((ONE-PAGE BRIEFING PAPER AND QUESTIONS: you will write a one-page briefing paper based on Dr. Ben Embarek’s presentation (posted in the attachment) and also compose 1 to 3 questions you may have asked about the presentation. The PDF of his slides were also posted together with a video he kindly recorded after we had some technical difficulties (see a summary of some draft emails I was unable to send below as the technical difficulties were ever changing). In addition, I have posted under the same folder Dr. Ben Embarek’s bio))
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AAP Recommendations on Timing of Introduction of Complementary Foods and Risk of Childhood Obesity
NUTR522: Nutrition across the Lifespan
30 November 2018
To the Senator…
Re: AAP Recommendations on Timing of Introduction of Complementary Foods and Risk of Childhood Obesity
I hope this letter finds you well. My name is Hani Morshisd, and I am excited to write to you about an issue that is wrecking public health. The country is grappling with poor nutritional habits that result in excessive weight gain. My interest is childhood obesity that has adverse health effects that can persist into adulthood. According to the Center for Disease Control and Prevention (CDC), the burden of childhood obesity is 18.5%, and the most hit ethnic groups are Hispanics and non-Hispanics at 25.8% and 22.0% respectively. 1 An increased intake of high-calorie foods is responsible for energy imbalances that lead to weight gain. The American Academy of Pediatrics (AAP) blames poor infant nutritional habits that begin in the first year after birth. This professional association has come up with recommendations on the appropriate time to introduce complementary foods in a child’s diet.
The target population of this policy is the infants who are under the care of their mothers. Infancy is a period characterized by rapid growth both physically and cognitively. Breast milk is rich in all nutrients that are necessary for child development. An advantage of breastfeeding is that infants have a regulated energy intake that is difficult to achieve in complementary feeding. Levels of micronutrients such as iron in breast milk reduce at six months and hence, solid foods are meant to achieve a balanced diet. 2 Notably, a mother should notice the signs that a child is ready to take additional foods. They include attempts to grab food from an adult, cessation of tongue thrusting behavior, and proper head control. Most children experience these signs at around five-six months. A gradual introduction of complementary feeding is required to achieve breast comfort. Once a child starts to take solid foods, a mother should not stop breastfeeding but should reduce the weaning frequency in response to changes in an infant’s desire.
There are claims that complementary feeding at an early age enhances the growth of a child. Some mothers have relied on unconfirmed reports that introducing solid foods at four months is necessary for healthier weight gain in addition to height and head circumference. However, a randomized controlled trial by Jonsdottir et al. did not find any growth difference between exclusive feeding up to six months and the initiation of complementary feeding at an earlier age. 3 Delaying introduction of solid foods until a child is six months old does not rob him/her any health benefits, but interrupted breastfeeding at four months can lead to nutritional deficiency. While the anthropometric measurements are similar, the impact of increased energy intake is realized in later years in form of obesity.
AAP requires nursing mothers to provide exclusive breastfeeding for the first six months after birth. At this age, a child should not be given solid foods, as the body is not mature enough to achieve proper energy balance. Unfortunately, only 14% of mothers adhere to the guidelines. Hence putting their children at risk of excessive weight gain. 4 Scientific findings show feeding children on solid foods before they reach four months raises the risk of obesity by six-fold.5 The formula-fed infants are likely to be introduced to solid foods before six months and hence have a high probability of gaining unwanted weight. While mothers are willing to offer exclusive breastfeeding, the work demands make it impractical and they instead supplement milk with solid foods. Paid maternity leave is not guaranteed in the US meaning that nursing women have to continue working. 6 The implication is the adoption of improper nutritional behavior for an infant. There is a need to formulate enabling policies on maternity leave that will enhance the viability of AAP recommendations.
