How the fight against flab can start before birth

At a svelte 15 pounds, Triniti Holland could be a poster child for the war against childhood obesity.

True, she's only 4 months old, but researchers and health care advocates are starting to focus more on her age bracket to manage the bulging waistlines of America's youth.

The Portsmouth baby, who's right on target in terms of weight, has two things going for her.

First, her mother, Alisha Robinson, maintained a healthy weight herself before and after she had Triniti.

And second, Triniti is being breastfed.

Those are two recommendations in a report from the White House Task Force on Childhood Obesity to help reverse America's obesity epidemic.

The report, released this month by first lady Michelle Obama, found that babies like Triniti are less likely to become obese.

A recent Virginia survey found that one in four children ages 10 to 17 in southeastern Virginia is overweight; nationally, about one in three is overweight. Other studies indicate that efforts to curb those numbers need to begin early in children's lives - even before they're born.

"If you wait too long, then the horse is out of the barn," said Dr. Michelle Brenner, a pediatrician at General Academic Pediatrics, which is based at Children's Hospital of The King's Daughters in Norfolk.

Babies who are born to mothers of the proper weight and who are breastfed tend to fare better, in part because babies learn to control their intake of food better than bottle-fed babies.

"People who bottle-feed often encourage babies to finish what's in the bottle," Brenner said.

The "self-regulation" aspect of breastfeeding could be key in teaching children how to eat proper amounts as they get older.

Brenner, who is also an associate professor at Eastern Virginia Medical School, is working with medical residents and local obstetricians to reach women early in their pregnancies to get them thinking about these obesity-prevention measures.

The White House report said that infant formula contains nearly twice as much protein per serving as breast milk, and that the extra protein may stimulate production of an unhealthy amount of insulin. Obesity is 22 percent lower among children who are breastfed.

But while three-quarters of America's babies start out breastfeeding, by 6 months of age it's down to 43 percent.

There's also a disparity between races, with 74 percent of white babies being breastfed compared with 57 percent of blacks.

Robinson decided on breastfeeding long before her baby was born 4 months ago. She knew that breastfed babies tended to be healthier, and she also learned that the practice helps mothers lose the weight they gain during pregnancy.

"She's very alert and active, and I believe the breast milk has a lot to do with that," Robinson said.

Another key factor: Her own mother had breastfed her children.

Kim Griffin, a breastfeeding counselor for the Women, Infants and Children program at the Portsmouth Health Department, also has helped Robinson. Griffin said seeing family and friends breastfeed is important in persuading mothers to do the same.

Griffin provides another layer of support by talking with new and expectant mothers who come to the WIC agency, which provides food for low-income families with children up to age 5 who are at nutritional risk. She visits moms in hospitals and in their homes, and organizes "breastfeeding showers" at the WIC office to share tips and education.

The breastfeeding moms get more food from WIC because they are not using formula, and they also have access to breastfeeding equipment.

Griffin, who breastfed her own children, now 10 and 14, said she tries to help women overcome the common barriers.

"They'll say they don't think it's something they have time to do. I try to help them appreciate that you can save time because you don't have to worry about bottles and mixing formula."

Many also worry about going back to work or school. Robinson works at Bank of America, where there's a lactation room for her to pump breast milk. One of the obesity task force recommendations is for workplaces and child-care centers to make that kind of accommodation for breastfeeding mothers.

Another recommendation WIC emphasizes is measuring the body mass index of children as young as 2, and talking with parents when the BMI falls outside the target zone.

The focus on reaching children earlier is due to a number of studies, one by local pediatrician John Harrington, who works in the same practice as Brenner. His research shows that overweight children begin packing on extra pounds by the time they're 2 - an age he has dubbed a critical "tipping point" - and that some kids start even earlier.

Parents are generally well aware of their children's hunger cues, but not as attentive to signs of when they're full, such as pushing away or losing interest in eating.

Instead of encouraging them to eat more, parents should take a hint from their babies and toddlers.

Brenner said such lessons, which she tries to relay to parents during well-child visits, can last a lifetime: "We need to be better at listening to our own bodies."

Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com