It turns out that breastfeeding doesn't actually protect against later childhood obesity. This finding -- based on results from a major random control study involving the outcomes of nearly 14,000 children in Belarus -- comes as no surprise to those of us who have devoted much energy over the years trying to quell the 'breast milk as miracle food; formula as rat poison' polemic.
The study's conclusion is thus:
Among healthy term infants in Belarus, an intervention that succeeded in improving the duration and exclusivity of breastfeeding did not prevent overweight or obesity, nor did it affect IGF-I levels, at age 11.5 years. Breastfeeding has many advantages, but population strategies to increase the duration and exclusivity of breastfeeding are unlikely to curb the obesity epidemic.
As an experimental design -- the undisputed gold standard for evidence-based medicine -- this study provides us with the kind of evidence much of the existing research on infant feeding lacks; randomized samples and a control group. Research studies like this one give us findings we can count on. They allow us to isolate causal relationships and mechanisms by effectively controlling for confounding factors.
The article, published in this week's issue of JAMA (Journal of the American Medical Association), reports results from the third phase of a major longitudinal randomized control study that began in the mid-1990s, involving 31 maternity hospitals in Belarus. The study, known as PROBIT (which stands for Promotion of Breastfeeding Intervention Trial), randomly assigned the 31 hospitals into either a control group (i.e., 'normal practices') or an experimental group (i.e., breastfeeding promotion intervention). The experimental group implemented a breastfeeding promotion intervention program, based on the WHO/UNICEF Baby Friendly Hospital Initiative. The result of the intervention led to much higher rates of breastfeeding among the experimental group than among the control group.
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Alanis Morissette
The singer recently <a href="http://www.huffingtonpost.com/alanis-morisette/attachment-parenting_b_1563667.html" target="_hplink">expressed</a> her pro-attachement parenting beliefs and <a href="http://www.huffingtonpost.com/2012/05/21/celebrities-who-breastfeed_n_1533167.html" target="_hplink">said</a>, "I breastfeed and I'll be breastfeeding until my son is finished and he weans," on "The Billy Bush Show."
Beyonce
Beyonce was <a href="http://www.huffingtonpost.com/2012/03/01/beyonce-breastfeeds-blue-ivy_n_1312950.html" target="_hplink">spotted breastfeeding</a> Blue Ivy in New York City while dining out with husband, Jay-Z.
Alicia Silverstone
Alicia Silverstone -- whose <a href="http://www.huffingtonpost.com/2012/03/27/alicia-silverstone-chews-food-for-bear-blue-mouth-to-mouth_n_1383262.html" target="_hplink">pre-mastication video</a> thrust her baby-feeding philosophy into the public spotlight -- was once <a href="http://socialitelife.com/is-alicia-silverstone-breastfeeding-bear-blu-while-walking-photos-video-03-2012" target="_hplink">photographed breastfeeding</a> Bear Blu <em>while</em> walking.
Mayim Bialik
Actress, <a href="http://www.kveller.com/blog/parenting/it-may-be-time-to-wean-my-three-year-old/" target="_hplink">Mayim Bialik blogged</a> in September about starting to wean her 3-year-old. In her new book, "Beyond The Sling," Bialik writes that he still nurses about five times a day, and r<a href="http://www.huffingtonpost.com/2012/05/14/attachment-parenting-mayim-bialik_n_1515029.html" target="_hplink">ecently told CNN</a> "it is still a tremendous source of discipline, and of bonding, that occurs between a mother and a child."
Alyssa Milano
Milano <a href="http://www.bestforbabes.org/alyssa-milano-charmed-by-breastfeeding" target="_hplink">told Best for Babes</a> that she has had no trouble breastfeeding her son, Milo. "I was lucky to have a baby who from the moment he came into the world, was a pro at latching on," she said.
Tori Spelling
In November 2011, Spelling's husband, Dean McDermott <a href="http://www.huffingtonpost.com/2011/12/01/tori-spelling-talks-tople_n_1123162.html?" target="_hplink">accidentally tweeted a photo </a>of his son, Liam, who was 4 at the time, which showed Spelling's breasts in the background.
