Reading this on ScienceNews.org annoyed me a bit.1 I just Googled my title “Baby Led Weaning and Obesity” and caught a ream of secondary articles dismissing my hypothesis of overweight and obesity prevention on some pretty selective data. I just chanced to read this one first. It pegs infant self-feeding down as merely “entertaining”, but gives the practice a back-pat for promoting a positive overall feeding experience. It does concede reduced fussiness, but that isn’t a problem unless it is, so I can see why this is so easily dismissed in a single sentence in their last paragraph.
The piece seems to conclude though, that overweight is not due to overfeeding (the risk of spoon-feeding); or at least that self-regulation does not prevent over-nutrition and weight gain.
... So what does?
The old mantras of “Good food and exercise” and “Calories in / calories out” don’t give a complete picture and clearly aren’t working. We’re more complex than that, and if someone can point me to a model or algorithm that gives a complete picture and makes consistent sense, I’d be delighted.
But for the sake of a starting point, let’s try applying it to babies:
Do we need to put more effort into avoiding junk foods or junk food marketing for infants? I’d hope there aren’t too many parents baby led weaning with pizza and churros. So what about exercise? How much can an infant get? There’s not a lot of cardio possible before you’ve grown knee-caps, and crawling around and doing pull-ups on things would surely be close to equivalent effort as straining to do so if you were unable. A healthy gut microbiome is the new trendy (and meritable) emerging field of research, but I think there’s little hope for us as a species if we’re not born with that system fairly close to on track.
I think there are complex contributing factors, but that quantity consumption is significant and largely overlooked. Current generations are slowly waking up to the misfortune of the habit of “finishing your plate” (no matter how much is on it, or its nutritional content) that we inherited from pre-boomer values in times of scarcity. I’ve observed few that still encourage their kids above hip height to eat more than their fill, but I dread to think that some may still consider refusing food as disobedience to be forced or punished.
But if our first expression of parental love is to raise an infant to the breast to feed, how do you know that this love isn’t what they’re hungry for when they later accept the spoon? Or an extra treat for that matter? Just accepting a few morsels more than required, every time or often enough, is all it takes to start stacking on excess baggage. But this also develops enduring habits on a spectrum between mindless eating and comfort eating - of which most of us are at least occasionally guilty - or more severe food addictions. I think these are a leading cause of our adult obesity pandemic.
Along with diet and exercise.
And gut microbiome.
... And possibly in that order.
Point is that it starts in infancy or early childhood. Obese kids rarely inherit obese genes from obese parents. They are saddled with obesogenic habits, and these are getting worse.
The 2017 Bliss Study2 referenced in the ScienceNews article was the first randomised clinical trial on Baby Led Weaning to explore potential as an obesity prevention initiative by supporting children to feed themselves only as much as they need, as inspired by results of a small and less formal but promising study in 2012.3
Unfortunately - as I found out when I went to do trials with the University of Canberra, 2017 - there is a documented increased risk of choking with baby led weaning, so no university is going to touch the field without assuaging that somehow.4
Whether or not this increased choking risk owes to the subjective interpretation of baby led weaning is a valid question. BLW can mean anything on a spectrum between bub painting themselves with mush and hopefully ingesting some, to a child that perhaps wasn’t physiologically or developmentally ready to handle a raw carrot or strip of leathered beef. I remain unclear how or if that’s been factored. But I guess it’s simply far too risky for a trial to suppose that an emerging feeding practice can be done sensibly by the general public when under University liability, or recognise that choking incidents are rarely a death sentence and are actually pretty common.
Our pilot trial - (hasn’t happened yet, but that’s another story) - passed ethics approval by commencing study from 9 months of age, where the choking risk drops off according to another particularly interesting study, 2012.4
We seem to have overlooked one from 2016 though, with its elegant conclusion that “we didn’t find any significantly increased risk as long as they’re fed appropriate foods under supervision, but that ensuring this across such a large group is a challenge”. 5 [paraphrasing from abstract]
Since it’s been lead by the same people that appear in multiple research references (including Bliss), I’m thinking the whole purpose was to satisfy risk management requirements so they could just get on with researching health benefits.
Bliss passed risk criteria by modifying diet:
Lactation consultants assisted to enable exclusive breast-feeding for the first six months so that children would be more developmentally ready for solids, but I’m getting scant insight on what the diet modifications were post weaning. Was it doughnuts? Cucumber? Fructose rich paleo bars soaked in milk? Bread? (examples selected to match suggested textures from the 2016 study)
They make point to mention their choking risk management, but surely what these kids weren’t choking on is at least equally as important for a paper reported to conclude that this BLW / self-feeding idea can’t help one of our most pressing global health concerns, sorry.
I did ask prior to publication last year if they were going to follow the infants into their childhood to take measurements there: maybe there’s a latent effect of self-regulation habits set early that one would hope they’d keep for a while. But no, not this time.
Here’s what we know from Bliss: It didn’t help when they modified the diet. We don’t know what the diet was modified to, but that hasn’t stopped waves of the news that it doesn’t work.
So can we please cease with the articles saying there’s no merit to it? Risk and participation rates have tied up research so that we just don’t know enough yet.
At least the study concludes that, “Further research should determine whether these findings apply to individuals using unmodified baby-led weaning.” The persistence of such decorated research leads in a field that’s being reported as ineffective has got to say something though. Reading between the lines, perhaps they still think it has potential, but while they reported no “adverse events” (choking), they still don’t want the risk and aren't sure how to get around it.
Perhaps this is where my product Mashblox comes in, by giving kids a versatile tool to self-feed indisputably age appropriate textures, both for family meal times and clinical research purposes.
Wouldn’t it be nice to get started on that.
2 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2634362 Taylor, R. PhD1; Williams, S. DSc2; Fangupo, L. MSc3; et al (2017), Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight (Baby Led Introduction to Solids: Bliss)
3 http://europepmc.org/articles/PMC4400680 Townsend, E. & Pitchford, N. (2012) Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample.
4 http://bmjopen.bmj.com/content/3/12/e003946 Cameron, S; Taylor, R; Heath A-L; (2012) Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand families
5 http://pediatrics.aappublications.org/content/early/2016/09/15/peds.2016-0772 Fangupo, L; Heath, A-L; Taylor, B; Taylor, R (2016) A Baby-Led Approach to Eating Solids and Risk of Choking