Excess Maternal Weight, Suboptimal Breastfeeding, Formula Food Fuelling Infant Obesity: Indian Researchers

The foundations of obesity are being laid not in adolescence but in infancy—and even before birth itself—with a study highlighting how unhealthy parental lifestyles, inadequate breastfeeding, and early dependence on formula feed are quietly increasing obesity risks among children under two years of age.

The study, Risk Factors of Obesity Among Infants and Young Children Below 2 Years of Age: A Case-Control Study, emphasises the importance of the “first 1,000 days”—from conception to a child’s second birthday—as a crucial period during which metabolic programming occurs. It is in this window that parental health, particularly maternal nutrition and body weight, exerts a lasting influence on the child’s physiology through epigenetic mechanisms.

The findings reveal that maternal Body Mass Index (BMI) greater than 25 kg/m²—both before conception and during early child-rearing—emerges as one of the strongest predictors of obesity in infants. Children born to mothers with higher BMI were found to be over 11 times more likely to develop obesity before the age of two.

This suggests that lifestyle factors such as poor diet, physical inactivity, and inadequate weight management among women of reproductive age may silently predispose the next generation to metabolic disorders.

Globally, an estimated 35 million children under the age of five were overweight or obese in 2024, with nearly half of them in Asia. According to the National Family Health Survey (NFHS) data, India is witnessing a rapid surge in overweight and obesity among under-five children, with prevalence rising by 127 per cent (from 1.5 per cent to 3.4 per cent between NFHS-3 (2005–06) and NFHS-5 (2019–21)).

Published in the prestigious journal Indian Journal of Medical Research (IJMR), the study was conducted by paediatricians Dr. Reshma Raj Meena Pushparajan, Dr. Priya Sreenivasan, and Dr. Ajithkrishnan Anandakrishnan Sarasam from the Department of Paediatrics at Government Medical College, Thiruvananthapuram, Kerala.

Beyond maternal health, infant feeding patterns also play a decisive role. The study identifies formula feeding as a significant risk factor, increasing the likelihood of obesity by over six times compared to non-obese counterparts.

Unlike breastfeeding, which allows infants to self-regulate intake based on hunger and satiety cues, bottle feeding—often associated with formula milk—may encourage overfeeding. Caregivers, consciously or otherwise, may pressure infants to finish a bottle, disregarding natural appetite signals.

Moreover, formula milk contains certain amino acids and bioactive compounds that may influence fat metabolism and gene expression, potentially promoting adipogenesis—the formation of fat cells.

Equally concerning is the early cessation of exclusive breastfeeding before six months and the premature introduction of semisolid foods. These practices, often driven by cultural norms, misinformation, or maternal employment constraints, disrupt optimal nutritional programming and may contribute to excessive weight gain.

The study also points to the broader family environment as a critical determinant. The presence of lifestyle diseases such as diabetes, hypertension, and dyslipidaemia within the family was associated with nearly sevenfold higher odds of obesity in infants.

This association reflects not just genetic predisposition but shared behavioural patterns—sedentary lifestyles, calorie-dense diets, and poor health awareness—that shape the child’s environment from birth.

Research cited in the study suggests that a child with one obese parent has a 40% chance of becoming overweight, which rises to 70% if both parents are obese. These figures highlight how obesity is not merely an individual condition but a familial and societal issue.

Alarmingly, the study also notes the presence of “junk food” consumption even among infants and toddlers—defined as foods high in sugar, salt, or fat, including bakery items and sugar-sweetened beverages.

Though often given in small quantities, early exposure to such foods can condition taste preferences, leading to unhealthy dietary habits later in life. Combined with reduced physical activity—another emerging concern even in very young children—this creates a fertile ground for rapid weight gain.

One of the study’s notable observations is the inadequate use of growth monitoring tools. Growth charts in Mother and Child Protection Cards were often not properly maintained, resulting in missed opportunities for early detection of abnormal weight gain.

Regular tracking of a child’s growth trajectory is a simple yet powerful tool that can alert caregivers and health workers to deviations, enabling timely interventions.

The findings carry significant implications for public health policy. Experts argue that efforts to combat childhood obesity must begin not in schools but much earlier—targeting adolescents and young adults, especially prospective parents.

Awareness campaigns promoting healthy BMI, balanced nutrition, and regular physical activity among women of reproductive age could have far-reaching benefits. Strengthening breastfeeding support systems, regulating the marketing of infant formula, and educating caregivers on appropriate complementary feeding practices are equally critical, said the study.

Further, integrating obesity prevention into existing maternal and child health programmes—such as antenatal care and immunisation visits—could help reach families at the right time, the researchers said, concluding that the battle against obesity begins not in adulthood but in the cradle—and, indeed, even before birth.