Field Notes

Mom’s Socioeconomic Background
Affects Babies’ Dietary Habits

You have to be at least age 2 to be covered by US dietary guidelines. For babies under that age, there are no US dietary guidelines other than the general recommendation by national and international organizations that mothers exclusively breast-feed their babies for at least the first six months.

So what do American babies eat? That is the question that motivated researchers at the University at Buffalo (UB) School of Medicine and Biomedical Sciences to study the eating patterns of American infants aged 6 months and 12 months old. Their study, “Sociodemographic differences and infant dietary patterns,” was published in Pediatrics.

“We found that differences in dietary habits start very early,” says Xiaozhong Wen, MBBS, PhD, an assistant professor in the UB department of pediatrics and lead author on the paper.
Wen conducts research in the UB department of pediatrics’ behavioral medicine division, studying how and why obesity develops in infants and children. Studying the first solid foods that babies eat can provide some insight into whether or not they will develop obesity later on, he explains. “From six to twelve months is a critical period for babies—it’s when infants learn the tastes of different foods,” he says.

The UB researchers found that dietary patterns of children aged 6 months and 12 months vary according to the racial, ethnic, and educational backgrounds of their mothers.

For example, babies whose dietary pattern was high in sugar, fat, and protein or high in dairy foods and cereals, were associated with mothers whose highest education level was some or all of high school, had low household income (generally under $25,000 per year), and who were black. Both the high-sugar/fat/protein pattern and the high-dairy pattern resulted in higher BMI scores for the babies compared with those who had higher consumption of vegetables and fruits, baby cereal, and meat.

Babies who consumed larger amounts of formula and baby cereal, indicating little or no breast-feeding, were associated with being born through emergency caesarean section and enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Wen notes that one possible reason for high-formula consumption in this group is that WIC provides financial assistance for formula purchases.

On the other hand, babies whose dietary pattern included more breast-feeding and solid foods that adhere closely to infant guidelines from international and pediatric organizations were associated with higher household incomes, generally above $40,000 per year, and higher education levels ranging from some college to postgraduate education.

“This study showed us that dietary patterns already exist among young infants, and they’re harder to change later if you ignore the first year,” Wen says.

Some of the unhealthful ‘adult foods’ that were consumed by 6- and 12-month-old babies in the study included items that are inappropriate for infants, such as candy, ice cream, potato chips, and French fries.

“There’s substantial research to suggest that if you consistently offer foods with a particular taste to infants, they will show a preference for these foods later in life,” Wen explains. “So if you tend to offer healthful foods to infants, such as pureed vegetables, they will develop a liking for them. But if you always offer sweet or fatty foods, infants will develop a stronger preference for them.

“This is both an opportunity and a challenge,” Wen continues. “We have an opportunity to start making dietary changes at the very beginning of life.”

The researchers also found that babies whose diets consisted mainly of high-fat/sugar/protein foods were associated with shorter length-for-age scores.

“We’re not sure why this happens, but it’s possible that because some of these foods that are high in sugar, fat, or protein are so palatable they end up dominating the baby’s diet replacing more nutritious foods, that could be higher in calcium and iron, therefore inhibiting the baby’s growth,” Wen says.

The UB researchers based their analysis on a subsample covering more than 1,500 infants, nearly evenly split between genders, from the Infant Feeding Practices Study II, conducted by the FDA and the Centers for Disease Control and Prevention, from 2005 to 2007. In that study, mothers recorded which of 18 different food types their 6- and 12-month-old babies ate in a week; those data then were used to develop dietary patterns.

— Source: University at Buffalo


Almost Two-Thirds of American Adults
Recommended for Weight-Loss Treatment

New research shows that 140 million American adults—about 65%—are recommended for behavioral weight-loss treatment, with 83% of those (or 116 million) considered for pharmacotherapy. Thirty-two million adults recommended for both pharmacotherapy and behavioral treatment also are potential candidates for bariatric surgery. Researchers used data from the 2007-2012 National Health and Nutrition Examination Survey (NHANES) to estimate the proportion of adults in the United States recommended for treatment based on The Obesity Society, The American Heart Association, and The American College of Cardiology Guidelines for Managing Overweight and Obesity in Adults, released in November 2013. The findings were presented by lead researcher June Stevens, PhD, AICR, distinguished professor of nutrition and epidemiology at the University of North Carolina, Chapel Hill and The Obesity Society member, during a poster session at The Obesity Society Annual Meeting in Boston.

This research comes at a time when the American obesity epidemic is one of the worst in the world. The development and release of the Obesity Guidelines are intended to offer health care providers empirically based and effective weight-loss treatments for those affected by obesity.

“These guidelines address critical questions in obesity treatment and provide evidence-based recommendations on topics such as: Who needs to lose weight? How much weight loss is needed to improve health? And what are the best and most appropriate methods for losing weight?” Stevens said. “Our team was eager to apply these recommendations to the population of the United States, and unfortunately, we were not surprised to see that a massive number of Americans are recommended for weight-loss treatment.”

Nationally representative data were used to estimate the number recommended to lose weight among adults aged 20 or older who weren’t pregnant. The recommendation to lose weight was based on an algorithm that included weight, height, waist circumference, and risk factors such as diabetes, hypertension, and blood lipid levels. Researchers also compared various demographics and found that individuals were more likely to be recommended for treatment if they were older than 45, male, black, or Mexican American, didn’t have a college degree, and were insured by either Medicaid or Medicare rather than another type of health insurance.

“These findings remind health care providers, policymakers, and the public that obesity is a disease that needs to be taken seriously,” said Donna Ryan, MD, Obesity Journal associate editor-in-chief and professor emeritus at Louisiana State University’s Pennington Biomedical Research Center, speaking on behalf of The Obesity Society. “With more than half of US adults recommended for weight-loss treatment, we call on all health practitioners from primary care physicians to registered dietitians to review the guidelines and take steps to put them into practice. This huge number of Americans recommended for weight-loss therapy reinforces the need for broad, sweeping transformations in obesity management in the primary care setting. The good news is that there are evidence-based treatments readily available for most adults recommended for weight-loss treatment.”

Today, millions of Americans continue to be denied health insurance coverage for legitimate and proven obesity treatments. The Obesity Society and its partners in the Obesity Care Continuum are advocating for change, and the organization recently launched an Advocacy Action Center to enable others to sign onto its efforts.

In addition to the Obesity Guidelines, health care providers soon can look forward to reviewing the first pharmacotherapy guidelines for the medical treatment of obesity, which are expected to be released by The Endocrine Society and The European Society of Endocrinology, and The Obesity Society in January. These guidelines will expand upon the current Obesity Guidelines, and combined, both resources will fill a gap in the treatment of obesity, a disease that puts individuals at risk of more than 30 other health conditions.

"Seeking the support of a health care practitioner for weight loss can make all the difference for people affected by obesity,” Ryan said. “As an adjunct to diet and exercise, medications approved by the FDA for treatment of obesity can help people with obesity lose weight, specifically if they haven’t found prior success with diet and exercise alone. However, the decision to add medical treatment or surgery for any disease should be one made by the physician and the patient. The guidelines are intended to provide an evidence-based tool to help physicians identify and treat patients that may need the additional support."

— Source: The Obesity Society