The ads on the bus go bad, bad, bad – a response to the Calgary Breastfeeding Matters Group campaign

“Children of parents who have diabetes have higher risk of diabetes themselves. Reproduce responsibly. Learn more.”

“Hispanic and Black children have higher risk of diabetes. Race matters. Learn more.”

“Children who are poor have higher risk of diabetes. Money matters. Learn more.”

 

If any of the above statements were posted on the walls of a bus, there would be an intense backlash, and rightfully so. Not only do these messages contribute to the shaming of people with diabetes – a condition that, according the American Diabetes Association, is primarily due to genetic predisposition – they are also offensive, misleading, and would fit quite well into a sci-fi thriller about eugenics. True, these factors are associated with higher rates of diabetes, but the story is far more complex than these slogans suggest, and to imply otherwise is nothing short of irresponsible.

Yet, a similar advertisement will be posted on public buses in Canada, suggesting that mothers of children who develop diabetes may be to blame for their children’s condition, due to their infant feeding choices (or lack thereof).

Ad from the Calgary Breastfeeding Matters Group (CBMG.ca)

Ad from the Calgary Breastfeeding Matters Group (CBMG.ca)

The slogan Babies who aren’t breastfed have higher risk of diabetes, is problematic. The omission of the word “may” (“Babies who aren’t breastfed may have higher risk…) implies that ALL babies whose mothers do not (or cannot) provide mother’s milk are doomed to a higher risk of diabetes.

Yet, the recent meta synthesis study by the World Health Organization (1) which examined 314 studies from 43 countries, reported that while breastfeeding may have protective effect for type -2 diabetes among adolescents, “Generalization from these findings is restricted by the small number of studies and the presence of significant heterogeneity among them” (p. 12). Moreover, there is no evidence to support that breastfeeding is protective against Type 1 diabetes, which is more common in the pediatric population (2).

To understand how this ad is misleading, it’s important to understand that diabetes is not one disease, but actually a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Saying blanket statements about diabetes is like saying “Brittany S sucks”. Who? Brittany Spears? Brittany Snow? Brittany S. Pears from Glee? Brittany spaniels? Same name, but very different entities. The causes of the various types of diabetes also vary. Although there are 3 main types of diabetes (Type 1, Type 2, and Gestational), people can get diabetes as a result of other conditions, like cystic fibrosis, organ transplantation, or having HIV/AIDS.

Type 2 diabetes, formerly known as non-insulin dependent diabetes or adult onset diabetes, is the most common form of diabetes across the general population. It is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities, and can typically be managed via weight control, dietary changes, and exercise. It has come to be viewed in society as a disease of “fault”; another spoke in the wheel of the obesogenic machine that is currently speeding through our society like a shiny, red Corvette, crushing all nuance and holistic scope in its path.

Type 1 diabetes is an autoimmune disease, unrelated to weight or lifestyle factors. This is important to distinguish because children with Type 1 and their parents often get unjustly blamed for the condition (imagine how it must feel, on top of worrying about your chid’s blood sugar levels getting deathly high or low, to contend with people asking if you fed him or her nothing but junk food?) While there is some data suggesting the existence of environmental, viral, or physiological “triggers” for Type 1 diabetes, current research has not shown that it can be prevented (3) by any means, including maternal feeding.

Furthermore, to date, no studies have shown direct correlation between maternal feeding and the development of either form of diabetes, as this campaign would suggest. There is some evidence that children who were breastfed have a lower incidence of developing Type 1 diabetes [4] but the data are merely associative, as there are multiple confounding factors known to develop conditions for the disease. For example, the data coming from the burgeoning field of epigenetics have demonstrated a fairly robust association between allostatic load, or stress, in pregnancy, and higher risk for diabetes, coronary and ischemic disease. [5]

The Babies who aren’t breastfed have higher risk of diabetes advert, sponsored by the Calgary Breastfeeding Matters Group (CBMG), is the fifth in a series of pro-breastfeeding posters. The first four successfully inform and empower public awareness regarding breastfeeding; promoting the message that breastfeeding in public is normal with witty slogans and amusing imagery. This makes the current diabetes-themed poster all the more troubling–with its image of a bottle marked with the word “insulin” next to a foreboding hypodermic needle. To promote the scientifically inaccurate message with hyperbolic imagery misleads the general public, and burdens the parents and children affected by both Type 1 and Type 2 diabetes with unnecessary doubt and concern.

