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RAPID WEIGHT GAIN

If an exclusively breastfeeding mother is concerned that her baby is overweight, ask about his weight and discuss obesity-prevention strategies.
Weight can be a very emotional subject for mothers, especially for those who are overweight or obese. If the mother of a rapidly gaining breastfeeding baby is concerned about future obesity, begin by asking for some basic information, such as the baby’s age and whether he is exclusively breastfeeding. If not, ask what other foods he consumes and how much per day. Also ask for his current weight, his birthweight, and his weight at each of his weight checks.
In a breastfeeding baby, rapid weight gain is normal during the first few months, however, during months 6 to 12, breastfed babies lose more body fat than formula-fed babies, so tell the mother to expect her baby will slim down then (Dewey, Heinig, Nommsen, Peerson, & Lonnerdal, 1993).
Whether a mother’s milk-fat content is high or low, doesn’t matter, as the baby adjusts his milk intake accordingly. Babies whose mothers make higher-fat milk take less milk per day and those whose mothers make lower-fat milk take more milk per day (Dewey, 2003; Nommsen, Lovelady, Heinig, Lonnerdal, & Dewey, 1991; Perez-Escamilla et al., 1995).
Be sure the mother knows that a baby in the 95th percentile on the growth charts is not necessarily overweight. Most of these babies are also longer than average, and it is the weight-for-length ratio that determines overweight (Hopkinson, 2003). Weight-for-length growth charts are on p. 863 and available free online from the World Health Organization at: http://www.who.int/childgrowth/standards/en/.
During the first year of life, a baby’s healthcare provider will typically notice and comment when a baby is seriously overweight. Overweight babies often find it difficult to roll over and crawl. Ask the mother what the healthcare provider has said about the baby’s weight and how her baby is doing with these developmental milestones to determine if her baby is indeed overweight or if her concerns are a reflection of her own body image issues.
Although breastfeeding has been found to reduce the risk of overweight and obesity (see next point), one of the strongest predictors of overweight and obesity in children is having overweight or obese parents (Butte, 2009; Hawkins, Cole, & Law, 2009; Panagiotakos et al., 2008). If the mother is overweight or obese, suggest she be proactive about helping her child develop healthy eating habits and exercise regularly. If the mother is very concerned about her baby’s weight, suggest she consider seeing a dietitian or nutritionist to discuss strategies to minimize her baby’s chances of become an overweight child or adult.
Attempting to slow a baby’s weight gain by limiting time at the breast is not a good strategy because the young child is growing rapidly and needs the nutrients in mother’s milk for normal development.
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Breastfeeding is associated with a 20% to 30% reduced risk of childhood obesity.
Many studies and meta-analyses have found early breastfeeding reduces the risk of obesity in childhood, adolescence, and adulthood, even within families (Arenz, Ruckerl, Koletzko, & von Kries, 2004; Gillman et al., 2006; Grummer-Strawn & Mei, 2004; Ip et al., 2007; Ip et al., 2009). This association is most obvious in research that measures the effect of breastfeeding duration and exclusivity and when the children are followed for at least 6 to 15 years (Dewey, 2009b).
Although other factors, such as parental overweight, have a greater effect on a baby’s risk for overweight and obesity (see previous point), the effect of breastfeeding is significant.
Be sure the mother knows that greater intensity and duration of breastfeeding have been associated with decreased risk of overweight. This was the finding of two U.S. studies that compared weight gain in babies fed by breast and bottle, along with the effects of mothers’ attempts to coax their babies to finish the bottle and regular emptying of the bottle by the baby. One found that for every 3 months the babies breastfed, their body mass index (BMI) score decreased by 0.045 (Taveras et al., 2006). Mothers who regularly coaxed their babies to finish the bottle increased their babies’ odds of becoming overweight by 13%. But this study found that future risk of overweight was only partly explained by feeding mechanics. The other study concluded that when less than 80% of babies’ daily milk intake was mother’s milk, babies were twice as likely to become overweight between 6 and 12 months as those who received more than 80% mother’s milk each day (Li et al., 2008). In this second study, babies who often emptied their bottles were 69% more likely than those who rarely emptied their bottles to be overweight between 6 to 12 months.
Several studies have found rapid weight gain during the first 4 months of life to be a significant risk factor for later overweight or obesity (Baird et al., 2005; Dennison, Edmunds, Stratton, & Pruzek, 2006; Ong & Loos, 2006; Stettler, Zemel, Kumanyika, & Stallings, 2002). Unfortunately, these studies did not examine the effects of infant feeding (breast or bottle) on later weight, so it is not known whether later overweight and obesity were more common among formula-fed babies (Dewey, 2009b). For reasons formula-feeding contributes to greater weight gain, see ”Growth from Birth to 12 Months.”
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If the baby is eating solid foods, discuss feeding strategies and food choices that may affect weight gain.
Solid foods and weight gain before 6 months. Both babies and mothers have better health outcomes when solid foods are delayed until 6 months (see “Not Too Early”). But rapid weight gain is a common reason for early introduction of solids among U.K. mothers, who consider this an indication their baby “needs” other foods (Savage, Reilly, Edwards, & Durnin, 1998; Wright, Parkinson, & Drewett, 2004).
In cultures that believe overweight babies are “healthier,” parents may consider introducing solid foods early necessary, so their babies “get enough.” If this belief causes mothers to consistently override their babies’ signs of fullness and give more food, this can set up unhealthy feeding habits that increase the risk of childhood obesity later.
