medicine 1 (2011) 88-93
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
longer a child is breastfed, the less likely the child is to
become overweight or obese in later life.
Armstrong & Reilly [29] assessed 32, 2000 children
and found the most statistically powerful results were
detected in exclusively breastfed populations. Those
subjects who were formula fed in infancy were signify-
cantly more likely to develop overweight and obesity
during later childhood. These results are critical as they
demonstrate the protective effects of exclusive breast-
feeding as opposed to formula feeding or breastfeeding
using formula supplem ent at ion.
Bergman, et al. [32] conducted a longitudinal birth
cohort study that tested whether exclusive breastfeeding
was correlated with BMI at six years of age. They
looked at newborns with almost identical BMI’s, and
revisited these infants at three months of age, and at four,
five, and six years of age. At every interval, the formula
fed children had significantly higher BMI’s and thicker
skin folds than the breastfed cohort. At the ages of four
through six, the prevalence of obesity tripled in the for-
mula fed population.
Other researchers have found that breastfeeding sig-
nificantly decreases ov erweight and ob esity in childhood
regardless of maternal diabetes status, or weight status
[33]. Gillman and Colleagues [31] work demonstrates
that overweight during adolescence predicts short and
long term morbidity as well as obesity in adulthood.
According to Gillman, et al, formula feeding in infancy
is a significant predictor of adult overweight and obesity
even when controlling for variables such as gender, en-
ergy intake, time watching TV, physical activity, mo-
ther’s BMI, and socioeconomic status.
Decades of systematic reviews of epidemiological
studies (cohort, case-control, cross-sectional, and longi-
tudinal studies) have compared breastfed and formula
infants. These studies have adjusted for a multitude of
confounding variables such as gender, race, age, mater-
nal status, parental education, birthweight, and geo-
graphical location. All of these studies have concluded
that breastfeeding plays a significant role in reducing
overweight and obesity in child, adolescent, and adult
populations [18,32,33]. Additional research have clearly
demonstrated the dose-response specifity of breastfeed-
ing as data confirms that the longer a child is breastfed,
the stronger the protective effect of breastfeeding against
overweight and obesity throughout life [31,34].
Numerous studies have concluded that breastfeeding
not only decreases the prevalence of overweight and
obesity, but is also inversely related to the development
of type 2 diabetes, elevated blood pressure and choles-
terol, and cardiovascular disease.
The rates of type 2 diabetes are higher now then at
any other time in recorded American history [2]. Over-
weight and obesity are thought to precipitate type 2 dia-
betes by interfering with insulin signaling as excess fat
in the muscle cells leads to physio logical atrophy result-
ing in hyperglycemia and chronic glucose intolerance
[35]. Exclusive breastfeeding has been found to protect
individuals from type 2 diabetes by encouraging optimal
lipoprotein metabolism and gastrointestinal adaptation
Exclusive breastfeeding has also been correlated with
lower fasting insulin concentrations and lowered pre-
prandial blood glucose lev els in adults [36]. Ravelli [37]
studied a co hort of sub jects that w ere born between 1943
and 1947 in Amsterdam. Ravelli’s data revealed that
those adults who were exclusively breastfed were sig-
nificantly less likely to be diagnosed with type 2 diabe-
tes when compared to those subjects who were partially
or exclusively formula fed.
Although investigations are still ongoing, there exists
substantial evidence to support the supposition that
breastfeeding acts as a buffer with regard to the develo-
pment of type 2 diabetes in child, adolescent, and adult
populations [5,9 ,13,15,36].
According to the World Health Organization [15],
elevated blood pressure in adolescence and adulthood
has been correlated with formula feeding in infancy.
Martin and Colleagues [38] conducted a systematic re-
view which included over 17,000 adults and found that
systolic blood pressure was significantly lower in sub-
jects who were exclusively breastfed during infancy.
Martin, et al. [38] acknowledged that the particular me-
chanisms underlying these findings are not fully under-
stood at this time, and that more research is needed in
this area.
Plagemann & Harder [39] found that breastfeeding
positively impacts bo th HDL and LDL cho lesterol levels
and significantly reduces blood pressure in adolescents
and adults. Waterland & Garza [22] hypothesized that
the metabolic imprinting that occurs with formula feed-
ing actually alters vascularization and cell structure
causing changes in the production of enzymes, hormones,
and transmembrane transporters. Waterland & Garza [22]
suggest that this metabolic alteration significantly in-
creases the risks of later cardiovascular disease.
Although nu merous studies have indicated that exclu-
J. M. Stolzer / Open Journal of Preventive Medicine 1 (2011) 88-93
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
sive breastfeeding has been associated with a protective
effect against elevated blood pressure and elevated cho-
lesterol levels later in life [40], researchers have ac-
knowledged that the mechanisms which regulate lipo-
protein concentrations and blood pressure functioning
need further investigation. What is certain at this point is
that breastfeeding is statistically related to the prevention
of metabolic atrophy in human populations [15,25,40].
A number of studies have indicated that elevated BMI
is correlated with cardiovascular disease [5,9,15,35], and
that childhood overweight and obesity are significant
predictors of la t e r cardi o vascular, dysfunct i o n [2 ,4 1, 2].
