It’s nearly time for the federal government to update its Dietary Guidelines for the public, and this time around the recommendations will include legally mandated dietary guidance for pregnant women, infants, and toddlers (from birth to age 24 months). With that in mind, my colleagues and I were troubled to read of a dust-up over infant formula that occurred at the World Health Organization this past spring.
According to attendees of the World Health Assembly in Geneva, the United States advocated for industry positions as it negotiated a draft resolution on infant and young child feeding, threatening countries with trade retaliation if they introduced the resolution as written. This led to Ecuador who had originally drafted the resolution to pull out from introducing it. Fortunately, Russia stepped in to reintroduce it and member countries worked together to ensure the passage of a version with strong language in support of breastfeeding over breast milk substitute therein, however the final version was missing some important provisions, including one that would give member countries the ability to ask the WHO director general for support in “implementation, mobilization of financial resources, monitoring and assessment” and legal and regulatory enforcement of the code and those countries seeking to halt “inappropriate promotion of foods for infants and children.”
This type of inappropriate interference from the infant formula industry and the willingness of the US to aggressively push for its positions by employing threats of trade restrictions does not bode well for the what lies ahead for the Dietary Guidelines, the process for which kicked off this year. Like with all science-based processes in federal policymaking, there is an opportunity for undue influence to occur to obscure the facts in order to achieve outcomes that maintain the status quo. And undue industry influence is not a stranger to this process. For example, in the 2015 guidelines, the final recommendations failed to incorporate all of the Dietary Guidelines Advisory Committee’s (DGAC’s) evidence-based recommendations that food system sustainability be incorporated into the guidelines, after the big food industry players, most notably the meat industry, opposed the scientific conclusion. Already, the Infant Nutrition Council of America has been actively engaged in the start of the Dietary Guidelines 2020 process, and has lobbied the USDA and HHS on the issue this year. While it makes sense that they’re weighing in on this process, there is no room for inappropriate influence and false characterization of the science.
The formula industry’s long, sordid history spreading misinformation
Three companies dominate the infant formula market: Nestle, Abbott Laboratories, and Mead Johnson. They are members of the Infant Nutrition Council of America, the trade association representing the infant formula industry. There’s a long history of the infant formula and baby food manufacturers pushing back against science-based policies that would limit their ability to make health claims on or sell their products to limited demographics. As a result, we’ve seen delays to evidence-based added sugar labels, missed opportunities to tighten the language on health claims in children’s foods, and even the language in government breastfeeding campaigns toned down.
The infant formula industry used this same disinformation playbook tactic as in the recent WHO proceedings decades ago. In 1977, there was a massive boycott of major formula maker Nestle that urged participants not to buy Nestle products until the company stopped misleading advertising that favored bottle-feeding over breastfeeding. The company then ardently fought against a WHO/UNICEF Code of Marketing of Breast-Milk Substitutes which, once passed in 1981, prevented formula companies from targeting mothers and health care providers with promotions and health claims on packaging. When it passed, 118 countries voted to approve. The United States was absent from that list of countries, presumably because of industry sway.
Breaking down the science on breastfeeding
Leading scientific authorities on maternal and children’s health at The American Academy of Pediatrics, The American Public Health Association, and the American College of Obstetricians and Gynecologists all promote exclusive breastfeeding for the first six months of life as the preferred method of infant feeding due to the health benefits for both mother and child. The literature on breastfeeding has revealed its association with a variety of beneficial health outcomes including decreased risk of asthma, obesity, type 1 and 2 diabetes, sudden infant death syndrome, and respiratory tract infections for the infant and decreased risk of type 2 diabetes and breast and ovarian cancers for the mother. Not only is it healthful, but it is cost-effective. A 2013 Lancet series on maternal and child nutrition estimates that universal breastfeeding would prevent the deaths of over 800,000 children and 20,000 mothers, saving $300 billion globally each year. According to researchers at Harvard Medical School, in the United States alone, if 90% of families breastfed exclusively for 6 months, it would save $13 billion per year in healthcare costs and prevent 911 deaths.
It’s imperative that moms are supported in breastfeeding as an option, some moms are unable to for a variety of reasons and formula is the best alternative. Having breast milk substitutes as alternatives is crucial, but spreading misleading information about the benefits of formula over breastfeeding and marketing accordingly to certain demographic groups is completely irresponsible.
Despite what President Trump and others might argue about the need for infant formula for poor women in developing countries, the data has shown that it may actually be more feasible for women to produce healthy breast milk than to have access to clean water to mix with powdered infant formula to feed their infants. A 2018 National Bureau of Economic Research study found that the availability of formula actually increased infant mortality by 9.4 per 1,000 births and estimated that, as a result, 66,000 infants died in low- and middle-income countries just in 1981.
The 2020 Dietary Guidelines must preserve scientific integrity
UCS submitted comments to HHS and USDA in April on the Dietary Guidelines process urging the agencies to “maintain a high degree of integrity, autonomy, and transparency to ensure that the guidelines represent the best available science and avoid any bias that could work against the interests of public health.” In other words, the US government cannot allow the makers of infant formula to pressure them into weaker dietary guidelines that go against the best available science. Ultimately, we need access to accurate information so that we can make dietary decisions that help us achieve optimal health through nutrition, and we are counting on our government to rely on evidence, not industry talking points on matters of our children’s health. We will continue to monitor this process as the Dietary Guidelines Advisory Committee is formed in the coming months to ensure that scientific integrity at the agencies is upheld.