"I am a mom, I was nursing my baby... [Dean] was so devasted about it that I couldn't be mad. I mean it was genuinely an accident," Spelling <a href="http://marquee.blogs.cnn.com/2011/11/29/tori-spelling-at-least-my-breasts-looked-great/" target="_hplink">told CNN about the incident</a>.
Kourtney Kardashian
Kourtney K. quit breastfeeding son, Mason, when he was 14 months old. "I think I stopped early because my sisters were like 'OK, it's time, it's time,'" <a href="http://www.huffingtonpost.com/2011/10/07/kourtney-kardashian-talks_n_1000125.html" target="_hplink">she said on the "Today" show</a>. "I miss it, I loved it."
Miranda Kerr
Shortly after giving birth to her son, Flynn, Kerr <a href="http://www.koraorganics.com/blog/live-in-my-skin/all-things-organic/organic-certification/our-darling-little-man-xxx/" target="_hplink">posted a photo</a> on her blog that husband Orlando took of her nursing.
Gisele Bundchen
In 2010, Bundchen <a href="http://www.usmagazine.com/celebrity-moms/news/gisele-bundchen-mandatory-breastfeeding-should-be-a-worldwide-law-201028" target="_hplink">declared there should be a "worldwide law" </a>requiring new mothers to breastfeed for six months after they give birth. Many critics</a> were unhappy with her statement, and <a href="http://www.bettyconfidential.com/ar/ld/a/gisele-backtracks-on-breastfeeding-law-comment.html" target="_hplink">she eventually clarified</a> by writing on her blog:
"My intention in making a comment about the importance of breastfeeding has nothing to do with the law. It comes from my passion and beliefs about children."
Kendra Wilkinson
Wilkinson <a href="http://www.babyzone.com/mom/celebrity-babies/kendra-wilkinson_210550" target="_hplink">once told Baby Zone</a> an outrageous story about the first party she went to after giving birth to baby Hank:
"I went to Eve nightclub in Vegas and my boobs started leaking. I couldn't do anything so I breastfed myself [laughs]. And it tasted sweet, too!"
Salma Hayek
<a href="http://www.huffingtonpost.com/2009/02/10/salma-hayek-breastfeeds-a_n_165676.html" target="_hplink">Salma Hayek breastfed a newborn baby boy in Africa </a>whose mother had no milk in 2009. Hayek was weaning her own daughter, Valentina, at the time, but still had milk to donate.
Naomi Watts
<a href="http://www.huffingtonpost.com/2009/01/13/radiant-naomi-watts-steps_n_157477.html" target="_hplink">Watts told PEOPLE magazine in 2009</a> that breastfeeding was how she lost weight. "He's sucking it all out of me, it seems," she said.
Rebecca Romijn
In 2009, Romijn <a href="http://www.huffingtonpost.com/2009/04/30/rebecca-romijn-on-weight_n_194226.html" target="_hplink">told Extra!</a>, "Breastfeeding is the very best diet I've been on. It's amazing."
Angelina Jolie
The November 2008 cover of <em>W magazine</em> <a href="http://www.wmagazine.com/celebrities/2008/11/brad_pitt_angelina_jolie" target="_hplink">featured Jolie nursing. </a>
Elisabeth Hasselbeck
In 2008, <a href="http://www.huffingtonpost.com/2008/01/16/talk-of-nipples-breast-pu_n_81887.html?" target="_hplink">Hasselback demonstrated how to use a breast pump</a> on "The View" -- she was nursing her son, Taylor, at the time.
Christina Aguilera
Five weeks after giving birth to son, Max, Aguilera <a href="http://www.huffingtonpost.com/2008/02/20/christina-aguilera-talks-_n_87645.html" target="_hplink">went on The Ellen Show </a>wearing a low cut, revealing dress that prompted the talk show host to ask, "Are you nursing?"
