title: Association between support from a health professional and breastfeeding knowledge and practices among obese women: evidence from the Infant Practices Study II.
abstract: BACKGROUND
  Obese women are less likely to initiate and continue breastfeeding. We described barriers to breastfeeding and examined the association between support from a health professional and breastfeeding knowledge and practices, by prepregnancy obesity status.
  
  
  METHODS
  Using data from the Infant Feeding Practices Study II, a cohort of U.S. women (N = 2,997), we performed descriptive statistics to describe barriers to breastfeeding by prepregnancy obesity status. We conducted multivariable regression to examine the association of breastfeeding support from a physician or nonphysician health professional with knowledge of the recommended duration of breastfeeding, breastfeeding initiation, and breastfeeding duration, and whether breastfeeding support had different associations with outcomes by prepregnancy obesity status. Average marginal effects were calculated from regression models to interpret results as percentage-point changes.
  
  
  RESULTS
  Believing that formula was as good as breast milk was the most commonly cited reason for not initiating breastfeeding, and milk supply concerns were cited as reasons for not continuing breastfeeding. Physician breastfeeding support was associated with a 9.4 percentage-point increase (p < .05) in breastfeeding knowledge among obese women, although no increase was observed among nonobese women. Breastfeeding support from a physician or nonphysician health professional was associated with a significantly increased probability of breastfeeding initiation (8.5 and 12.5 percentage points, respectively) and breastfeeding for 6 months (12.5 and 8.4 percentage points, respectively), without differential associations by prepregnancy obesity.
  
  
  CONCLUSIONS
  Support for exclusive breastfeeding is an important predictor of breastfeeding initiation and duration among obese and nonobese women. Health educational interventions tailored to obese women might improve their breastfeeding initiation and continuation.
authors.affiliation: Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania. Electronic address: mpj@pitt.edu.
authors.forename: Marian
authors.initials: M
authors.lastname: Jarlenski
authors.affiliation: Sexual Health Innovations, New York, New York.
authors.forename: Jenny
authors.initials: J
authors.lastname: McManus
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
authors.affiliation: Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California.
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
authors.forename: Edwina
authors.initials: E
authors.lastname: Yeung
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Bennett
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D009765:Obesity / Q000150:complications / Q000523:psychology*; D050177:Overweight / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians; D049590:Postpartum Period / Q000523:psychology; D012944:Social Support; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult