Breastfeeding might not protect kids from obesity. So what?

The past few days have produced a flurry of articles on how breastfeeding may not protect against obesity. You’d think I’d be shouting an obnoxiously loud DUH or TOLD YOU SO. Instead, I want to poke my eyes out and claw at my ears until they bleed. That’s maybe slightly dramatic, but seriously – I’m at my wit’s end, here.

The truth is, there have been quite a few studies and reviews that showed negligible or conflicting results regarding the effect of infant feeding practice on later obesity (ie, this one, this one, or this one). That hasn’t stopped numerous government or health organization from urging us to support breastfeeding because it will solve the obesity epidemic, opting to focus on this convoluted claim rather than the myriad of health benefits that have been repeated consistently over metastudies and reviews (i.e., lower risk of gastrointestinal infection, lower risk of ear infections, hell, even the IQ thing is more soundly supported by the research).

I get why there’s more attention being paid to this finding – it comes from the PROBIT study, which is the closest thing we have to a randomized, controlled experiment in the infant feeding world (other than sibling studies, of which there have been exactly two- at least that I’ve been able to unearth). For those who don’t spend their free time reading the canon of breastfeeding research, let me give you the Cliff’s Notes: PROBIT was a study undertaken in Belarus, which had low breastfeeding rates at the time. They took a cohort of pregnant moms and gave one randomized group more intensive prenatal breastfeeding education and baby-friendly hospital etiquette when they delivered; the other group got the status quo by way of breastfeeding support. The thought was, the group that got better education and support would breastfeed more exclusively and for longer; the other group probably wouldn’t.

Are you confused? You should be. The thing that puzzles me (and hopefully you as well) is that while this plan might have convinced more women to initiate breastfeeding, the same pitfalls that plague all breastfeeding research still remain. Some of the women in the “breastfeeding friendly” group still – presumably – could not breastfeed for physical reasons, others may have chosen not to. All this study can really show us, after all the necessary confounders are accounted for, is whether this type of breastfeeding promotion and support can increase breastfeeding rates. Otherwise, it’s basically more of the same. There are still fundamental differences in the women who were able to breastfeed and those that couldn’t/didn’t.

But, for whatever reason (desperation?) the medical and advocacy communities have grasped onto PROBIT as the Holy Grail of irrefutable breastfeeding science. So, if PROBIT shows that breastfeeding confers no protective effect against obesity, that means something. (Incidentally, as the babies involved in PROBIT get older, I’m sure we will see a lot of headlines on the long-term effects of breastfeeding… so if you’re interested in this stuff, try and familiarize yourself with it now. Here’s some good literature on it, to get you started.)

While I believe, based on my reading of additional research into the obesity link (more on this in Bottled Up, not that I’m plugging my book or anything. I mean why would I have to, book sales being as horrible great as they are?), that there truly is little to no advantage to breastfeeding in regards to later obesity, there’s no excuse for bad science or bad reporting. And this, my friends, is a both. We are taking ONE finding from ONE study – a well-designed one, to be sure, but far from perfect or immune from the problems plaguing most infant feeding research- and proclaiming its results as absolute truth. The sad thing is, some of the biggest breastfeeding advocates are just as guilty of this as the knee-jerking media: Dr. Ruth Lawrence, one of the founders of the Academy of Breastfeeding Medicine, even admitted that she was “disappointed” about the result (although as someone so wisely pointed out on our FFF Facebook page, how freaking ridiculous is it that she is “disappointed” to find out that the vast majority of Western babies – being that they are nearly all at least partially bottle fed – are not doomed to a life of morbid obesity just because their mothers were “suboptimal” breastfeeders?? And what does this suggest about the inherent bias of breastfeeding researchers?).

The near-hysteria surrounding this finding is just further evidence of how warped our thinking is around infant feeding. Why is it such a big deal that breastfeeding doesn’t solve the obesity epidemic? Because we’ve made it a big deal. We’ve built a house of cards on top of this one health claim: it’s the basis of the First Lady’s push to support breastfeeding; Mike Bloomberg has used it to justify locking up formula in NYC hospitals; pretty much every article about breastfeeding in the past year has suggested that formula fed babies better start saving up for Lap Band surgery. The grotesque amount of fat-hating aside (because if you think formula feeders have it bad, you should see how awfully we treat overweight people in our public health discourse), it’s ridiculous that we’ve focused so much attention on this supposed benefit of breastfeeding when common sense says that our nation’s growing waistlines are due to a multitude of factors – genetics, cultural differences, lack of clean air/safe streets/room to move in our cities, processed food, sedentary lifestyles, the time we waste on the (ahem) internet….