The CBMG may have expected backlash as its website offers a “Resource Sheet” to accompany the advertisement. They link to three different sources of data to back up their claim, with the introductory proclamation that “Recent 2013 research states that breastfeeding as a preventative measure against Type I and Type II diabetes is Level III Evidence”. The first link, to a Nordic systematic literature review, does confirm that the evidence supporting longer-term breastfeeding as a preventative measure (as opposed to “any” breastfeeding) is “Level III evidence”, indeed. What the CBMG fails to mention is that “Level III evidence” is defined as “limited-suggestive”. [6] (To be fair, the study does qualify the evidence for “any” breastfeeding being potentially protective as Level 2 – “probable” – based on studies of varying quality and methodologies.)The other two citations – another review and a seminar about epigenetics [7] [8] – both contain numerous caveats about their findings; neither offers anything close to conclusive evidence that breastfeeding is protective against diabetes – evidence that is hardly worth screaming from the rooftops. Or posting on the wall of a bus.

Without going into a lengthy discussion on the limitations of using two reviews and a lecture as the basis of an emotive advertising campaign, It should suffice to say that infant feeding has not been adopted as a significant reductive factor worthy of promoting to the general public by the American Diabetes Association, nor the Canadian Diabetes Association, expert authorities on this condition (although both of these sources do discuss the research into the breastfeeding-diabetes connection on their websites). In fact, diabetes expert Dr. David Lau  has already spoken against about the campaign, telling the Calgary Herald that the studies used to support the campaign “were essentially surveys…(and) he called any ad based on current, formal research to be an ‘extrapolation’.”

The CBMG “Resource Sheet” also contains a “Q and A”:

So, I breastfed my baby but she still got diabetes!  Is that my fault?

  • There are many risk factors which influence chronic diseases, not breastfeeding is only one of these risk factors.
  • When you have not realized your breastfeeding goals, you may inappropriately blame yourself, when it is the lack of information and support which is the real culprit
  • Let go of guilt. Use that energy to enjoy and celebrate your child and the accomplishments you have made.

This ad is cruel! It makes women who did not breastfeed feel guilty.

 

  • This argument by the public and health professionals takes the responsibility away from those supporting mothers who have not provided the information and support to help her reach her breastfeeding goals. 

  • Information about the health risks of formula do not come from formula companies, but it is very important for moms-to-be to realize there are risks. This needs to be delivered along with breastfeeding support resources.

(Source: CBMG.ca)

In other words, if your baby was breastfed and still got diabetes, there’s a potential that other factors may be at play- but more likely, you didn’t meet your breastfeeding goals. Don’t feel guilty, though – you were probably booby trapped! It’s not your fault you gave your baby diabetes. Although it kind of is.

This ad, well intention as it may be, will quite possibly inflict unnecessary shame and guilt on the parents of children with diabetes; perpetuate the confusion between Type 1 and Type 2 diabetes; and stigmatize women into breastfeeding rather than encouraging them to do so in a positive, constructive way. It would serve CBMG to remove this ad from their otherwise positive breastfeeding promotion campaign. Otherwise, they risk ruining an empowering, powerful campaign with the usual polarizing, negative, and historically ineffective tactics that have perpetuated the “bottle/breast” wars and kept parents from the important work of keeping themselves, and their babies, happy and healthy.

This post was a collaborative effort between Suzanne Barston (the FFF) and Walker Karraa, MFA, MA, with assistance from Polly Palumbo, PhD,  Sarah Lawrence, PharmD, MA,  Teri Noto, and Kristin Cornish, and several others who wish to remain anonymous for professional reasons. 

Citations

[1] Word Health Organization. 2013. Long-term effects of breastfeeding: A systematic review.

[2] University of Rochester Health Encyclopedia, date unknown. Type 1 Diabetes in Children.

[3] American Academy of Pediatrics, 2013.  Healthy Children.org – Diabetes Mellitus.

[4] American Diabetes Association, date unknown. Genetics of Diabetes.

[5] Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ (1989) Weight in infancy and death from ischaemic heart disease. Lancet 2:577-580.

