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.

 

Could environment or genetics affect milk supply? (File under, “will never be answered in our lifetime.”)

I’m a real estate fiend. I peruse the MLS like it’s a covert issue of Playboy. I love watching the prices rise and fall; seeing how trends change; and I especially adore reading the descriptions of properties and how they are marketed. Realtors often highlight the “walkability” of a location, the proximity to good schools, and any unique features of the home. I have yet to see any real estate professional describe a listing based on its health merits… but maybe they should start.

Last summer, an article on Harvard Health pointed out the health ramifications of where we live. “Laden’s research group has found a number of links between environmental factors and health,” the authors explain. “For example, the results of one study showed that greater exposures to UV light correlate with a higher incidence of squamous cell carcinoma. In some regions of the U.S.—for example, the Southwest—people are more exposed to UV light and thus face a higher risk…Other research from Laden’s group has shown an association between fine particulate levels in the air and mortality rates—the more fine particles, the higher the rate. The researchers found relationships between particulates and increased levels of cancer, renal failure, coronary heart disease and cognitive decline. They also observed associations of some negative health outcomes—for instance, rheumatoid arthritis and diabetes—among people living closer to highly traveled roads. In regions of the U.S. where air pollution has decreased over time, Laden said, there has been an improvement in public health.”

This makes sense: your health can be affected by where you live, and how you live, and who you are. Not only does your environment play a role in health, but your gene pool may, as well. For example, since both my husband and I are Ashkenazi Jews, we had to get a “panel” of genetic testing done prior to conceiving to ensure we weren’t both carriers of a few key diseases which tend to strike only members of our ethnic group. Black Americans have to worry about Sickle Cell Anemia. And my husband has an eye condition which typically only strikes people descended from British of Irish stock (making us suspicious that someone in his family tree must have slept with the redheaded mailman, considering his peeps ain’t from that part of the world).

I’m talking about all of this because I came across another study today – this one of the “self-reported”, survey breed – which claims that 72% of new parents surveyed in a group encompassing mothers from the United States, South Africa, Egypt, U.S., Brazil, China and India wanted to breastfeed for as long as possible. “The main reason that stopped women from breastfeeding within the first three months was pain, whilst lack of supply commonly caused women to give up breastfeeding between three and seven months,”  states the study, which was funded by Philips (the makers of Avent bottles and pumps). However, “67% of American women compared with 40% of women globally reported that their reason for stopping was a lack of milk supply, and in comparison to 41% of mothers globally, 73% of American women completed a breastfeeding course.”

Hmm.

Something doesn’t quite compute, here. American women were more likely to be educated about breastfeeding, and also more likely to cite lack of supply as a reason for quitting. Presumably, the more educated about breastfeeding you are, the more you’d know about what constitutes a true lack of supply; how to pick up on hunger cues; how to recognize growth spurts; and how to avoid the “booby traps” which could adversely affect supply. So either these classes we’re taking are teaching all the wrong things, or American women really are having more trouble with supply.

If it is a widely accepted belief that genetics and environment can impact health both positively and negatively, why do we have a hard time believing that on a population level, one country’s breasts might be short-circuiting? It could be something social in nature; maybe it is something as simple as a lack of good breastfeeding help in the hospital, which is impeding the second stage of lactogenesis (the process which the body must go through to start producing milk). Even this would be good to know, because regardless of the cause being an avoidable one, it speaks to the point that women are having trouble with supply and are not just using it as an “excuse”. But maybe it is something in our water or environment. Maybe lack of supply is more prevalent among certain ethnic groups or geographic cohorts – have there been any studies done examining “perceived” lack of supply in eastern versus western states, for example? The rural south versus the Pacific Northwest? I’d be interested in that. Or you know what else would be cool? A study which actually examined the breasts and overall physical health, down to the cellular level, of women who “claim” insufficient supply. Maybe we could find enough proof for people to stop accusing new mothers of lying or giving excuses, and actually make some real strides for women who want to breastfeed and find themselves unable to do so without going to extreme lengths.

A girl can dream, right?

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