Thursday, October 18, 2007

Will the UK Government deliver on its claimed commitment to tackling obesity through breastfeeding?

A new UK report was launched by the Government Office for Science this week. The report is called 'Tackling Obesities: Future Choices' and originates from what is called the 'Foresight programme'. It can be downloaded at:

The report cites the role of breastfeeding in tackling the obesity epidemic (page 47):

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There is evidence that the period soon after birth is a time of metabolic plasticity. Factors in the environment, such as nutrition, can have long-lasting consequences in that they appear to set the baby on a particular developmental trajectory. There is strong evidence, for instance, that low birth weight is associated with increased risks of heart disease and diabetes and, while there is less evidence of a direct link between birth weight and obesity, weight gain in early life appears to be critical. Some low-birth-weight babies may be especially susceptible to catch-up growth (that is, rapid weight gain), while others experience this as a direct consequence of their diet. Breast-fed babies show slower growth rates than formula-fed babies and this may contribute to the reduced risk of obesity later in life shown by breast-fed babies. Weaning practices are also thought to be important, given the association between the characteristic weight gain seen in early childhood at approximately five years of age (early adiposity rebound) and later obesity. Despite the uncertainties surrounding this evidence, and the need for additional research, the work suggests that early life is a critical period for healthy development.
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The criteria checklist for an effective obesity strategy includes (page 130)

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The intention to increase rates of breast-feeding:

• at an individual level includes support networks to help new mothers to breast-feed

• at a local level means positive breast-feeding policies at local hospitals and initiatives such as Sure Start to inform and educate mothers

• at a national level means regulation to give women the right to breast-feed in public places or to protect employment rights and maternity leave entitlements.
---quote ends

While these are amongst the 7 goals of the Breastfeeding Manifesto campaign we support, a fundamentally important one is missing: the protection of breastfeeding through the implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly.

As the report we have submitted to a government consultation on revising the UK Infant Formula and Follow-on Formula Regulations shows, promoting breastfeeding has little impact if there is not protection. The UK formula industry advertising spend is already ten times that of breastfeeding promotion and the industry attempts to co-opt health workers to recommend its products through a range of strategies from idealizing claims to giving of gifts.

Companies encourage parents to look to them for information on infant care. You can see examples of the promotion in the submission report: "Protecting breastfeeding - Protecting babies fed on formula" which contains the legislative recommendations of the Baby Feeding Law Group, a broad coalition of UK health worker organisations and mother support groups. It is endorsed by the Breastfeeding Manifesto Coalition, which is an even broader group of organisations. See:

Government efforts to increase breastfeeding duration in the UK is failing - indeed rates have stayed still or even fallen in some regions, according to the latest Infant Feeding Survey. Contrast that with Brazil where median breastfeeding duration has increased from 3 months to 10 months.

The big question is will the Secretary of State for Health have the courage to heed the advice of health experts and implement the International Code and Resolutions? Or is he scared of pressure and a possible legal challenge by the baby food industry? If the Secretary, Mr. Alan Johnson, is feeling nervous he could gain courage from his counter part in the Philippines, Dr. Francisco T. Duque III.

In the Philippines, the Department of Health issued strong regulations last year and when challenged by the baby food industry fought a legal battle at the Supreme Court, which was won last week when the Court lifted the Temporary Restraining Order on the regulations.

Dr Duque stated: "By reinforcing the power of the DOH to more strongly regulate milk company sponsorships and advertisements and upholding the independence of the health community in scientific research and policy, the Supreme Court has shown the country’s sovereignty in protecting public health above the narrow trade interests"


Mr. Johnson should also learn from the difficulties encountered by the Philippines attempting to address new aggressive marketing tactics through Department of Health Regulations rather than primary legislation. In two areas the Court ruled that the DoH would have to seek changes in primary legislation first.

It concerns us that the UK Food Standard Agency is apparently intending to rely on 'guidelines' published alongside the law to address some practices, rather than legislating. This approach could involve more legal challenges, expense and delay in the future than would showing courage now and introducing strong legislation as everyone whose focus is infant health is advising.

The UK Government claims to be commited to tackling the obesity epidemic. The Public Health Minister, Dawn Primarolo MP, has put her name to the preface of the 'Forsight programme' report, which states:

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An unhealthy weight is often seen as a result of individual choice on diet, exercise and lifestyle. However, this report maps the complex web of societal and biological factors that have, in recent decades, exposed our inherent human vulnerability to weight gain. If we fail to tackle this ‘obesogenic environment’ the consequences for individuals, families, communities and society as a whole are grave.

We will therefore jointly be acting on the findings of this project, taking a system-wide approach with Ministers across Government and with professionals and policy makers on a local level. An Expert Panel, drawing on the breadth and depth of expertise that contributed to the report will help us with this. As the report demonstrates, there is no quick and easy solution to tackling obesity. However, we have the long-term commitment – and the learning now – to work together to create a 21st century society better in tune with our biology.
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We will soon learn whether this stated commitment is genuine or not. Does the government really want to empower women to breastfeed? Remember 9 out of 10 mothers who stopped breastfeeding by 6 weeks said they wanted to breastfeed for longer, as did 40% who breastfed for at least 6 months. Or will it continue with its current failing approach of promotion without protection?

Will the government listen to expert advice on the Infant Formula and Follow-on Formula Regulations, including that of its own Scientific Advisory Committee on Nutrition, which has called for the legislation to be strengthened in several areas?

If it does not act on this advice it will not only show its commitment to public health is empty words, it will have failed another generation.

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