Gwen Stefani
Stefani was still breastfeeding son, Kingston, when she went on tour in 2007. <a href="http://www.guardian.co.uk/lifeandstyle/2007/aug/05/fashion.popandrock" target="_hplink">She told The Guardian</a>, "I don't know when I'm going to stop breastfeeding... I'll just keep going while I can -- like, he's getting his teeth so it is a little bit scary. He's bitten me a few times!"
Jennifer Garner
In the the April 2007 issue Garner told <a href="http://celebritybabies.people.com/2007/03/25/jennifer_garner_3-4/" target="_hplink">Allure Magazine:</a> "All I ever heard was everyone bitch about [nursing] -- nobody ever said, 'You are not going to believe how emotional this is.' It's like, I'll say I'm going to stop, and then I'm in there, feeding her."
Maggie Gyllenhaal
Gyllenhaal was <a href="http://celebritybabies.people.com/2007/05/05/maggie_gyllenha/" target="_hplink">photographed by the paparazzi </a>in 2007 nursing her daughter, Ramona, during a walk by the Hudson River.
Kate Beckinsale
<a href="http://celebritybabies.people.com/2006/06/20/bizarre_breastf/" target="_hplink">Kate Beckinsale told Jay Leno in 2006</a> that she missed breastfeeding her daughter and that "she was very good at it."
Mary-Louise Parker
In 2004, when Mary-Louise Parker won a <a href="http://www.youtube.com/watch?v=5K91VXG6xFI" target="_hplink">Golden Globe for "Angels in America"</a> she said, "Janel Moloney just told me she would pay me $1,000 if I thanked my newborn son for making my boobs look so good in this dress."
As the authors of the study describe, randomization ensures that you end up with "two groups [breastfeeding intervention group and control group] with similar distributions of baseline socio-demographic and potential confounding factors." In other words, randomization ensures the analysis is comparing apples to apples when measuring outcomes across the two groups.
In observational studies -- which is what most of our research on breastfeeding is -- the lack of randomization means we are typically not comparing apples to apples. Mostly, this is because kids from higher socio economic backgrounds are much more likely to be breastfed than are kids from low socio economic backgrounds.
Those who write about the misapplication of breastfeeding research have always been very clear about this being an important point for interpreting results: when you have an observational study that measures the outcomes of breastfed kids versus non-breastfed kids, you're typically measuring differences between two population groups -- richer kids versus poorer kids.
Socio-economic status is the biggest and most significant of all known social determinants of health. Put in all the statistical controls you want, it's still going to be a major confounding factor. This creates all kinds of limitations for how results of observational studies can and should be interpreted. It creates questions about what findings mean and how they can be explained.
The new PROBIT study results, which show no major difference between the two groups with respect to overweight or obese children at 11.5 years, are consistent with earlier PROBIT results, which showed no difference on measures of obesity at 6.5 years of age.
If the breastfeeding-obesity link isn't causal -- and we know now it's not - why have we been led to believe that it is? Is previous research wrong?
Previous research isn't wrong. The link between breastfeeding and obesity still exists. The problem is that our 'breastfeeding is all things great' paradigm made us prone to jump to conclusions about what that link meant.
Today's breastfeeding culture is a zealous one. The paradigm that guides our thinking is one where we are prone to believe everything about breastfeeding is good and everything about not breastfeeding is bad. This paradigm colours our theories and our thinking.
It gives us ideological blinders. And ideological blinders make us sloppy.
Being careful to acknowledge the limitations of what claims we can and cannot make based on the evidence at hand doesn't seem to matter as much as promoting breastfeeding at all costs. Find a link between breastfeeding and obesity? That must mean breastfeeding causes lower obesity! Of course this must be the right explanation -- because we already know that breast milk is a miracle food and not breastfeeding is really really bad.
And so it goes. One more danger added to the already heaping pile of 'risks of not breastfeeding.' More pressure for new moms to be successful with breastfeeding -- if they fail, they risk losing that 'protection against obesity.' (For the record, this pressure pile-on for breastfeeding is not a good thing for new mothers' stress levels and their ability to adjust to motherhood successfully and with ease.)
