Tag Archives: Breastfeeding

An equal start: longitudinal evidence to support children’s healthy development

Using longitudinal evidence to support children’s healthy development and give them an equal start in life is the subject of our editor Yvonne Kelly’s keynote address at the Growing up in Ireland Annual Conference in Dublin today.

Her talk discusses findings from the most recent of the British ‘birth ‘ cohort studies – the Millennium Cohort Study that have so far informed policy development. They include work by researchers at the ESRC Centre for Lifecourse Studies where Yvonne is based on alcohol consumption during pregnancy, breastfeeding and the introduction of solid foods, the physical punishment of children , childhood obesity, reading to children in the early years, and sleep patterns throughout childhood.

She will also share work with the potential to inform future policy challenges such as young people’s drinking, social media use and mental health.

Ahead of her talk, she said:

“It is well established that what happens in the early years of life has long-lasting consequences for health and social success across the lifespan. Stark social inequalities in children’s health and development exist and emerge early in life. It is therefore crucial to identify potential tipping points and opportunities for intervention   during childhood with the potential to affect change and improve life chances.”

 

 

Giving children the best possible start – what matters most?

Child of our Time Editor Yvonne Kelly spoke to a 500-strong audience of politicians and professionals in Gothenburg recently on what matters when it comes to giving children the best possible start in life.

Yvonne was the keynote speaker at the conference hoping to identify the best strategies for making Gothenburg a more equal and socially sustainable city.

Yvonne, Professor of Lifecourse Epidemiology at the ESRC International Centre for Lifecourse Studies at UCL  explained which factors are most closely linked with a child’s health and well-being and presented her research findings on children’s verbal skills, behaviour, bedtimes, reading and obesity.

Sugar-coating the childhood obesity problem

Child obesity figures appear to be on the rise again, causing much concern after earlier signs they had levelled off.  The proportion of  10- and 11-year-olds who were obese in 2015-16 was 19.8 percent, up 0.7 percent on the year before. There was a rise of 0.2 percent among four- and five-year-olds. The announcement comes as researchers at the ESRC International Centre for Lifecourse Studies at UCL have been looking in detail at how and when children become overweight. The team has also been asking whether children who are overweight are more likely to go on to smoke and drink alcohol and if their mental health suffers as they become adolescents. Yvonne Kelly explains the research findings, and considers their implications for the Government’s recent strategy for tackling the childhood obesity epidemic.

The Government’s much-awaited and much-debated childhood obesity strategy was published in August. In the end, it was less comprehensive than had been anticipated, less draconian too. It focuses on two things – reducing sugar consumption and increasing physical activity. But will it be effective in reversing this worrying obesity trend among our children?

It’s fair to say we don’t fully understand what things influence whether, when and why a child might become overweight. Research to date has shown three distinct weight pathways for children: a healthy BMI throughout childhood; becoming overweight during childhood and being overweight/obese throughout childhood.

Previous research has also shown that the child’s mother’s weight, smoking in pregnancy, mental health and other social and economic factors have some link to childhood obesity. But the evidence is far from complete and, where a child’s own mental health is concerned, it’s not at all clear which way the association works.

To try to get a clearer picture of all these things, our research looked at the BMI paths of the participants in the Millennium Cohort Study, which has tracked the lives of nearly 20,000 children born between 2000-2002. We used data collected at birth, 9 months, age 3, 5, 7 and 11.

Once we had established who was on which BMI path, we were able to look at what factors were at play in their lives and to see whether a tendency to overweight and obesity was an indication that a child would go on to face mental health difficulties in early adolescence or start smoking and drinking.

Four pathways to obesity

The BMI data for the 17,000 children we were able to look at for our study showed four distinct groups of children. More than 80 per cent of them stayed on an average non-overweight path throughout their childhood – we call it the ‘stable’ path. There was a small group (0.6 percent) of children who were obese at age 3 but were then in the stable group by age 7. We call them the the ‘decreasing’ group. There was a ‘moderate increasing group’ (13.1 percent) where children were not overweight at age 3 but whose BMIs increased throughout childhood into the overweight (but not obese) range. Finally we had a ‘high increasing’ group of children (2.5 percent) who were obese at age 3 and whose BMIs continued to increase.

