Healthy Eating and Breastfeeding

Definition

The foundation of a healthy lifestyle includes consuming a balanced variety of nutrient-rich foods and beverages in moderation (1). Breastfeeding, also known as nursing, is the feeding of babies and young children with milk from a woman's breast.

The World Health Organization recognizes that healthy eating behaviors begin with infancy and breastfeeding. Breastfeeding supports healthy brain development and reduces the risk of long-term illness (2).

A Healthy, Well-balanced Diet

A healthy, well-balanced diet includes plenty of fruits and vegetables, whole grains, a variety of lean proteins and healthy fats. More specifically, a healthy diet focuses on:

• At least five servings of whole fruits and vegetables that include a variety of colors and types — i.e., dark green, red, orange;
• Whole grains that are unprocessed such as maize, millet, oats, wheat, brown rice and quinoa;
• A variety of protein rich foods such as plant-based sources (legumes, nuts, seeds, soy), low fat dairy, seafood, lean meats, poultry and eggs;
• Unsaturated fats such as fats in fish and seafood, avocado, nuts and olive oil — which are preferable to saturated fats— limiting saturated fats to less than 10 percent of your daily calories and overall fat to less than 30 percent of total calories per day;
• Limiting added sugars to less than six teaspoons per day for kids ages 2-18, no more than six teaspoons per day for women and no more than nine teaspoons per day for men; and
• Limiting sodium to one teaspoon or 2,300 mg per day, ideally no more than 1,500 mg per day (3,4,5).

Infant Recommendations

For infants in the United States, the American Academy of Pediatrics (AAP) currently recommends the following:

• Infants should be fed breast milk exclusively for the first six months after birth. Exclusive breastfeeding means that the infant does not receive any additional foods (except vitamin D) or fluids, unless medically recommended.
• After the first six months, and until the infant is one year old, the AAP recommends that the mother continue breastfeeding while gradually introducing solid foods into the infant's diet.
• After one year, the AAP recommends continuation of breastfeeding as long as mutually desired by both mother and infant (6).

Consuming a healthy diet is perhaps the best pathway to good health (7). It also helps prevent a list of chronic diseases and conditions. In the United States, poor diet and physical inactivity are leading contributors to poor health and death. Over 75 percent of Americans are not consuming the recommended amounts of healthier foods such as fruits, vegetables and whole grains. In addition, over 86 percent of adults exceed the daily recommendations of fat, sugar and salt (8). Sugary drinks are the largest source of added sugar in the diets of Americans. Researchers have found that drinking just one to two sodas per day increases risk for type 2 diabetes by 26 percent, risk for heart disease by 33 percent and the likelihood of being overweight or obese by 55 percent (9,10,11,12). Overall, the eating patterns of many individuals are too high in calories and exceed the amount of calories burned through activity, creating patterns of overconsumption. American families are eating larger portion sizes than in last four decades (13). These eating behaviors, coupled with physical inactivity have contributed to the “obesity epidemic.” Data show that more than two-thirds of all adults in the United States and nearly one-third of all children and youth are either overweight or obese (14).

In Colorado, one out of six adults and one out of four children and adolescents are at an unhealthy weight. According to the Colorado Health Indicators 2013-2015 data, 18.3 percent of adults and 19.2 percent of children ages five to 14 years are overweight or obese in Jefferson County, Colorado.

For infants and children, healthy eating is vital for optimum growth and cognitive development. It can reduce the risk of becoming overweight or obese and the risk of developing chronic diseases later in life (7). Even though the percentage of infants ever breastfed in Colorado is high at 88.6 percent, state data show that by three months only 57.3 percent of infants are exclusively breastfed, and by six months that percentage drops to only 26.4 percent of infants.