It's a relief to now have one item knocked off the pressure list.
But read the coverage on this story and you will notice a distinct pattern: report on the finding but then promptly be sure to remind everyone that breastfeeding is nevertheless a miracle food and a really really important thing to do. It's as though there's a kind of cultural paranoia that mothers will suddenly stop breastfeeding en masse if they hear anything at all contrary to the 'breast milk as miracle food, formula as rat poison' polemic.
Do we really think new mothers are that fickle? Do we really think they don't already know the message? And do we really need reams of scientific research to make this basic point?
What if we place a moratorium on the 'endless advantages of breastfeeding' and 'research suggests' angles of breastfeeding promotion and instead focus on the basics: breastfeeding is a healthy practice (which means it should be supported), a reproductive right (which means it should be protected), a varied and subjective experience (which means it's not going to work for everyone), and a socially patterned form of maternal work (which also means it's not going to work for everyone).
Breastfeeding is also something that the vast majority mothers in Canada already do -- nearly 90 per cent initiate breastfeeding and over half are still breastfeeding at six months. Overstating the science to encourage breastfeeding and prop up its importance is not only not necessary, it's also false advertising.
Previewing Your Comment.
This comment has not yet been posted1) women who forumla feed their babies feel defensive
2) women who promote breastfeeding say things that make those women feel defensive
3) one (questionable) study showed breastfeeding research might be exaggerated, so discussion of breastfeeding benefits is unnecessary and done to cause #1
4) the 'polemic nature of breastfeeding culture' is the fault of women who promote breastfeeding
This is very simplistic reasoning. Your article not only misses the larger picture of this issue, but it puts the blame for the whole mess on those trying to correct it and completely ignores that there is a billion dollar business profiting from it.
My breast was painfully grabbed, my baby's head was shoved, I was shamed and intimidated into trying it over and over again, until I became almost suicidal and my baby's weight was dropping rapidly because they told me that formula was so bad for her.
Finally, I somehow found the courage to kick them out the door, and for the first time since my daughter's birth, we both were able to calm down. Her with a belly full of food and me with a sleeping (not starving) baby in my arms.
Don't get me wrong, I'm not against breastfeeding, I wish I could have done it, but it should not be forced upon women. It should truly be a choice, according to the circumstances... just like everything else in life. My daughter is now a healthy, intelligent, amazing 13-yr-old, but it speaks much to the trauma I experienced that to this day, telling this story chokes me up.
We need to spread the message somehow that even if it doesn't happen, you're not a failure as a mother...
Thank you,
Ali Anari, MD
Firstly, in this article, the author asserts that most of the pro breastfeeding research comes from observational studies and therefore is flawed because it doesnt account for socio-economic status. While this was determined to be an issue with some studies, it is misrepresentational to use the word most. Many of the thousans of studies done did account for SES, which on its its own doesnt completely discount the findings anyway. Those who wrte about the misapplication of breastfeeding research are not even always qualified to do so, and often have an anti-breastfeeding bias and so creedance given to their opinions needs to be adjusted accordingly. One cant compare the results of studies following the rules of scientific studies to mere opinion coloured by agenda as equal. Apples to oranges.
Secondly, as already pointed out in the comments numerous times, the PROBIT study is ONE study and it was partially funded by a formula company. I hardly think it has a place in serious discussion about the validity of breastfeeding studies.
Next, for the author to blame breastfeeding and its supporters for causing new mothers angst because of the pressure to breastfeed is ridiculous. Firstly because many of the problems associated with launching breastfeeding are caused by deliberate attempts by formula companies to undermine breastfeeding by misinformation or by manipulation through advertising and secondly because that treats formula feeding as the norm and breastfeeding as something extra you might want to try for your baby's sake.
Breastfeeding is not promoted because the promoters see new mothers as fickle or ignorant or because they wish to bully new moms at a time when they are fragile.. Its promoted to try and level the playing field against phamacuetical companies who deliberately violate the code of ethics of marketing human milk substitutes on a continuous basis and who make billions of dollars each year doing it. What sort of moratorium do you suggest we place on THAT? When not even WHO seems to be able to rein them in?