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Girls were 30 percent more likely to be in the ‘moderate increasing’ group than boys and were half as likely to be on the ‘decreasing’ path. Indian, Pakistani and Black African children were up to two times more likely to be on the ‘moderate increasing’ path whilst Pakistani, Black Caribbean and Black African children were up to three times more likely to belong to the ‘high increasing’ group.

The wealthiest children were least likely to be in the ‘moderate increasing’ BMI group and children of mums who smoked during pregnancy were up to two times as likely to belong to increasing BMI groups. Children with overweight mums were most likely to be on the moderate and high increasing paths.

Children on the moderate and high increasing paths were less likely to have regular family routines – they were more likely to skip breakfast or have non-regular bedtime schedules. Interestingly, however, no strong links emerged with some of the things more readily linked with childhood obesity such as sugary drinks and snacks, watching TV and lack of physical activity such as sports, the main focus of the newly published childhood obesity strategy.

Overweight factors

So it seems quite a large range of factors influence the likelihood of a child becoming overweight or obese over the first decade of their life. On top of this, being overweight or obese would also seem to point to a less happy and fulfilling early adolescence and a tendency to explore risky behaviours like smoking and drinking.

Although our research did not show a clear link with sugary drinks and snacks, there are nevertheless some compelling arguments for reducing the sugar intake of our children. These are not only related to problems of obesity, but to wider issues including the major issue of tooth decay and associated emergency hospital admissions. There is also increasing evidence of the ‘addictive’ nature of sugar with research suggesting that it stimulates a sort of ‘reward path’ in certain centres of the brain meaning that the more we have the more we want. It has been shown that people who reduce their sugar intake tend to crave it less.

Where sugar taxes have been introduced in other countries (Mexico, France, Denmark, South Africa amongst others), the intervention has been shown to help reduce the consumption of sugary drinks. As yet, there is no evidence that it helps reduce BMI and tackle obesity, but it’s argued it will take time for us to see an effect on whole populations.

Disadvantaged families

It is hard to predict how much impact the voluntary rather than mandatory reduction in sugar content of drinks and snacks agreed in the strategy will have. As for the sugar tax that will be introduced in two years’ time, there remain concerns that disadvantaged families more likely to purchase and consume sugary goods than their better off counterparts will be hardest hit. Policy makers will need to think hard about how any negative consequences of this might be counteracted.

Our research shows clearly that when it comes to the likelihood of a child becoming overweight or obese in the first decade of their life, there are many more influences than just sugar. Those influences are at play in families even before our children are born.

Helping pregnant women to stop smoking and maintain a healthy weight, making sure all young children have healthy eating and sleeping routines would seem to be key, together with targeted support for the ethnic and social groups identified as being most at risk.

Further information and resources

BMI development and early adolescent psychosocial well-being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery, and Amanda Sacker. The work, published in Pediatrics, is funded by the Economic and Social Research Council.

Media coverage

Photo credit: Kim Stromstad

Why poorer children are at greater risk of obesity

Obesity may be the biggest public health crisis facing the UK today. Levels have risen more than three fold since 1980. Being obese makes you vulnerable to a range of health risks. Being an overweight child makes it more likely you will become an obese adult. And you are much more likely to be an overweight child, if you come from a poor family. If current trends continue, half the population of Britain could be obese by 2050. Early intervention is the most effective way to break this cycle. And that requires a better understanding of why children become overweight. A new study by a team at the ESRC funded International Centre for Lifecourse Studies in Society and Health at UCL and LSE makes clear the scale of the problem and points to some crucial factors likely to lead less-well-off children to gain excess weight, as co-author Professor Yvonne Kelly explains.

A link between poverty and childhood obesity has been found in many developed countries. Intuitively, it seems likely this link is the result of poorer parents not being able to afford healthier food, like fruit, or outings involving exercise for their children. It could also be that those parents know less about healthy lifestyles and that they themselves eat less healthily and exercise less. But intuition is an insufficient basis for the scale of intervention required. This study is the first attempt to examine and compare in detail why children in poorer families are more likely to be overweight.