Further research supports AAP recommendations on regulated timing of introducing solid foods. A study conducted in Netherlands by Pluymen et al. emphasized the need to take care of the breastfeeding duration. 7 Feeding a child on solid foods before reaching four months increased the odds of excessive weight gain in their later childhood and adolescent life. Infants who depend on formulas are unable to control energy intake as mothers often include solid foods in their diet. Some people consider complementary feeding an alternative to breastfeeding and are reluctant to proceed with weaning. Similarly, Pearce et al. indicate that part of the burden of childhood obesity can be attributed to the transition period between exclusive breast milk and solid foods. 8 While developing countries emphasize breastfeeding to avoid malnutrition, the US is worried about the ever-rising burden of childhood obesity.
The government has been successful in reducing infant and maternal mortality, but there is a low emphasis on child nutritional behavior. National and international bodies such as AAP and the World Health Organization have identified the gap and have proposed measures to be taken to enhance the well-being of children. Mothers are insufficiently educated on the value of exclusive breastfeeding and the consequences of complementary feeding at an early age. They are not ready to break the tradition of introducing solid foods to infants. In most cases, the society faults fast food outlets and the government for failing to control the availability of low-nutrient foodstuff. Research has shown that mothers should take part of the blame for embracing poor nutritional behavior that puts children at the risk of excessive weight gain. AAP has stepped in to reverse the worrying trends of child obesity. It seeks to create an enabling environment that will allow healthier dietary intake.
Your influence in the Congress is instrumental in ensuring that AAP recommendations are prioritized in the government agenda. We cannot remain silent and assume that the society is progressing well. The House is responsible for protecting the future generation from obesity that has significant health and economic costs. Adequate funding of breastfeeding programs is required to reach every pregnant and nursing mother. The government should also invest in human resource to ensure that there are adequate nutritional experts to drive proper dietary behavior. However, the effectiveness of the policy can be limited by the absence of a favorable environment to facilitate uninterrupted breastfeeding. Mothers have no guarantee that they will receive salaries during the maternity leave. They are ready to introduce complementary feeding to avoid losing their jobs. Therefore, the House should work on additional policies to extend the maternity leave and ensure that nursing mothers are properly remunerated.
I hope that you have found AAP recommendations important to deserve the attention of the government. In case of any query, I will be glad to have a face-to-face conversation with you.
1. Childhood Obesity Facts | Overweight & Obesity | CDC. Cdc.gov. https://www.cdc.gov/obesity/data/childhood.html. Published 2018. Accessed November 9, 2018.
2. Working Together: Breastfeeding and Solid Foods. HealthyChildren.org. https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Working-Together-Breastfeeding-and-Solid-Foods.aspx. Published 2018. Accessed November 9, 2018.
3. Jonsdottir O, Thorsdottir I, Hibberd P, et al. Timing of the introduction of complementary foods in infancy: A randomized controlled trial. Pediatrics. 2012; 130(6):1038-1045. doi:10.1542/peds.2011-3838
4. Infant Food and Feeding. Aap.org. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/Pages/Infant-Food-and-Feeding.aspx. Published 2018. Accessed November 9, 2018.
5. Huh S, Rifas-Shiman S, Taveras E, Oken E, Gillman M. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011; 127(3):e544-e551. doi:10.1542/peds.2010-0740
6. Beckerman J, Alike Q, Lovin E, Tamez M, Mattei J. The development and public health implications of food preferences in children. Front Nutr. 2017; 4. doi:10.3389/fnut.2017.00066
7. Pluymen L, Wijga A, Gehring U, Koppelman G, Smit H, van Rossem L. Early introduction of complementary foods and childhood overweight in breastfed and formula-fed infants in the Netherlands: The PIAMA birth cohort study. Eur J Nutr. 2018; 57(5):1985-1993. doi:10.1007/s00394-018-1639-8
8. Pearce J, Taylor M, Langley-Evans S. Timing of the introduction of complementary feeding and risk of childhood obesity: A systematic review. Int J Obes. 2013; 37(10):1295-1306. doi:10.1038/ijo.2013.99
AAP Recommendations on Timing
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AAP Recommendations on Timing of Introduction of Complementary Foods and Risk of
NUTR522: Nutrition across the Lifespan
30 November 2018