Ask the mother what solids she’s been feeding her baby and how often. Also ask her why she decided to start solids early. Although feeding cereal to babies 3 to 6 months old has been associated with lower weights (Kramer et al., 2004), giving large amounts of high-calorie solids may contribute to rapid weight gain. If solids have been a substantial part of the baby’s diet and the mother wants to reduce or eliminate them, encourage her to reduce them gradually and breastfeed more often to boost her milk production and fill the gap.
Solid foods and weight gain after 6 months. Food choices can affect a baby’s weight gain. If the baby is gaining weight very rapidly, suggest the mother avoid high-calorie solids (like egg yolks and avocados and “empty calories”, such as sweetened foods and drinks) and offer a greater variety of fresh fruits and vegetables. Suggest the mother also breastfeed first, before giving solids. Encourage her to think of her milk as her baby’s primary food during his first year and solids as a supplement to breastfeeding. Greater intensity and duration of breastfeeding have been associated with lower weight gain between 3 and 12 months (Li et al., 2008; Taveras et al., 2006).

Arenz, S., Ruckerl, R., Koletzko, B., & von Kries, R. (2004). Breast-feeding and childhood obesity--a systematic review. International Journal of Obesity and Related Metabolic Disorders, 28(10), 1247-1256.
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Benson, S. (2001). What is normal? A study of normal breastfeeding dyads during the first sixty hours of life. Breastfeeding Review, 9(1), 27-32.
Binns, C. W., & Scott, J. A. (2002). Using pacifiers: what are breastfeeding mothers doing? Breastfeeding Review, 10(2), 21-25.
Butte, N. F. (2009). Impact of infant feeding practices on childhood obesity. Journal of Nutrition, 139(2), 412S-416S.
Butte, N. F., Wong, W. W., Hopkinson, J. M., Heinz, C. J., Mehta, N. R., & Smith, E. O. (2000). Energy requirements derived from total energy expenditure and energy deposition during the first 2 y of life. American Journal of Clinical Nutrition, 72(6), 1558-1569.
Butte, N. F., Wong, W. W., Hopkinson, J. M., Smith, E. O., & Ellis, K. J. (2000). Infant feeding mode affects early growth and body composition. Pediatrics, 106(6), 1355-1366.
Dennison, B. A., Edmunds, L. S., Stratton, H. H., & Pruzek, R. M. (2006). Rapid infant weight gain predicts childhood overweight. Obesity (Silver Spring), 14(3), 491-499.
Dewey, K. G. (2003). Is breastfeeding protective against child obesity? Journal of Human Lactation, 19(1), 9-18.
Dewey, K. G. (2009a). Infant feeding and growth. Advances in Experimental Medicine and Biology, 639, 57-66.
Dewey, K. G. (2009b). Infant feeding and growth. In G. Goldberg, A. Prentice, P. A., S. Filteau & K. Simondon (Eds.), Breast-feeding: Early influences on later health (pp. 57-66). New York, NY: Springer.
Dewey, K. G., Heinig, M. J., Nommsen, L. A., Peerson, J. M., & Lonnerdal, B. (1992). Growth of breast-fed and formula-fed infants from 0 to 18 months: the DARLING Study. Pediatrics, 89(6 Pt 1), 1035-1041.
Gillman, M. W., Rifas-Shiman, S. L., Berkey, C. S., Frazier, A. L., Rockett, H. R., Camargo, C. A., Jr., et al. (2006). Breast-feeding and overweight in adolescence: within-family analysis [corrected]. Epidemiology, 17(1), 112-114.
Grummer-Strawn, L. M., & Mei, Z. (2004). Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Pediatrics, 113(2), e81-86.
Hawkins, S. S., Cole, T. J., & Law, C. (2009). An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study. Journal of Epidemiology and Community Health, 63(2), 147-155.
Hopkinson, J. M. (2003). Is it possible for a breastfed baby to be overweight? Journal of Human Lactation, 19(2), 189-190.
Motil, K. J., Sheng, H. P., Montandon, C. M., & Wong, W. W. (1997). Human milk protein does not limit growth of breast-fed infants. Journal of Pediatric Gastroenterology and Nutrition, 24(1), 10-17.
Nommsen-Rivers, L. A., & Dewey, K. G. (2009). Growth of breastfed infants. Breastfeeding Medicine, 4 Suppl 1, S45-49.
Ong, K. K., & Loos, R. J. (2006). Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatrica, 95(, 904-908.
Panagiotakos, D. B., Papadimitriou, A., Anthracopoulos, M. B., Konstantinidou, M., Antonogeorgos, G., Fretzayas, A., et al. (2008). Birthweight, breast-feeding, parental weight and prevalence of obesity in schoolchildren aged 10-12 years, in Greece; the Physical Activity, Nutrition and Allergies in Children Examined in Athens (PANACEA) study. Pediatrics International, 50(4), 563-568.
Stettler, N., Zemel, B. S., Kumanyika, S., & Stallings, V. A. (2002). Infant weight gain and childhood overweight status in a multicenter, cohort study. Pediatrics, 109(2), 194-199.
Taveras, E. M., Rifas-Shiman, S. L., Scanlon, K. S., Grummer-Strawn, L. M., Sherry, B., & Gillman, M. W. (2006). To what extent is the protective effect of breastfeeding on future overweight explained by decreased maternal feeding restriction? Pediatrics, 118(6), 2341-2348.