Published data indicates that formula feeding increase s
the risks of later cardiovascular disease. Rich-Edwards,
et al., [42] examined over 87,000 individuals observing
differences in feeding methods and later cardiovascular
malfunction. Participants were born between 1921 and
1946 and reported in 1992 if they were breastfed or for-
mula fed, and for how long they were breastfed. During
eight years of investigation, these researchers found that
breastfed populations had significantly lower rates of
cardiovascular disease and stroke. The most significant
protective effects of breastfeeding were observed in
those participants who were breastfed for nine months or
Owen, Whincup, Odoki, Gilg, and Cook [43] cross
sectional study suggests that breastfeeding plays a major
role in the prevention of cardiovascular disease. Ac-
cording to this study, breastfeeding is associated with
lower LDL cholesterol and blood pressure, and has long
term benefits for cardiovascular functioning.
The widely known Muscatine Study demonstrated that
cardiovascular risk in adulthood is related to childhood
LDL cholesterol levels and childhoo d BMI [41]. In addi-
tion, postmortem studies have indicated that with regard
to atherosclerosis, the extent and severity of cardiovas-
cular disease is highly correlated with elevated BMI and
lipoprotein levels [2].
Researchers have postulated that infant nutrition is a
reliable predictor of later cardiovascular functioning.
Tracy, Newman, Wattigney, and Berenson [44] con-
cluded that atrophy of the arterial wall most likely oc-
curs during childhood as data indicates that formula
feeding in infancy is a more powerful predictor of car-
diovascular disease then is adult risk factors.
It has been well established that breastfeeding signify-
cantly decreases overweight and obesity and those co-
morbidities associated with these conditions [5,15]. How-
ever, any discussion regarding increasing breastfeeding
rates in America must take into account the multifarious
variables associated with this issue. In order to increase
breastfeeding rates across diverse populations, research-
ers must acknowledge the complexities associated with
breastfeeding, which include, but are not limited to 1)
The lack of breastfeeding role models in the family, the
community, and the mass media [28]; 2) federal policies
which impede both the initiation and duration of breast-
feeding [6,17]; 3) culture ideologies which dictate that a
woman’s worth is based on her economic earning power
[28]; 4) the lack of physician breastfeeding education
[13,16] and 5) The mass sexualization of the female
breast [7,16].
The Surgeon General [13] has stated that increasing
breastfeeding rates is essential, and has urged research-
ers to improve the public’s understanding of the com-
pendious benefits associated with breastfeeding [13]. At
the present ti me, the United States of America has one of
the lowest breastfeeding rates in the world, and contin-
ues to rank significantly higher than other industrialized
nations in terms of morbidity and mortality rates [15]. If
we are to see a reduction in overweight and obesity,
American’s can no longer afford to ignore the protective
effects of breastfeeding which have been well docu-
mented in the medical literature.
In light of the overwhelming body of scientific evi-
dence that documents the risks associated with formula
feeding, the medical profession, parents, researchers,
educators, and concerned others must strengthen their
advocacy of breastfeeding. We can no longer claim that
breastfeeding and formula feeding are equal methods of
nutrition, or that health outcomes are the same for
breastfed and formula fed populations.
Data confirms that breastfeeding in infancy is associ-
ated with a reduced risk of overweight and obesity, type
2 diabetes, elevated blood pressure and cholesterol, and
cardiovascular disease [5,11,12,36]. While the decrease
in caloric intake and an increase in physical activity are
the primary environmental protections against over-
weight and obesity, preventative strategies such as in-
creasing breastfeeding initiation and duration rates are
essential if we are to be successful in reversing the
overweight and obesity epidemic in future generations
[5]. Accordingly, we must address this obesity crisis by
making breastfeeding a public health priority, and by
uniting forces across disciplines to support a strong and
effective public health campaign to increase breastfeed-
ing rates exponentially [10,11].
Extensive epidemiological data demonstrates that ex-
clusive breastfeeding has long term benefits including
J. M. Stolzer / Open Journal of Preventive Medicine 1 (2011) 88-93
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
the reduction of obesity and overweight, type 2 diabetes,
blood pressure, LDL cholesterol levels, and cardiovas-
cular disease [5,10,15,37]. The inverse relationship be-
tween breastfeeding and th e above stated risk factors can
no longer be ignored. According to decades of published
empirical data, breastfeeding significantly impacts health
outcomes not only in childhood, but throughout the
life-span [14,16,11].
In order to increase breastfeeding rates exponentially,
experts have suggested the following:
Requiring that the formula industry inform the Ame-
rican consumer of the risks associated with their pro-
duct [7,16].
Incorporating breastfeeding role models in the famil-
ial sphere, the community, and the mass media [7].
Regulating the advertising of formula, particularly in
medical journals and parenting magazines [7].
Demanding that the economic alliance between the
medical community and the formula industry be sev-
ered, including a halt to the formula industry’s fund-
ing of medical research, as well as its practice of giv-
ing free samples to new mothers via hospitals or
physician offices [28].
Reassessing America’s cultural view of the female
breast [16,28].
Providing mandatory continuing breastfeeding edu-
cation for practicing physici ans [16,17].
Formally questioning the ethics of medical journals
that carry advertisements for formula (a product that
is known to increase morbidity and mortality rates)
Demanding that the public be informed via public
service announcements of the protective effects of
Requiring physicians to inform their patients that
breastfeeding significantly decreases morbidity and
mortality rates (including overweight and obesity).
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