Fun and games with Kaiser’s new breastfeeding policy

This image was used in conjunction with this story, about how Kaiser Permanente (an American health system which prides itself on being Baby Friendly) is now promoting breastfeeding as a means to fight obesity.

For our first game, I’ll give you two guesses as to where I am heading with this one.

The article states that “The breastfeeding-obesity link is now recognized by key government agencies such as the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).” True dat, as they say. The LINK between reduced chance of obesity and breastfeeding is certainly recognized by the CDC and AAP (although last I checked, the AAP was not a “government agency”, but rather an independent association of pediatric physicians). But, um, a link is not a cause or cure. It’s a link.

The CDC’s own document on the breastfeeding/obesity link states:

…Breastfeeding is associated with a reduced odds of pediatric overweight; it also appears to have an inverse dose-response association with overweight (longer duration, less chance of overweight). While more research is needed, exclusive breastfeeding appears to have a stronger effect than combined breast and formula feeding, and the inverse association between breastfeeding and overweight appears to remain with increasing age of the child. The three meta-analyses reported in these review articles suggest a 15% to 30% reduction in odds of overweight from breastfeeding.

If you read the entire report, you’ll see that several of the studies in question reported a reduced risk of obesity with breastfeeding initiation – meaning that if women just breastfed in the hospital, there was less of a chance that the child would be overweight. And all studies were observational in nature, as the report authors go on to explain:

There are several possible explanations for why breastfeeding appears to reduce the risk for overweight, but conclusive evidence is not yet available. The studies presented in this brief are limited in that they are based on observational studies and cannot demonstrate causality. One possible explanation for why the literature indicates that breastfeeding reduces the risk of overweight is that the findings are not true but instead are the result of confounding. It may be that mothers who breastfeed choose a healthier lifestyle, including a healthy diet and adequate physical activity for themselves and their children. This healthier lifestyle could result in a spurious relationship between breastfeeding and reduced risk of overweight. The results of Arenz et al. and Owen et al.,however, suggest a true relationship between breastfeeding and reduced risk of overweight, because after adjusting for potential confounding variables, significant inverse associations remained. For example, Arenz et al.reported a significant adjusted OR of 0.78 (95% CI: 0.71, 0.85) among nine studies that adjusted for at least three of the following confounding or interacting factors: birth weight, parental overweight, parental smoking, dietary factors, physical activity, and socioeconomic status/parental education. Similarly, when Owen et al.30 conducted a subanalysis of six studies that controlled for possible lifestyle confounders, the significant inverse association between breastfeeding and pediatric overweight remained, but it was smaller than in the unadjusted analysis. While randomized clinical trials are required to adequately test this relationship, it is unethical to randomize infants to a group with no breastfeeding because of breastfeeding’s known health benefits…

Fair enough. But then the paper launches into a slew of hypotheses about why breastfeeding confers a protective effect against obesity (none of them proven, or even studied, in some cases) and continues with a lengthy discussion about how to improve breastfeeding rates. So what can we gather from this paper?

1. Breastfeeding is associated with a lower risk of obesity.
2. We don’t know why.
3. Breastfeeding rates are low.

Hardly evidence-based proof that we should be promoting breastfeeding as a means of reducing obesity, and yet, here we are again, beating the same dead horse. Somebody should probably call PETA.

Time for the next game… going back to the image at the top of this post… can you spot the misleading or outright false claims?
First of all, breastfeeding does not “prevent” asthma. In fact, several studies (like this one and this one) have suggested that longer breastfeeding may increase the risk of asthma in babies whose mothers have the disease. One meta-study recommended that short-term breastfeeding (4-6 months) was optimal for asthma prevention, but that breastfeeding longer than that may have a reverse effect; another, published in 2011, “(did) not provide evidence that breast feeding is protective against wheezing illness in children aged 5 years and over.”
Breastfeeding also does not “prevent” postpartum depression; this particular claim is outright dangerous. If women believe that breastfeeding protects them from getting PPD, they may fail to seek treatment when symptoms arise. The only studies I’m aware of show an association between breastfeeding cessation and PPD; all this proves is that women who already are showing symptoms of PPD are more likely to quit breastfeeding (another plausible theory is that breastfeeding failure may be a risk factor for PPD).
I’m not sure how this image is being used, but it concerns me…. this is exactly how misleading information spirals out of control. If policymakers and physicians do not have the good sense to differentiate between “links” and causalities, what hope do we have for the general public having a decent understanding of what will impact our health?
Breastfeeding may be good for baby, and good for mom. But please, can we stop with the false advertising? It’s not fair for the formula companies to do it, but it’s just as unfair for the government or health authorities to make unsubstantiated claims. Maybe even worse – we are taught to be skeptical of big corporations, but most of us still have a blind faith that doctors and health organizations are 1) honest and 2) out for the common good. I still believe #2 but I am highly doubtful of #1. And I’d still prefer the truth, even if does make for a less convincing “sell”.

One more little postscript…. my friend J is exclusively breastfeeding, and is a member of Kaiser. Despite the fact that you can’t go two feet in a Kaiser hallway without seeing a breastfeeding promotion poster, she was recently prescribed an allergy medicine that killed her milk supply. She couldn’t understand why her son seemed fussier all of a sudden, until she tried pumping first thing in the morning (her son sleeps through the night, so she hadn’t nursed for over 6 hours and should have been full) and only got a few drips. When she called Kaiser to inform them of this development, they told her that since the meds she was given weren’t contraindicated for breastfeeding, they were deemed “safe” even though she was a nursing mom. She asked what was safe about not having enough milk to satisfy her baby, and the nurse on the phone told her that “she could always just give him formula.”
Interesting. I guess she can blame that nurse if her son is chubby at the age of 5, huh?

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.

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