Barker DJP, Bull AR, Osmond C, Simmonds SJ (1990) Fetal and placental size and risk of hypertension in adult life. BMJ 301:259-262

Barker DJP (1995) Fetal origins of coronary heart disease. BMJ 311:171-174.

Barker DJP, Osmond C, Forsén T, Kajantie E, Eriksson JG (2005) Trajectories of growth among children who later have coronary events. N Engl J Med 353:1802-1809.

[6] Hörnell A,et al. Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food Nutr Res. 2013; 57: 10.3402

[7] Nolan CJ, Damm P, Prenkiki M.Type 2 diabetes across generations:from pathophysiology to prevention and management. Lancet. 2011 Jul 9;378(9786):169-81.

[8] Patelarou E, et al. Current evidence on the associations of breastfeeding, infant formula, and cow’s milk introduction with type 1 diabetes mellitus: a systematic review. Nutr Rev. 2012 Sep;70(9):509-19]


 

 

 

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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8 thoughts on “The ads on the bus go bad, bad, bad – a response to the Calgary Breastfeeding Matters Group campaign

    • Jade, do you have a legitimate response to this piece (i.e., response to the arguments or evidence) or are simply going to hurl unfounded accusations? If you know anything about me or this website, you’d know that was an asinine question.

      • Suzanne, I can’t respond to your opinions because they’re so ludicrous! Time and time again you strive to rubbish scientific facts its pathetic! It’s every child’s right to receive the best start in life and the milk they are biologically meant to consume and rates across countries such as the uk, us, etc are appalling! You bad mouthing breastfeeding campaigns is ignorant and pathetic! If you want to fly the flag for formula then that’s your weird agenda however you are setting out to try and destroy something that benefits the human race! Society needs to change and ignorant people like you hold it back!

  1. I am a type one diabetic, have been since I was 2, and have had it for 22 years.
    This notion that breastfeeding protects against diabetes is unspeakably offensive. There was NOTHING *either* of my parents could have done to prevent my disease. And to even imply otherwise is a slap in the face to every mother out there with a child who has diabetes.
    Not to mention the worst “yo’ Mama” joke yet. Because apparently she’s such a bad mother she GAVE ME DIABETES!!!!!!! (Which is funny, because I WAS breastfed).
    No. Just no.
    People seriously need to be taught about statistics and what they actually mean in schools as required general ed, because no one seems to understand such important details as cultural, econimic, and genetic relevance.
    The data is irreparably flawed, and meaningless in the society we live in today. It is used as another notch in the belt of mommy martyrdom to make people feel good about themselves by making others feel worse. Never okay, and not the attitude we should be exemplifying for our children.
    Diabetes HAPPENS. And until there is a cure there will be no magic safeguard under which you can protect your children from it. Telling yourself that breastfeeding *WILL* protect your babbies does nothing but make you FEEL better.
    So go ahead, feel better, but stop throwing your talisman in everyone else’s faces and realize how insulting you are coming off as, whether you intended it “that way” or not.
    My mother fed me “the best” and I STILL got diabetes. Perhaps we should move on to blaming people who reproduce knowing that they carry possible genetic repercussions like a predisposition to diabetes? Should we blame THEM for the rise in diabetes???
    Or would that be a little too callous for everyone?

  2. Are you aware of what you’re actually doing by advocating the use of formula and rubbishing breastfeeding campaigns? There’s no way any right minded human being would advocate a PRODUCT that increases the risk of SIDS unless they were being paid big $$$$! You’re so ignorant it’s laughable!

    • Jade,

      It’s quite obvious, then, that I am either not “right minded”, or I must be making tons of money off the formula companies. Either way, I’m curious why you keep torturing yourself by coming here? Is it just an outlet for your anger? If so, I’m more than happy to be your virtual punching bag so that you don’t express it in a more destructive way.

      Best,
      Suzanne

  3. You don’t choose your race, you don’t always choose to be poor, your parents didn’t choose to be diabetics … but you did choose to formula feed, this is why your opening statement is pointless.

    I don’t think they need to include the word ‘may’ increase … with breastfeeding established as the normal feeding method, anything else is inferior and the risks are proven time and time again … the word ‘risk’ encapsulates the meaning you wish to convey when using ‘may’ so it is redundant… formula feeding does increase the risk, sad but true 🙁

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