Does Formula Feeding Lead to Obesity?

Before my twins, I had breast fed each of my three babies for a full year and never once used formula. In fact, putting powder from a can in water freaked me out. However, I’m the last person who would judge what works best for another mom and hopefully made that clear when I wrote about best products for breastfeeding. And when I HAD to give my twins formula, I was glad I hadn’t previously been judgmental! As I wrote about in Learning to Breastfeed Twins, after doing all I could to avoid formula, I either break my bias or take my tiny duo to the hospital for IVs: they were starving. But does formula truly make babies fatter and set them up for a life of obesity as many reports suggest? Breezy Mama turned to Dr. William H. Cotton, Clinical Professor of Pediatrics, to get the 4 ounce scoop.

Are the reports true that formula feeding can lead to obesity later in life for the baby who drinks it?

Any baby who is fed too many calories during their first year of life is at risk for being overweight as an infant and also as they grow older. Bottle fed babies are more likely to be overfed and obese than breast fed babies.

After having no choice but to use formula with my 4th and 5th babies, I realize just how easy it could be to stick a bottle in. If it was my tired boobs, I wouldn’t just feed a baby again; I would try and soothe them. Do you think part of why formula can lead to obesity is because it’s so easy to overfeed the baby?

It is easier to over feed a bottle fed baby than it is to overfeed a breast fed baby. When most mothers breast feed they feed until their child is satisfied, not knowing how much milk they have taken. When you bottle feed you know how much the baby has taken and may become more focused on how much the child has taken instead of whether the child was still hungry.

What can parents do to avoid this?

The obvious answer is for everyone who is able to breast feed should breast feed.

Those parents who bottle feed need to learn how much formula is usually needed to satisfy their baby’s nutritional needs. They also need to learn when their baby isn’t hungry, but really only wants non-nutritional sucking. This is when a pacifier can be used to sooth the baby, but not over feed them.

Regular visits with their pediatrician should include counseling and support for appropriate amounts of formula as well as techniques for avoiding over feeding.

Are there other reasons formula can make babies fatter for life?

Formula is made to take the place of breast milk for those who cannot or chose not to breast feed. The basic make-up of the most used formulas is cow’s milk or soy based milk. These basic “milks” are augmented by the formula companies to simulate breast milk. Over the years the formula companies have developed their formulas to be safe and very much like breast milk. The formula companies have also developed specialized formulas for allergic infants or infants who were born with severe life-threatening metabolic problems. These formulas have improved the quality of life for many infants and in some cases have saved lives.

Back to the basics, formula in and of itself does not cause obesity. Feeding too much formula does cause obesity.

It seems like pediatricians are quick to suggest supplementing with formula for a breast feeding mom and I read this also contributes to the problem of overweight children. Do you recommend parents pay attention to their own child’s growth – makes sure that the baby is growing and gaining weight at a Dr’s visit – versus getting to caught up in the percentages on the growth chart?

Each well child visit during the first year should include looking at the weight, height, and head circumference and reviewing the infant’s diet. Growth curves are an important part of this to measure if the child is growing appropriately. The pediatrician is able to use information from the growth curves, dietary history, and family history to help decide if that child is growing appropriately. This includes determining if the child is overweight and that they are taking in too many calories. Counseling then follows to encourage the family to feed the appropriate calories that will support normal growth.

Most pediatricians strongly encourage breast feeding. There are instances when exclusive breast feeding is not possible and supplemental bottle feeding is necessary. Ideally, if this occurs, the supplemental bottle feeding should consist of breast milk that the mom has collected. This takes a lot of work and some moms (especially working moms) don’t have the time and energy to do this. Most can successfully supplement with occasional formula and still mostly breast feed.

How can moms be sure to avoid over weight issues with their children once formula is stopped?

Learning to feed foods to your child that will promote healthy growth is important and is sometimes overlooked during well child visits. At Nationwide Children’s Hospital we use a program “Ounce of Prevention”, which was developed in conjunction with the Ohio Chapter of the American Academy of Pediatrics. This program consists of nutritional information that is made to be shared at each well visit. These handouts cover suggested amounts and kinds of foods to start at different ages. Handouts from this program are available at http://www.nationwidechildrens.org/ounce-of-prevention.

And is age 1 best to stop offering a child formula and switch to milk?

The suggested change from formula to milk is at one year of age. It is also suggested that you start working with cup training (sippy cup) at about 9 months of age to ensure that your child’s teeth are not harmed by using a bottle too long.

What makes formula healthy?

Human breast milk is best for human babies, and cow’s milk is best for calves. Over the years the formula companies have developed their formulas to be safe and very much like breast milk. Formula is made under high quality control and is very safe. A recent event that questioned the safety of formula showed that the formula companies work very hard to maintain a safe product and that they are quick to respond when there is a question of quality or safety.

Still breast milk is best and its use should be encouraged whenever possible.

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About Dr. Cotton
William H. Cotton, MD is a Clinical Professor of Pediatrics at The Ohio State University living in Columbus, Ohio since 1987. He is a past president of the Ohio Chapter of the American Academy of Pediatrics and currently the Advocacy Chair for the Ohio Chapter. He is the past president of the medical staff at Nationwide Children’s Hospital and President Elect of the Columbus Medical Association. Dr. Cotton is the Medical Director of the hospital’s Primary Care Network that provides a medical home to ~ 75,000 of the children of the greater Columbus area. He sees patients as well as teaching in the Primary Care Network. He lives in New Albany, Ohio with his wife Dr. Patty Davidson and daughter Ali.