Childhood obesity (CO) is a critical health problem and has alarmed health professionals for its rapid growth worldwide with UK childhood obesity statistics doubling from the previous 25 years (Foresight 2007 & HM Government 2008). The World health organization (WHO) reported that in 2016 there were 41 million infants and young children across the world who were obese or overweight. Given the epidemic nature of this condition, it is a national duty that professionals from all fields battle to reverse and overcome CO trends, and the adverse effects it has on children’s quality of life, and detrimental negative health implications.
As a consequence of the obesity epidemic, there have been numerous studies carried out that indicate breastfed (BF) children have a lower risk of childhood obesity than those who are not BF. Wang et al (2014) found that BF acts as a protector and a shield for CO, and that BF is directly related to decreasing the risk of obesity. The World Health Organization (WHO) has stated in their findings that exclusively breastfeeding infants is a key factor to decrease and prevent childhood obesity. Furthermore, the American Academy of Paediatrics (2003) advise us of the long-term benefits of BF, as infants who were BF had lower rates of obesity, type-2 diabetes, and hypertension than those who are formula-fed. This is because formula-fed babies receive higher levels of fat/protein that they do not need, which is positively associated with childhood obesity (Agostoni et al 2009) , whereas breastmilk contains higher nutritional goodness and bacteria that prevent obesity (McCarthy 2016)
However, despite the research and data showing the high protective benefits breastfeeding has in relation to childhood obesity prevention, BF rates around the world, especially in the United States remain low and are dismal. According to Li et al. (2005), a shocking reduced number of 13.3% of infants were exclusively breastfed until the age of six months old, and 16.1 were BF until they were 12 months old. It is alarming that breastfeeding rates continue to stay low, despite all the scientific evidence that surrounds the topic of the positive impacts of BF, including its ability to reduce obesity, and other health diseases in infants and children.
Socioeconomically disadvantaged infants face large exposure to weight gain early in life which is positively associated with the development of Childhood obesity (World Health Organisation 2014). Childhood obesity is a serious public health concern, as obese children have an increased likelihood of suffering from serious health problems as adults, including cardiovascular disease, and insulin resistance (Wang et al 2014). Choisis, Sacker & Kelly (2015) reported that infants who had low-income mothers were more at risk of experiencing childhood obesity. Mothers who are from a lower class background, and have a lower income face barriers to prevent them from breastfeeding, e.g. they may not have access to the correct health care advice regarding sound nutrition for their infants, and they also lack education of the benefits of breastfeeding, lack of money to afford professional classes with regards to breastfeeding, and can’t afford high nutritional food. All these factors are intricately inter-connected which can limit a mother’s self-efficacy to breastfeed and creates a barrier for early inhiation of exclusively breastfeeding their children.
My intervention will target all infants ages 0-1 years old born in Wolverhampton. The British Heart Foundation (2018) found that childhood obesity is above the national average with 40% of children in Wolverhampton being obese. Furthermore, statistics have shown those with higher levels of obesity in Wolverhampton are among children from more lower-class deprived areas. Likewise, Skelton & Cook’s (2009) findings suggested that childhood obesity was higher among those from lower-income and African American/ Latino families. Cordero et al (2014) noted that the main risk factor for childhood obesity in infants who were socioeconomically disadvantaged was formula-feeding children. The previous literature and statistics magnify the combined problems that infants in Wolverhampton are facing. Thus, higher levels of childhood obesity, alongside the fact that these children are from low-income backgrounds and their inequalities expose them further to childhood obesity, therefore I believe there is scope to create an intervention that targets infants from low-income mothers.
