The association between psychological factors and breastfeeding behaviour in women with a body mass index (BMI) ≥30 kg m⁻²: a systematic review

Abstract

Breastfeeding can play a key role in the reduction of obesity, but initiation and maintenance rates in women with a body mass index (BMI) of ≥30 kg m are low. Psychological factors influence breastfeeding behaviours in the general population, but their role is not yet understood in women with a BMI ≥30 kg m . Therefore, this review aimed to systematically search and synthesize the literature, which has investigated the association between any psychological factor and breastfeeding behaviour in women with a BMI ≥30 kg m . The search identified 20 eligible papers, reporting 16 psychological factors. Five psychological factors were associated with breastfeeding behaviours: intentions to breastfeed, belief in breast milk's nutritional adequacy and sufficiency, belief about other's infant feeding preferences, body image and social knowledge. It is therefore recommended that current care should encourage women to plan to breastfeed, provide corrective information for particular beliefs and address their body image and social knowledge. Recommendations for future research include further exploration of several psychological factors (i.e. expecting that breastfeeding will enhance weight loss, depression, anxiety and stress) and evidence and theory-based intervention development.

To what extent does maternal body mass index predict intentions, attitudes, or practices of early infant feeding?

“…The variance in breastfeeding practices explained by constructs in the model (attitudes, subjective norm, perceived behavioural control, and intentions) ranges from 10% (Ismail et al, ) to 4% (Wambach, ) and is less accurate at predicting breastfeeding behaviour over the postpartum period (McMillan et al, ). Intentions for infant feeding in this cohort are consistently measured using dichotomous and categorical scales (Hauff et al, ; Jarlenski et al, ; Lyons et al, ; Newby & Davies, ; Visram et al, ), which dilutes the wide variability in intentions for infant feeding and subsequently overinflates the magnitude of differences observed. Using the IFIS (Nommsen‐Rivers & Dewey, ), which is both theoretically informed and psychometrically validated, observed differences in the strength of intentions to breastfeed among healthy weight, overweight, and obese women are negligible.…”

“…When antenatal intentions were comparable between obese and non‐obese women, rates of breastfeeding initiation and duration were previously observed to be significantly lower among women with a prepregnancy BMI ≥30 kg/m 2 (Babendure et al, ; Lyons et al, ; Marshall, Lau, Purnell, & Thornburg, ). In this study, no differences in feeding practices were recorded in the early postnatal period, suggesting that variation in practices may only emerge over time.…”

“…Attitudes towards infant feeding were breastfeeding positive across women in this study. No differences in beliefs about breastfeeding have been observed in the wider literature with regard to maternal BMI (Lyons et al, ), and little evidence is available to explain why differences in beliefs or attitudes would be dependent on maternal BMI alone. Knowledge and beliefs about breastfeeding vary as a function of access to education and socio‐economic environment (Johnson et al, ; McAndrew et al, ).…”

“…The current study did not consider the construct of breastfeeding self‐efficacy (comparable with perceived behavioural control) in the associations explored. Self‐efficacy is a recognized predictor of breastfeeding initiation and duration across cohorts (De Jager, Skouteris, Broadbent, Amir, & Mellor, ; Lawton et al, ; Martinez‐Brockman et al, ) with evidence to date, indicating that women with higher BMIs (≥25 kg/m 2 ) may have lower confidence in their ability to breastfeed, both antenatally and postnatally (Babendure et al, ; Lyons et al, ). Some intervention studies targeting breastfeeding self‐efficacy have been successful at increasing rates of exclusive breastfeeding (Noel‐Weiss, Rupp, Cragg, Bassett, & Woodend, ; Wu, Hu, McCoy, & Efird, ), although this was not observed among cohorts of women with overweight or obese BMIs (Chapman et al, ).…”

“…Recent systematic review evidence suggests that women with obesity are significantly less likely to intend to breastfeed (Lyons, Currie, Peters, Lavender, & Smith, ) and argues that such reduced intentions contribute to lower breastfeeding rates in this cohort compared with healthy weight counterparts (Turcksin et al, ). Although this association is theoretically supported by the conceptual framework of the TPB (Ajzen, ; Azjen, ), the methodological quality in the measurement of infant feeding intention is consistently poor (Lyons et al, ) with studies frequently using dichotomous or unvalidated scales, meaning associations are likely to be tenuous. For example, a national longitudinal cohort study using a categorical measurement of intention found no differences in intentions for infant feeding according to maternal prepregnancy BMI status (Hauff et al, ).…”