Our data comes from the Millennium Cohort Study (MCS). This tracks nearly 20,000 families from across the UK. We used measurements made when the children were aged 5 (when just entering primary school) and 11 (the point at which they leave primary school and are on the cusp of adolescence). We used standard definitions for ‘obese’ and ‘overweight’.

‘Stark’ link between poverty and obesity

The first thing we found was that the link between relative poverty and childhood obesity is stark. At age 5, poor children were almost twice as likely to be obese compared with their better off peers (6.6% of children from families in the poorest fifth of the sample were obese while the figure for the richest fifth is just 3.5%). By the age of 11, the gap has widened- nearly tripling (7.9% of the poorest fifth are obese; for the best-off, the figure is 2.9%).

Given that obesity is linked to the development of numerous chronic diseases and that there is evidence overweight and obese children are less likely to grow into economically and socially successful adults, this is a significant burden to be borne by the children of the less-well-off. And unless we can weaken the link our chances of reversing the overall obesity trend are much reduced.

Potential causes of that link

The MCS collects a broad range of data, allowing us to dig beneath these headline numbers to identify some of the specific ways in which relative poverty in childhood leads to an increased risk of obesity.

To measure the degree to which the mother followed a healthy life-style we looked at factors previously shown to be linked to the increased risk of obesity, such as whether the mother smoked during pregnancy, how long she breastfed for and whether the child was introduced to solid food before the age of four months.

We could also factor in the degree to which the mother was herself overweight or obese. To assess the impact of physical behaviour, we compared the frequency of sport or exercise, active play with a parent, hours spent watching TV or playing on a computer, journeys by bike and the time that children went to bed. We compared dietary habits via data on whether the child skipped breakfast and on fruit and sweet drink consumption.

Multiple factors

What we found was that a lot of these factors were relevant. Maternal behaviour in early childhood was certainly important. Markers of ‘unhealthy’ lifestyle here could mean as much as a 20% additional risk of obesity for a child. Measures of physical activity and diet were also relevant at both 5 and 11 years of age, as were early bedtimes and fewer hours in front of the TV or games console. Skipping breakfast and eating more fruit were factors at 5 but less significant at 11. Doing sport more frequently played a more important and protective role at age 11 than at age 5.

Further examination of the differences between the children aged 5 and aged 11 revealed that poorer children aged 5 were much more likely to gain excess weight up to age 11 than richer children. The earlier certain lifestyle factors can be challenged, therefore, the greater the chance of positive impact.

Multiple responses

Assuming that income inequality is not going to disappear, we can only tackle ‘inherited’ obesity via the lifestyle choices that tend to go with lower incomes. Early intervention with mothers clearly has huge potential. And evidence from our work suggests that this should start before birth or even conception. It is clear, too, that campaigns to encourage family physical activity and healthier diets would help.

The Government is already trying to persuade families to eat more healthily and take more exercise. But these efforts are widely targeted and their effectiveness only broadly assessed. Our analysis has already suggested better targeting. More research should be undertaken to narrow the aim and increase effectiveness still further.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study is research by Alice Goisis, Amanda Sacker and Yvonne Kelly and is published in the European Journal of Public Health.

Photo credit: Playing on the computer,  John Watson

 

 

Breastfeeding and ethnicity

Helping more mothers breastfeed is a policy goal shared by many governments. Advocates argue that breastfeeding has a positive impact on a child’s physical, cognitive and behavioural development. Because of overlaps with other factors such as a mother’s social class or education, it is hard to measure precisely the degree to which breastfeeding alone benefits a child, but most policy-makers accept there is a benefit and want to know how to encourage more mothers to start it and stick with it. The incidence of breastfeeding varies significantly between women with different ethnic backgrounds and in different ways in the UK and US. Professor Yvonne Kelly from the ESRC International Centre for Lifecourse Studies at UCL asks if there are clues here as to how best to encourage women from different backgrounds to breastfeed their children.

The UK has one of the lowest breastfeeding rates in the world, although according to the NHS Infant Feeding Survey of 2010, the proportion of babies breastfed at birth is 81%, up from 76% in 2005. At three months, the proportion of mothers breastfeeding exclusively is 17%. At six months, the figure is just 1% and that has not changed since 2005.

