Understanding Why Women With Obesity Don't Breastfeed

Despite documented benefits for both mother and baby, women who are clinically obese are less likely to start breastfeeding and sustain it than other women. Why this is so has not been well understood.

To gain insights into this disparity, a team of researchers from the United Kingdom conducted a qualitative study consisting of telephone interviews with 18 women who already had a body mass index (BMI) of at least 30 kg/m² when they became pregnant. Both the CDC and the World Health Organization considers a person with a BMI of this level or higher to be obese.

Prior research had found that obese women are less likely to start breastfeeding (82.2% vs 86.4%) and less likely to breastfeed for at least 6 months (44.4% vs 53.8% in a 2014 study).

As the number of women who are clinically obese rises, there are public health concerns that fewer newborns will be breastfed, and those that are will be breastfed for shorter intervals. Of note, breastfeeding aids in postpartum weight loss, which would be particularly important for this group. The researchers wanted to know which factors went into decisions to breastfeed or to quit breastfeeding.

Two themes emerged from the interviews: (1) “personal control over breastfeeding behavior,” and (2) “realistic expectations of the breastfeeding journey.”

Women described the need to feel in control of the decision to breastfeed, especially in the face of social and practical barriers, like not being able to find nursing tops in their size. They especially described the need for support from other women who were similarly obese and breastfeeding, and researchers cited the need for women to find breastfeeding support groups. Many of the obese women had already experienced a “medicalized” pregnancy and childbirth, and they did not always receive adequate support from their physician in their breastfeeding decisions.

“Women viewed breastfeeding as a natural behavior. However, after being deemed ‘high risk’ by health professionals during pregnancy (i.e. regardless of their whole health status), and requiring medical intervention during pregnancy or labor, they did not feel in control of their feeding decisions, which negatively impacted upon breastfeeding initiation and maintenance,” the researchers wrote. “Furthermore, social and practical barriers due to their body size and shape reinforced the idea that breastfeeding was not for them.”

Rather than offer guidance, physicians often reinforced the lack of being in control. But breastfeeding was not impossible with the right support.

“Many women acknowledged that they had needed a ‘cheerleader’, and that seeking professional and peer support had provided encouragement and reassurance that breastfeeding was for them,” the researchers wrote. “Therefore, promoting control over feeding practices despite pregnancy risk status, and helping women to find appropriate support may increase breastfeeding in this population.”

Reference

Lyons S, Currie S, Smith DM. Learning from women with a body mass index (BMI) ≥ 30 kg/m2 who have breastfed and/or are breastfeeding: a qualitative interview study [published online January 4, 2019]. Matern Child Health J. doi.org/10.1007/s10995-018-2679-7.