There are many factors that influence our eating behaviors and food choices. According to the United States Department of Agriculture (USDA), “store/restaurant proximity, food prices [and] food and nutrition assistance program’s community characteristics[,] which interact to influence food choices and diet quality,” essentially influence our diet and nutritional intake (15). Limited fresh and healthy food choices in someone’s food environment, and/or food “defaults” that are typically processed or fast foods, can result in consuming an unhealthy diet. Unhealthy food marketing, especially when targeting children, has made it clear there are systemic environmental and societal factors at play in rising obesity levels. A 2016 report showed that “despite improvements in the amount and types of food-related television ads viewed by children and adolescents, primarily unhealthy categories continued to represent more than 75 percent of ads viewed in 2016 (16).” The obesity epidemic can no longer be adequately accounted for solely based on poor individual choices. Improving access to healthy foods should be a top priority.

Federal level policies, such as the Farm Bill, have critical direct and indirect effects on the food environments in our communities. The subsidization of food commodities finances the overproduction of corn, soybeans, dairy, wheat and livestock. A substantial portion of these subsidized commodities are then converted into high-fat meat and dairy products, refined grains, high-calorie juices and soft drinks — sweetened with high-fructose corn syrup — and processed foods (17). Creating and sustaining healthy food environments, accessibility and improved public policies for all residents is a vital part of achieving health equity across populations in our community and will help to reduce negative health outcomes.

Health Disparities and Inequities

There is strong evidence showing how inequitable access to quality and healthy food options due to racial/ethnic and socioeconomic differences is linked to health disparities. For example, the mortality rate among black individuals are 146 percent higher from stroke, 131 percent higher from heart disease and 208 percent higher from diabetes, when compared to white individuals (17). Unhealthy food advertising targeted to Black, Hispanic and Latino youth can add to health disparities. A 2015 Rudd Report found that black children and teens viewed 70 percent more food-related ads than their white peers (16). Under-resourced communities are most likely to have their local food system inundated by cheap, processed and nutrient deficient foods. This is due to a combination of physical, political and economic forces that are primarily directed by the federal Farm Bill (17).

While Colorado breastfeeding initiation rates are above the Healthy People 2020 goals, there are disparities across Colorado in breastfeeding duration rates related to race/ethnicity. In Colorado from 2009-2011, Centers for Disease Control and Prevention data show 37 percent of Hispanic and Latino infants were being breastfed at six months versus 59 percent of Non-Hispanic white infants (18).  Jefferson County Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which serves families at or below 185 percent of the federal poverty level, shows breastfeeding initiation rates are high at 83 percent. However, notable declines in breastfeeding rates are seen at three and six months postpartum — down to 34 percent and 16 percent as compared to the Healthy People 2020 goals (19, 20). The discrepancies in breastfeeding duration show the shortfalls in systems of lactation care. These shortfalls create health inequities in access and quality of lactation care. High initiation rates show an interest in breastfeeding from the majority of Colorado parents, regardless of race/ethnicity or income. However, sharp decreases in breastfeeding duration, especially among communities of color and low-income families, suggest that support for continuation of breastfeeding is lacking. Language barriers, difficulties accessing lactation care, insufficient support and lack of advocacy for workplace accommodations — especially low-wage workplaces — are just some of the issues driving these inequities.


Implications and Data for Jefferson County

Breastfeeding

About 81 percent of mothers in Jefferson County and 74 percent in Colorado were breastfeeding their child at 9 weeks. However, when looking at mothers' demographics, those percentages show inequities exist in our populations. Mothers with a lower education level, whose income is below 250 percent of the federal poverty level (FPL),  individuals who belong to a community of color,  or who are younger than 25 are less likely to be breastfeeding their child at nine weeks.

Source: PRAMS via CDPHE's VISION Dashboard

Fruit and Vegetable Consumption 

Source: Colorado BRFSS (2013-2014), CDC BRFSS (2014), HKCS (2015)

Source: Colorado BRFSS (2013-2014), CDC BRFSS (2014), HKCS (2015)

In Jefferson County, 34 percent of adults eat less than one serving of fruit each day, even though it is recommended to eat two servings of fruit each day.

Across demographics in Jefferson County we see inequities in fruit consumption. Males are less likely than females to eat at least one serving of fruit each day. Those with less education, greater income, and individuals who belong to a community of color are less likely to eat at least one serving of fruit each day.

