The Influence of Obesity Stigma on Breastfeeding Rates

Artwork by Lajos Tihanyi, 1908
Image from Wikimedia Commons

A number of studies over the years have consistently found lower breastfeeding rates in high-BMI women. The question is, why? 

Typically, most authors speculate that there is some biological disturbance and that this is the main reason for lower breastfeeding rates in "obese" women. In other words, as always, researchers see our bodies as defective and blame our weight for every problem we encounter. 

However, a recent study found that there may be subtle obesity stigma at work as well. In the study, high-BMI women were consistently given less information about breastfeeding, less help in getting breastfeeding started, less opportunity to breastfeed within the first hour after birth, less access to breastfeeding support resource phone numbers, less rooming-in, and less encouragement to breastfeed on demand. 

My best guess is that there are multiple factors at work in lower breastfeeding rates in heavier women. Although many women of size breastfeed without any problems, it's possible that for some there may be biological factors like Polycystic Ovarian Syndrome (PCOS) or other hormonal differences that impact milk supply.

In addition, researchers rarely control for the effect of birth interventions on breastfeeding rates in obese women, despite the fact that unconscionably high cesarean rates in this group may be a strong factor impacting breastfeeding rates as well. Furthermore, as we have written about before, other factors such as subtle thyroid disturbances, greater postpartum blood loss leading to increased anemia, and psychosocial factors may also influence breastfeeding rates in obese women.

In all likelihood, the breastfeeding rate in women of size is influenced by many complex factors. No one answer is likely to fix the rate completely.

But one factor that would be easy to fix is improving the consistency and quality of breastfeeding support offered to high-BMI women. 

How sad that differences in quality of support even exist in the first place.

Reference

Matern Child Health J. 2016 Mar;20(3):593-601. doi: 10.1007/s10995-015-1858-z. Obese Mothers have Lower Odds of Experiencing Pro-breastfeeding Hospital Practices than Mothers of Normal Weight: CDC Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008.
Kair LR1, Colaizy TT2. PMID: 26515471 DOI: 10.1007/s10995-015-1858-z

OBJECTIVES: This study examines the extent to which a mother's pre-pregnancy body mass index (BMI) category is associated with her exposure to pro-breastfeeding hospital practices.  METHODS: Data from the 2004-2008 CDC PRAMS were analyzed for three states (Illinois, Maine, and Vermont) that had administered an optional survey question about hospital pro-breastfeeding practices. RESULTS: Of 19,145 mothers surveyed, 19 % were obese (pre-pregnancy BMI ≥ 30). Obese mothers had lower odds than mothers of normal weight of initiating breastfeeding [70 vs. 79 % (unweighted), p < 0.0001]. Compared with women of normal weight, obese mothers had lower odds of being exposed to pro-breastfeeding hospital practices during the birth hospitalization. Specifically, obese mothers had higher odds of using a pacifier in the hospital [odds ratio (OR) 1.31, 95 % confidence interval (CI) (1.17-1.48), p < 0.0001] and lower odds of: a staff member providing them with information about breastfeeding [OR 0.71, 95 % CI (0.57-0.89), p = 0.002], a staff member helping them breastfeed [OR 0.69, 95 % CI (0.61-0.78), p < 0.0001], breastfeeding in the first hour after delivery [OR 0.55, 95 % CI (0.49-0.62), p < 0.0001], being given a telephone number for breastfeeding help [OR 0.65, 95 % CI (0.57-0.74), p < 0.0001], rooming in [OR 0.84, 95 % CI (0.73-0.97), p = 0.02], and being instructed to breastfeed on demand [OR 0.66, 95 % CI (0.58-0.75), p < 0.0001]. Adjusting for multiple covariates, all associations except rooming in remained significant. CONCLUSIONS: Obesity stigma may be a determinant of breastfeeding outcomes for obese mothers. Breastfeeding support should be improved for this at-risk population.