Cesarean section linked with obesity?

Is there a link between cesarean delivery and obesity?

An invited commentary published November 21, 2018 by two medical doctors in one of the journals for the American Medical Association, say there is some evidence to suggest this could be so. Significant points from their commentary are the following:

  • In the study of the long-term health impacts of common surgical interventions, one of the most consistent findings is that birth by cesarean delivery is associated with a higher risk of childhood obesity.

  • Cesarean delivered individuals have up to 33% increased risk of obesity

  • Obesity may manifest in childhood, adolescence and may persist into adulthood.

  • In an Asian sample, elective cesarean delivery was associated with an almost 2-fold increased odds of childhood overweight or risk of overweight at 12 months. Emergency cesarean delivery was not associated with increased risk of childhood obesity.

  • In a white Canadian cohort, post-labor cesarean was more associated with weight issues than pre-labor cesarean delivery.

Why would there be such a link? The current evidence suggests it could be due to the differences between the microbiomes of infants born by cesarean section vs vaginal. Here is what the authors state:

“The neonatal gut microbiome has been proposed as one potential mechanism for the association between cesarean delivery and infant weight. Several studies have demonstrated a lower microbial community diversity over the first 6 to 12 months in infants born via cesarean delivery….”

A more diverse gut microbiome is usually associated with better health, including a healthier weight. Thus if cesarean delivery results in a less diverse gut microbiome, it may then contribute to increased risk of weight issues.

Not necessarily causal

It is important to note that the authors are not saying that cesarean delivery causes obesity. What they are exploring in this commentary is that the scientific evidence suggests a potential link may exist. The scientific evidence is sufficient to suggest that a link is plausible and serious enough to warrant on-going investigation.

Personal commentary

The gut microbiome refers to the bacteria, viruses, fungi and other microbes that naturally inhabit our digestive tract, particularly the large intestines. In the womb, babies have no gut microbiome; they get colonized soon after delivery. If born vaginally, the babies get a face-plant of the mother’s vaginal microbiome as they come out of the vaginal canal. The microbes go through the baby’s mouth and into the digestive tract. However, in cesarean delivery, the baby’s microbiome may reflect more of mom’s skin microbiome. The composition of the skin and the vaginal microbiomes may differ considerably. Scientists are now realizing that the infant microbiomes may be different based on the mode of delivery.

This is important because we now know from the scientific data that the gut microbiome has an effect on our weight. Thus, the idea that a link may exist between cesarean delivery and obesity is not as far-fetched as it may first seem.

It may be that future research continues to support a strong link between cesarean delivery and obesity via influences on the infant gut microbiome. Thus, cesarean delivery may be yet another factor that contributes to giving an individual a disadvantage in the fight against obesity. This would be most unfortunate given our already obesogenic environment. However it is unlikely that the mode of delivery would be the single cause for future weight issues. Obesity has many factors. Rarely is it the case that one solitary factor pulls the trigger. In most cases, a multitude of factors need to converge.

A thought to reflect on

In reflecting on this, it may encourage us to limit as many factors as possible so that we and our little ones can have the best chance at keeping a healthy weight and avoiding all the multitude of devastating diseases that often come with obesity. Though we may not be able to turn time backward to replay how we were born, living as optimal a life as possible now would definitely be a good starting place. Some practices to consider are:

  • Meeting the Canadian Physical activity guidelines of 150 minutes / wk of moderate-to-vigorous physical activity

  • Plant-based diet

  • Home-cooked meals. Greatly limit processed food-like-substances

  • Self-control in eating. Eat until you’re comfortable, not fully full.

  • Eating two meals per day may be better than three.

  • Consistent breakfast. Breakfast is largest meal of the day.

  • Limit snacking between meals

  • Bedtime by 9/10:00pm

  • Zero alcohol

Reference for the report

Mitchell, C & Chavarro, J. Mode of delivery and childhood obesity. Is there a cause for concern? JAMA Network Open. (2018); 1(7): e185008

George Cho