Source: Colorado BRFSS

Source: Colorado BRFSS

In Jefferson County, 17 percent of adults eat less than one serving of vegetables each day, even though it is recommended to eat at least three servings of vegetables per day.

Across demographics in Jefferson County we see inequities in vegetable consumption. Males are less likely than females are to eat at least one serving of vegetables each day. Those with less education, lower income and individuals who belong to a community of color are all less likely to eat at least one serving of vegetables each day.

Sugary Beverages

Source: Colorado BRFSS (2013-2015), HKCS (2013 & 2015), Colorado Child Health Survey (2014-2016)

The rates of children consuming sugary drinks every day has been declining in both Jefferson County and Colorado. However, as childhood obesity and diabetes rates continue to rise, this is still an area that needs attention.

Source: CO Child Health Survey

As shown above, the rates of children consuming sugary drinks every day are declining. Children who are living below 250 percent of the federal poverty level (FPL) and Hispanic and Latino children are more likely to consume sugary drinks. In addition, as children get older, their consumption of sugary drinks increases.

52.0 percent of Colorado high school students consume at least one type of sugary beverage per day.

- Healthy Kids Colorado Survey (2015)

Source: Healthy Kids Colorado Survey (2015)

Community Health Needs Assessment Focus Groups Findings

Nutrition was a highly prevalent topic discussed at great length across groups in the county. Participants identified numerous aspects of nutrition, which are described below.

1. The need for healthier school lunches was identified by participants at multiple focus groups. Several people discussed their children being introduced to unhealthy foods at school that they did not eat at home and expressed concerns around their children’s poorer food choices.

2. Food insecurity was voiced as a concern, with one participating noting that “food insecurity has an effect on diabetes.” Participants also worried about food insecure children and adolescents who utilize the Free and Reduced Lunch Program because they were unsure of the availability of summer feeding sites.

3. There was some discussion about the food options available for those use the Supplemental Nutrition Assistance Program (SNAP) and food pantries. Participants noted that frozen, canned, and processed foods available through these resources are often not very nutritious.

4. The high cost of healthy foods was recognized as a barrier for those of lower income to eat nutritious foods.

5. For some members of the community, it is difficult to find time to prepare healthy meals.

In addition to the topics discussed above, some participants voiced interest in attending some type of class on preparing healthy meals on a budget, as well as nutrition education for families and children. One person said that they wanted to learn “how to cook economically and health[ily].”

Community Health Needs Assessment Key Informant Interview Findings

Efforts targeting obesity and healthy eating are taking shape in the schools, but social and emotional support is an important component that needs additional attention as well. There is concern about healthy eating behaviors in children and easy access to fast food in some neighborhoods. Inequities in access to healthy food sources was cited as a concern for Hispanic and Latino neighborhoods, which may be connected with issues of cost and affordability.

Currently, numerous efforts are underway targeting both rising obesity and food insecurity with assistance from the Jefferson County Food Policy Council, both countywide and within municipalities. Click here to learn more about Food Insecurity.

____________________________________________________

Reference List

1. Academy of Nutrition and Dietetics (2018). Total Diet Approach to Healthy Eating Infographic. Retrieved from: https://www.eatrightpro.org/media/multimedia-news-center/infographics/total-diet-approach-to-healthy-eating-infographic

2. Unicef (2018). Breastfeeding. Retrieved from: https://www.unicef.org/nutrition/index_24824.html

3. American Heart Association (2018). Nutrition infographic. Retrieved from: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Sugar-Recommendation-Healthy-Kids- and-Teens-Infographic_UCM_487755_SubHomePage.jsp

4. Johnson, R., Appel, L., Brands, M., Howard, B., Lefevre, M., Lustig, R., Sacks, F., Steffen, L., Wylie-Rosett, J., (2009, September 15). Dietary Sugars Intake and Cardiovascular Health. Retrieved from: http://circ.ahajournals.org/content/circulationaha/120/11/1011.full.pdf

5. Van Horn, L., Carson, J., Appel, L., Burke, L., Economos, C., Karmally, W., Lancaster, K., Lichtenstein, R., Johnson, R., Thomas, R., Vos, M., Wylie-Rosett, J., Kris-Etherton, P. (2016, October 27). Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC): A Scientific Statement form the American Heart Association. Retrieved from: http://circ.ahajournals.org/content/early/2016/10/27/CIR.0000000000000462

6. American Academy of Pediatrics (2012, March). Breastfeeding and the use of human milk. Retrieved from: http://pediatrics.aappublications.org/content/129/3/e827.full#content-block

7. World Health Organization (2015, September 14). Healthy Diet [Fact Sheet]. Retrieved from: http://www.who.int/mediacentre/factsheets/fs394/en/

8. Moore, L. V., Carlson, S. A., Onufrak, S., Carroll, D. D., & Galuska, D. (2017). Development and implementation of a local government survey to measure community supports for healthy eating and active living. Preventive Medicine Reports, 6, 74–79. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/28271024

9. Welsh JA, Sharma AJ, Grellinger L, Vos MB. (2011). Consumption of added sugars is decreasing in the United States. Am J Clin Nutr. 94(3):726-734. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/21753067

10. Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. (2010). Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care.33(11):2477- 2483. Retrieved from: http://care.diabetesjournals.org/content/33/11/2477

11. Morenga LT, Mallard S, Mann J. (2013). Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. Brit Med J.346. Retrieved from: https://www.bmj.com/content/346/bmj.e7492

12. Harvard School of Public Health (2018). The Nutrition Source: Soft Drinks and Disease. Retrieved from: http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/soft-drinks-and-disease/

13. American Heart Association (2018). Portion size verse serving size. Retrieved from: https://healthyforgood.heart.org/eat-smart/articles/portion-size-versus-serving-size

14. US Health and Human Services (2015). 2015-2020 Dietary Guidelines: Current Eating Patterns in the United States. Retrieved from: https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/current-eating-patterns-in-the-united-states/#current-eating-patterns-in-the-united-states

15. USDA: Economic Research Service (2018). Food Environment Atlas: Documentation. Retrieved from: https://www.ers.usda.gov/data-products/food-environment-atlas/documentation/

16. Franzier, W., Harris, J. (2017, June). Trends in television food advertising to young people: 2016 update [Issue Brief]. Retrieved from: http://www.uconnruddcenter.org/files/TVAdTrends2017.pdf

17. Neff, R. A., Palmer, A. M., Mckenzie, S. E., & Lawrence, R. S. (2009). Food Systems and Public Health Disparities. Journal of Hunger & Environmental Nutrition, 4(3-4), 282–314. http://doi.org/10.1080/19320240903337041

18. Centers for Disease Control and Prevention (2018). Nutrition, Physical Activity, and Obesity: Data, Trends, and Maps. Retrieved from: https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DTM.ExploreByLocation&rdRequestForwarding=Form

19. Jefferson County Public Health (2018). Women, Infants and Children. Retrieved from: https://www.jeffco.us/2173/Women-Infants-Children-WIC

20. Centers for Disease Control and Prevention (2016, August). Breastfeeding Report Card. Retrieved from: https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf 

____________________________________________________

Data Sources

CDC, Breastfeeding Report Card 2016: https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf

PRAMS via CDPHE: Pregnancy Risk Assessment Monitoring System via Colorado Department of Public Health and Environment: https://www.colorado.gov/pacific/cdphe/vision-data-tool and http://www.chd.dphe.state.co.us/cohid/Default.aspx

Colorado BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey: http://www.chd.dphe.state.co.us/cohid/

CDC BRFSS: Behavioral Risk Factor Surveillance Survey: https://www.cdc.gov/brfss/data_tools.htm

HKCS: Healthy Kids Colorado Survey: https://www.colorado.gov/pacific/cdphe/hkcs

CO Child Health Survey: https://drive.google.com/file/d/0B2nM-3jK5N8pUE5uRFVHM2RmOWc/view

Click the logos below to return to the assessment home page. 

Published on July 17, 2018    Updated on October 4, 2018