My hope is that breastfeeding advocates and health officials might learn from this; that they might take a step back and reassess the way they are promoting something that should be a basic human right as a medical necessity. But at the very least, I hope this will be a cautionary tale for those of us who strive for critical thinking to remain skeptical of absolutism, in both science and in life.

 

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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10 thoughts on “Breastfeeding might not protect kids from obesity. So what?

  1. I’m not quite sure how a study you describe as having the same pitfalls of any other breastfeeding study will bring you to say that, “Duh, breastfeeding doesn’t prevent obesity.” After all, it’s one study, right? And there are more studies that show a link than do not show a link.

    • Tipper, that was sort of the point of the post – I’m NOT saying duh, I told you so. I WANT to, because one of my biggest bones to pick with breastfeeding advocacy is this reliance on the obesity claim as grounds for making NOT breastfeeding a public health issue. But I can’t, because this is just one study. That’s the point! I think the problem is that many breastfeeding advocates will do this very thing – take one study and proclaim it as absolute truth – and they hold up PROBIT as the gold standard, so they are now caught in the awkward position of having to accept a finding they dislike. I am in no way saying that the PROBIT result is proof that breastfeeding doesn’t prevent obesity. You are right that many other studies do show a benefit – but if you read them carefully, and especially the reviews and metastudies which assess them as a whole, you’ll see that when the necessary confounding factors are accounted for (maternal weight, socioeconomic status, childcare status, age of weaning to solids, race, class, etc, etc) the benefit is negligible if not statistically insignificant. THAT is why I believe that this claim is bogus. Plus, as we’ve discussed before, it seems to be the MODE of feeding that matters – so breastmilk in bottles is just as “bad” as formula in this case. That implies that it is not the properties of human milk but rather something psychosocial.

  2. I suspect that what a person eats for one year between the ages of 0 and 1 impacts the weight of a 40 year old far, far less than what he eats between the ages of 39-40.

  3. I don’t get the hysteria around this either, but perhaps for different reasons.

    First, my understanding was always that the evidence linking breastfeeding with the prevention of obesity was unsubstantiated, so it really isn’t something that I have leaned on or talked about as a breastfeeding advocate. I talk about the advantages to the mother from that perspective, but not the child.

    Second, the first article I read about this study noted at the end of it that the researchers were partially funded by Nestle. I have to admit I dismissed it and closed the tab in my browser at that point and didn’t think about it much more until I realized everyone was writing about it. Now I’m confused as to whether all of PROBIT is partially funded by the Nestle Nutrition Institute or just this particular study and/or these particular researchers at this point in time. In any case, the article is in German, but here it is if anyone is interested: http://www.spiegel.de/gesundheit/schwangerschaft/stillen-muttermilch-schuetzt-kinder-nicht-vor-uebergewicht-a-888631.html.

    If you know more re: Nestle/PROBIT link, Suzanne, I’d be very interested.

  4. Thanks for summing this all up so nice again, Suzanne! I had been reading bits and pieces here and there.
    The mess surrounding this one study is a vivid example of how difficult it is to making sweeping generalizations about child outcomes based on feeding practices. There are just so many confounding variables.
    My breastfeeding class when I was pregnant was taught by a nurse and a lactation consultant who made even more specious claims than this. (For instance, she said that her younger son was smarter than her older son because he had been breastfed, and studies showed that breastfed infants ended up much smarter as adults than formula-fed ones.) I raised my hand several times to try to play the devil’s advocate, but my husband made me stop because he was afraid that I was embarrassing us. At that point, I definitely wanted to breastfeed exclusively, but I was just annoyed as a doctoral student who spent my entire days studying research that a medical professional would be teaching women about inferences that even I — someone who didn’t know much about the topic — knew that the research couldn’t be there to support it.

  5. Do you know how they compared the two groups in the PROBIT study? Are they essentially comparing breastfeeders in the intervention group with non-breastfeeders in the control group? Or do they do many different comparisons to isolate confounders?

  6. hat’s reassuring for advocates of breastfeeding, who have always maintained that the practice has health benefits for both mom and baby that include helping both to keep up healthy weights. But a study published in the Journal of the American Medical Association in March undermined the association by noting that in a population of babies born in Belarus breastfed babies experienced fewer health issues but were not slimmer than formula fed babies. “There’s a lot of other evidence out there to continue to support breast-feeding, but in terms of breastfeeding reducing obesity, it’s unlikely to be effective,” the study’s lead author, Dr. Richard Martin, a professor of clinical epidemiology at the University of Bristol in the U.K. told TIME.

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