My intervention is guided by a theoretical approach ‘6SQuID model of intervention design’ (Six Steps for Quality Intervention Development) (Wight et al 2015). It will initiate changes in behavior through theoretical techniques, plus discover the mechanism of action by which interventions will have the effect to give low-income mothers confidence, knowledge, and social support to encourage self-efficacy and positive breastfeeding behaviors from mothers. It is appropriate to create a behavioral infant feeding intervention that encourages and educates mothers to breastfeed (BF) for the first six months of the infant’s life. Li et al (2007) commented that breastfeeding for at least six months prevents early-onset and late-onset childhood obesity, and these individuals were less likely to be overweight. Paul & Savage et al (2011) suggest that the role of the parent acts as an agent of change which is key to early childhood obesity prevention, thus being said we believe that it is crucial that early postnatal mothers from low-income backgrounds receive behavioral changing interventions.
Bai & Lee (2019); Zhu, Zhang, Ling, & Wan, (2017) noted that Ajzen’s Theory of Planned Behaviour would be a useful theoretical framework to guide interventions that would lead to mothers breastfeeding their babies. The delivery of adequate BF knowledge about the benefits of breastfeeding will make mothers perceive valued outcomes of BF that outweigh any costs. Other perspectives involving beliefs, attitudes, subjective norms, perceived behavioral control, breastfeeding intention and personal confidence, and ability to BF are determinants of mothers breastfeeding intentions.
Thus, being said, I believe it is important that low-income mothers are provided with furrow knowledge and education on the benefits of BF that are directly tailored to their needs, so there behavioral and normative beliefs can be fixed on their intention to BF. All low-income mothers in Wolverhampton who have infants aged 0-1 will be automatically booked in for weekly multi-educational breastfeeding support sessions for 6 months at New Cross Hospital antenatal unit. The sessions will be delivered by a combination of midwives and Lactation experts, which are designed to increase knowledge/ skills among low-income mothers and keep motivating intentions to BF and promote BF self-efficacy. Mothers will be educated on the benefits of breastfeeding and how it can reduce childhood obesity. E.g. information on the nutritional goodness in breastmilk, and advice on the problems with formula feeding including its high proteins, skin to skin contact whilst BF can be a good bonding special time for mothers and infants to promote positive psychological benefits, and also BF is much more cost-effective for those low-income mothers.
Modeling is a behavior change technique used in this intervention, which promotes its action on behavior through several mechanisms, including increasing mothers’ confidence, self-efficacy (SE), subjective norms, and Bandura’s social learning theory. Wozniak et al (2005) showed that modeling behaviors improve the likely hood of obesity prevention. We will teach mothers skills to exclusively BF their infants and how to adapt breastfeeding to their lifestyle including pump-expressed breast milk, by physical demonstration, diagrams, and videos, and encourage a positive BF community where they will view other mothers who are also BF or have an intention to BF. Bandura (2001) suggests that having a strong support network is essential for behavioral change, therefore this is why the intervention includes mothers together in a group who will all share positive beliefs of BF, and echo the message to other mothers creating a ripple effect. Furthermore, when BF techniques are modeled to mothers it should produce a favorable intention to BF, and also increase their perceived behavioral control as they believe they have a positive milk supply, and good lactation to BF their baby, which increases the likelihood of mothers continuing to BF as they feel they have it under control. Furthermore, as they will witness other mothers’ BF, and be surrounded by BF messages, and videos encouraging BF, this will acts as a subjective norm, in other words, mothers’ subjective perception of BF due to their exposure to seeing other mothers’ BF, and also the positive support and advice from others. Consequently, mothers, with strong breastfeeding intentions will lead to longer and more exclusive breastfeeding practices.
Conclusion
Psychological behavioral-based interventions with low-income infants currently lack enough empirical research, which greatly limits the external validity of current data, and makes it challenging in helping this low-income community of mothers and infants, leading to infants becoming more susceptible of facing childhood obesity. Going forward, prevention and intervention strategies need to focus on the early detection of psychological factors to help with the maintenance of childhood obesity. We note the importance of creating even a small change in behavior, thus being a professionally designed intervention for low-income infants, working with mothers to change thinking patterns has the potential to largely reduce obesity, as, through their adherence, a ripple effect will emerge that will benefit infants quality of life, mothers skills, and also benefit the national health service as it will save the economy millions per year in childhood obesity health-related issues.
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