Given a chance, even babies will overeat

(Reuters Health - Having infants feed themselves all their food from the start of solid feeding, so-called baby-led weaning, does not prevent them from becoming overweight, according to new research from New Zealand.

“It has always been assumed that if babies are allowed to control their own food intake then they will be better at judging when they have ‘had enough,’” Anne-Louise M. Heath and Rachael W. Taylor from University of Otago in Dunedin told Reuters Health by email.

“So we were surprised that letting babies feed themselves their solids from the start, rather than being spoon-fed by someone else, didn’t seem to improve their ability to stop eating when they were full. And that they were just as likely to become overweight as babies who had been spoon-fed.”

There has been considerable discussion of the possible benefits and harms of baby-led weaning, but precious little research, the authors note in JAMA Pediatrics.

Their Baby-Led Introduction to Solids (BLISS) study of 206 mothers and their infants was designed to see whether the baby-led approach reduces the risk of becoming overweight.

Mothers were recruited during pregnancy and divided into two groups, one of which would apply the baby-led approach to feeding after the babies were 6 months old, the age at which most guidelines recommend beginning to introduce solid foods in addition to ongoing breastfeeding.

Most of the mothers exclusively breastfed for five to six months, with mothers in the baby-led feeding group having access to additional counseling to help them keep breastfeeding for the full six months.

At 12 and 24 months into the study, however, there was no difference between the baby-led group and the spoon-fed group in rates of overweight.

There were other differences, though.

“We were very interested to find that babies following this baby-led approach to introducing solids enjoyed their food more and were less likely to be picky eaters as one year olds than babies who had been spoon-fed,” Heath and Taylor said. “This is particularly interesting because the difference in picky eating was fairly large, even though the families had been randomly assigned to follow this feeding approach with their baby.”

A commonly expressed concern is that baby-led infants may not eat enough to sustain their growth. At least in this study, that didn’t happen with any infant.

In a related editorial, Rajalakshmi Lakshman and colleagues from University of Cambridge School of Clinical Medicine in the UK remind us of the importance of rigorous testing of infant feeding approaches, even though they already have wide popularity among parents and experts based on intuition and limited evidence.

It might be, they say, that infants have a natural tendency toward overconsumption, a tendency that is partly influenced by the same genetic differences that predict adult weight and obesity risk.

“Instead of autonomy, adult supervision and some restriction to avoid excessive food intake may be required until children are sufficiently mature to exert the higher executive functions necessary to self-regulate their energy intakes,” they write.

“I think it is important to realize that there is no one right way to introduce solids to a baby,” said Amy Brown of Swansea University in the UK. “Family experience and context will influence this. Importantly this data shows that babies who follow a baby-led approach are consuming sufficient energy and are not at increased risk of underweight which should be reassuring,” she said by email.

“It should also be noted that if your baby has developmental difficulties or has had very slow weight gain, then you should talk to your health professional before starting solids as a baby-led approach might not be appropriate,” said Brown, who wasn’t involved in the current study.

“What is of central importance is feeding your baby responsively; looking to them for signs of hunger and fullness, and not trying to get them to finish a portion if they do not want to. This applies whether you are spoon-feeding or letting babies self-feed, and indeed is important during milk feeding and for older children, too. Offer a range of tastes, varieties, and textures and let your baby eat as much as they need,” Brown said.

SOURCE: and JAMA Pediatrics, online July 10, 2017.