Researchers in France used height and weight figures available in an obstetric database to determine body mass index (BMI) for each woman who delivered between March and October 2005. Ultimately, 111 obese women participated in the study; researchers compared their data with that of 111 normal-weight women.

Study participants completed a questionnaire which asked about their infant feeding decisions, the father’s role in the decision-making, and the infant feeding practices of close family members. Breastfeeding mothers completed additional questions about their breastfeeding practices and difficulties. Follow-up questionnaires at one- and three-months also asked about breastfeeding support and infant feeding practices.

Among study findings:

• Feeding practices of family members mattered. A whopping 84.3% of women who chose not to breastfeed came from families that predominantly formula-fed.

• The father’s opinion mattered. Nearly as many (83.1%) of the women who chose to breastfeed considered the father’s opinion; just 66.3% of formula-feeding women said they did.

• Reasons for not breastfeeding differed. Among obese women who formula-fed from the start, the #1 reason not to breastfeed was “decency” (33.3%). (For normal-weight women, the top reason was “no desire to breastfeed” (35.3%).) Other reasons were: bad past breastfeeding experience, father’s choice, formula-feeding was easier, fear of pain, use of medications, breast surgery, smoking, and fatigue.

• Infants’ weight differed. Infants of obese mothers lost more weight on the maternity ward and gained less at one month—but there wasn’t a difference at 3 months.

• Exclusive breastfeeding ended sooner. There was no difference in the percentage of mothers who were breastfeeding at all at 1 and 3 months, but obese mothers were less likely to be breastfeeding their infants exclusively.

• Breastfeeding difficulties were more prevalent. Both in-hospital and at-home, more obese breastfeeding mothers reported difficulties breastfeeding, such as cracked nipples, fatigue, or problems with initiation or milk supply.
  

• Reasons for quitting breastfeeding varied. More obese women felt their milk supply was inadequate at 1 and 3 months; this was the top reason they said they quit (55.5% compared with 33.3% of normal-weight women). Other reasons included insufficient infant weight gain, return to work, and fatigue. At 3 months, they also often said they felt uncomfortable breastfeeding in front of others.

• Little breastfeeding support was received. At three months, obese breastfeeding mothers were less likely to report being followed by health care providers or breastfeeding support groups.

So what does this all mean? Well, this study cannot show causation, but it can suggest areas that may be important in this issue. Researchers identified several reasons for quitting (perceived insufficient milk supply, discomfort with breastfeeding in public, reluctance to seek support for breastfeeding) and not starting (decency, family members’ decisions, fathers’ opinions) that may provide clues about the type of support these new mothers need. Health care providers need to be ready and able to provide such support—and I can’t help but think that friends who are themselves parents can provide it, too.

More resources
Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Survey, 1999-2006.