I am glad the author brings up the 90% initiation rate for breastfeeding, though that number doesnt match any I've encountered. 83% being the most recent figure for Canadian mothers. But the numbers drop off quickly from there. By six weeks, almost half of that number have stopped, despite evidence as to the benefits of breastfeeding beyond that time. There is a place for the promotion of breastfeeding.
I'd expect women who are more focused on breast feeding to be more into health issues generally so they would be more likely to take vitamins, eat vegetables, etc., and to make sure that their kids eat healthy- including after breast feeding- as well.
That is another methodological hurdle- if you want to know how the children of moms who breast fed them do compared with formula or bottle fed children later on, you have to consider whether the mothers of the two groups will treat their children the same after breast feeding.
Project further than that and you have to factor in whether breastfed children continue to approach health differently when they are out of their mother's care.
We should be conservative about the claims about the benefits of breastfeeding.
We should however be conservative in another way, even without evidence as to benefit.
Breast feeding has been tested by millions of years of natural selection. If some company that is trying to replicate the benefit it would be a happy accident if they didn't miss anything.
Even if they are sincere and diligent in their formulation, it is hard to say whether they missed anything.
On a related note- scientists and nutrient manufacturers have claimed that something called Allicin is "the" "active ingredient" in garlic. That sounds presumptuous.
Unfortunately, Kramer et al did not provide information on the mean number of weeks for which children in the intervention and control groups had been breastfed; that information would have allowed an estimation of the magnitude of the differences in outcomes that could have been expected. In addition, their attempt to reproduce the results of other observational studies by comparing infants completely weaned within the first month with those exclusively breastfed for >6 mo, to further illustrate the absence of an effect of extended breastfeeding, is misleading.
http://ajcn.nutrition.org/content/87/6/1964.long#xref-ref-1-1
The Archives of General Psychiatry reports from this study (Arch Gen Psychiatry. 2008;65(5):578-584. doi:10.1001/archpsyc.65.5.578
"Conclusion These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development." This study actually strongly reenforces the many benefits of breastfeeding but you happen to highlight just one of the conclusions, and even that is disputed.
http://archpsyc.jamanetwork.com/article.aspx?articleid=482695
Formula in a pinch is probably in a godsend, but stay away from the stuff if you can. You cannot trust corporations to not rig the system in some way in their favor. Why take the risk if you can avoid it?
Breastfeeding is not something "cute", or "a little extra good thing" that you do for your baby.
It simply is the right thing to do for your baby. Period. No formula can mimic breastmilk, no formula has the antibodies that the breastmilk has.
The study that you quote also showed that children who were exclusively breastfed had higher IQs.
Many formulas have trans fats, and formulas don`t need to be approved by the FDA before being marketed.
Yes, there are mothers that can`t breastfeed. Such is life. But just because some mom`s are unable to breastfeed we can`t just simply pretend is not a big deal to give kids formula.
Did I paraphrase you correctly?
Get a grip Stephanie. If you are not comfortable with breast-feeding just say "No!" like a big girl. Obviously you didn't take a Science For Arts Majors course at uni.
Sugar: The Bitter Truth
Almost 3 million hits = wow
http://youtu.be/dBnniua6-oM
Ever since he gave his now infamous lecture entitled “Sugar: The Bitter Truth” in July 2009 at the University of California-San Francisco “Mini Medical School for the Public” event (a physician who teaches pediatrics in the Division of Endocrinology at UCSF) Dr. Robert H. Lustig has become somewhat of a hero in the low-carb and health community for exposing the truths about the dangers of fructose, the negative impact it is playing on health, and what we can do about it.
http://livinlavidalowcarb.com/blog/dr-robert-lustig-from-sugar-the-bitter-truth-explains-why-he-doesnt-believe-in-the-low-carb-lifestyle/8164
psssssssssst: cut out all the sugary drinks, it’s killing you and your kids