The same survey found that breastfeeding was most common among mothers who were: aged 30 or over, from minority ethnic groups, left education aged over 18, in managerial and professional occupations and living in the least deprived areas.

The fact that younger, less educated, less well-off women are less likely to breastfeed is not surprising. Indeed, encouraging breastfeeding is at least partly about reducing inherited disadvantage. What may be less obvious (to the majority population, at least) is that ethnicity appears also to be a significant factor.

Millennium Cohort Study

When we looked at the data in the Millennium Cohort Study, which has been tracking the lives of some 20,000 children born at that time, we saw that well over 90% of Black African and Black Caribbean mothers at least started breast feeding.

The figure was over 85% for Indian and Bangladeshi mothers, 75% for Pakistani mothers and 67% for white mothers. Even after adjusting for demographic, economic and psychosocial factors, the difference remains significant.

At three months, with a range of factors considered, Black African mothers are more than 5 times more likely than white mothers to have started and continued to breastfeed. Clearly, if we understood why Black mothers were more likely to breast feed than white mothers we might have a better understanding of how to encourage all mothers to breast feed.

US comparison

An important part of our efforts to gain a clearer picture was to look for similar patterns in similar countries. So we did a comparison with the United States, where the overall rates for breastfeeding are very similar to the UK, as are the links between breastfeeding and socioeconomic status. Not at all similar, however, are the links between ethnicity and breastfeeding.

In the US, the highest rate, according to the National Immunization Survey in 2002, was among Hispanic mothers, at 80%. 72% of white mothers initiated breastfeeding. Only 51% of non-Hispanic black mothers did. So, in the UK black mothers are the most likely to breastfeed. In the US, they are the least likely.

Why the difference, given that usually, health problems suffered disproportionately by black Caribbean people in the UK affect black Americans similarly. Is there a mistake somewhere? We consider the possibility of recall bias in light of the fact that data were collected when the children were 9 months old.

It does seem reasonable to suspect mothers might want to believe they did more breastfeeding than was actually the case. But there is no obvious reason why that bias should apply differently in the UK and US. As the study suggests, the contrasting findings in the UK and US raise important wider questions about the nature of ethnic disadvantage.

One possible answer is that differences in breastfeeding reflect strength of cultural tradition and degree of “integration”. This, of course, can vary for similar ethnic groups in different “host” communities. The important thing is not the ethnic group itself, but the relationship between it and the rest of society.

Dominant cultural practices

Our study found that those who spoke only English at home were less likely to breastfeed. That raises the concern that as incoming groups adopt dominant cultural practices, their tendency to breastfeed will reduce. Cultural factors certainly merit further investigation, given that the only thing we considered in this study was whether English was the main language spoken at home.

Black people in the UK and black people in the US have different histories and, therefore, different identities. There are differences, too, in their “host” communities. In this instance, the very different health systems could be particularly relevant. Maybe future research should concentrate on this relationship rather than the behaviour of groups defined by characteristics that appear to have only secondary significance.

Those responsible for developing and implementing policies aimed at increasing breastfeeding rates in this area would certainly be advised to pay close attention to the different social, economic and cultural profiles of all ethnic groups.

Racial/ethnic differences in breastfeeding initiation and continuation in the United kingdom and comparison with findings in the United States  is research by Yvonne Kelly, Richard Watt and James Nazroo and is published in Pediatrics, Official Journal of the American Academy of Pediatrics..

Photo credit: US Breastfeeding Committee

 

Breastfeeding – to a schedule or on demand?

Mums-to-be are frequently advised in baby books that feeding to a schedule is best for their  child. But what does the evidence tell us when it comes to the different approaches and what might that mean for parents, practitioners and policy makers?

Dr Maria Iacovou from the University of Cambridge presents recent evidence breastfeeding research at an ESRC Centre for Lifecourse Studies Policy Seminar.

Photo credit: clogsilk

Related links

The Effect of Breastfeeding on Children’s Cognitive and Non-cognitive Abilities, Labour Economics 19, 2012.

The effects of breastfeeding on children, mothers and employersResearch project information, Institute for Social and Economic Research, University of Essex.