To the Editor.
—Dr Smith and colleagues conclude in their recent article that "women experience modest but adverse increases in body weight and fat distribution" after pregnancy.1 While the study took measures to control for age, education, baseline level of adiposity, smoking, and physical activity, breast-feeding mothers were eliminated from consideration as stated in the "Methods" section. Perhaps the conclusion should reflect this exclusion.
Lactation leads to increased energy needs.2 For many women, this results in enhanced postpartum weight loss.3 Not every study demonstrates this benefit, probably reflecting an increase in energy intake that offsets the greater energy requirement.
It is unclear why this study eliminates nursing mothers from consideration. Since lactation completes the reproductive cycle, its hormonal contribution to the mother's eventual health must not be discounted.
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