Toxic Hot Seat on HBO tonight!

Red sofa

Red sofa (Photo credit: Wikipedia)

Hallelujah! A new film about the struggle to understand and address the hidden poisons in our sofas — Toxic Hot Seat — airs for the first time tonight on HBO. Slate has a preview with a couple tantalizing clips. You can also see it on HBO-Go, the on-demand service.

This is exciting, as it appears it will tell the story the Chicago Tribune first unearthed over a year ago in its epic Playing with Fire series.  In sum, flacks from the chemical industry lied to California lawmakers about the reasons babies were killed in household fires in order to guilt them into maintaining a requirement for toxic flame retardants in furniture. The Trib also unearthed seedy connections to Big Tobacco and ripped the mask off a “fire-safety” front group that had been backed by the chemical manufacturers.

As we now know, we’ve now poisoned a generation or two with these chemicals. One study showed 97 percent of Americans have flame retardant chemicals in their bloodstreams, which are linked to health risks including cancer, infertility, obesity, neurodevelopmental delays and even behavior issues and lowered IQ levels. In a tragically ironic twist, the brave men and women who protect us in fires have been hit particularly hard, and now can face dire health consequences from the exposures to toxic smoke.

The film comes on the heels of an excellent but frightening study published last week by the Center for Environmental Health, Playing on Poisons, that showed that 90 percent of children’s furniture is laced with flame retardant chemicals. Because they crawl around on dusty floors and put things in their mouths, studies show kids have higher levels in their bodies of these chemicals than adults do. Thankfully, even recent action in California to ban one class of flame retardants chemicals produced a precipitous drop in the chemical in pregnant women, as measured in September of this year.

I’m glad the word is getting out. I imagine we’ll see a lot more couches on curbs in the coming days. Parents should also toss those adorable fuzzy pjs (which are often sprayed with the chemicals), and replace them with old cotton clothes or tight-fitting cotton jammies. A full post on that is coming soon. And here’s more information — including tips to avoid flame retardants — from Safer Chemicals, Healthy Families.

While it’s true that the California requirement is no longer on the books, many manufacturers will be slow to change their products, and there are state laws in many places requiring any public accommodations to purchase furniture containing flame retardant chemicals, as well as standards that require them in heavy doses in airplanes and children’s car seats. What we really need is chemical reform at the federal level to ensure that chemicals are tested thoroughly before we are all made into the guinea pigs of the chemical industry.

In the meantime, here’s my posts on this for folks new to the issue or blog:

Why “Let Them Eat Crap” Is Not the Answer to the Obesity Crisis

PolyfaceLast winter, I was invited to attend a nutrition class for low-income and disabled folks held by a local food bank, and I have not been able to write about it since.

But things have suddenly cleared up for me, and I know what I would like to say. I was jolted out of my confusion by a clumsy attempt in the Atlantic Monthly to blame Michael Pollan and his followers (e.g., people like me) for somehow retarding the junk food industry’s progress in creating better living through chemistry. You’ll see the connection in a moment, I promise.

First, the class. Although I went there intending to write an appreciative first-hand account of the food bank’s good work in the community, as I was watching the class, I grew increasingly (but quietly) disturbed. The lessons — and “lessons” they were — provided a short and painful tour through the arid world of what Michael Pollan has rightly criticized as “nutritionism” — dated concepts, an experience of food divorced from its cultural context, and not-so-subtle messages that the obese have only themselves and their poor choices to blame.

For someone like me who believes that environmental exposures like BPA can plausibly be linked to the dramatic rise in obesity, it was uncomfortable, and made only more so by my fast-developing allergy to all forms of fat shaming (which, as it turns out, is not such a great motivational tool after all. Shocker.).

The jury is really still out on the causes for the “obesity epidemic,” as a new brilliant article by David Berreby makes clear. When the public health folks finally lift nutrition sciences out of its squalling infancy, I doubt there will be enough accounting of the psychological harm done to millions of people — especially women — who have learned from the inescapable and constant nutrtition-y messages on “how to eat” and “what we should look like” to experience their own day-to-day through a lens of intermittent self-loathing and personal failure.

But back to the class: although the instructors were clearly well intentioned, well, we know where those lead. While I only got a snapshot of the overall curriculum from a single two-hour class, that session seemed obsessed with reducing fat, in a way that really has not been up-to-date, nutritionally, since at least the mid-90s. The lessons included a tediously detailed explanation of all the types of fats as well as, for one example, comparisons of the amount of dietary fats in low-fat versus regular dressings, exemplified by globby substances trapped in two test tubes that were dutifully passed around.

I was quietly horrified to contemplate how this lesson, should it be taken to heart, would drive class members to buy nasty-tasting, highly engineered, low-fat versions of dressings for their salads. Even the best bottled dressings, of course, are an oil and vinegar balance that requires chemical emulsifiers galore to keep the ingredients in suspension. Should one in fact choose to eat a healthy green salad, as the class was being cajoled to do, topping it with such gloppy coagulation would be enough to cure them of the impulse for quite some time. Not to mention that low-fat often means high-sugar, and almost certainly involves more laboratory than food.

The mostly minority, entirely low income, elderly and disabled class members handled it all with aplomb and grace, joking their way through an exercise in making unnecessarily sweet and complicated yogurt parfaits with layers of granola, yogurt and fruit preserves and gamely grinding up home-made hummus with tahini and canned chickpeas. (I, on the other hand, was childishly restless, wondering per the hummus: 1) um, how is this a “low-fat” food again? 2) why anyone bothering to go to the extraordinary trouble of making a readily available snack-dip wouldn’t use freshly cooked beans, so that they could taste the extra effort?)

In a side conversation while the “cooking” was going on, I learned that the elderly woman next to me, a grandmother of seven, was actually an accomplished and renowned cook among the group. She was on her way home after class to make an enormous batch of authentic Jamaican jerk chicken for the community’s party the following day, using her long-loved and reportedly delicious recipe, which I did manage to sweet-talk her into sharing with me. She should have taught the class, I muttered, sadly, to myself.

Why? Food as culture and as celebration. As the flavors of a people’s past, their ingenuity and history, their resources and adaptation. As a life-force and a gift.

Nutritionism does for the act of eating what Jazzercise did for dance: it sucks out the joy and narrative meaning and turns it into an exercise in forced jumping jacks rife with added potential for humiliation (remember the leotards we all wore?). In the same way, David Freedman’s antiseptic, condescending piece in the Atlantic Monthly is so caught up in his contempt for the arugula-eating food elitists allegedly swarming behind Michael Pollan, and so bought into an utterly simplistic and dated fat-avoidance strategy on obesity, that he misses the subject of food entirely.

His argument marshals so many straw men it’s like watching a parade of scarecrows traipsing through an Agribusiness cornfield: Whole Foods sells some junk food! Certain juice bar smoothies have a lot of calories! Pollan-ites have actually claimed that overpriced organic farmer’s market produce could feed the poor! His citations are almost entirely his own adventures in alternating healthier eateries with trips to MickeyDs. (He also repeatedly misuses “obesogenic,” a term with a rather specific definition, when what he really means is “fattening.”)

What he does get right is self-evident: of course it would be better if fast food purveyors started acting more responsibly and stopped marketing soda with sugar levels attuned to keep the most highly addicted users coming back for more. Of course it would be great if some portion of the marketing budgets of fast food companies went towards promoting healthier fare — though one has to question this given how Freedman rather mindlessly repeats standard industry lore concerning the flopped McLean.

Indeed, the pathetic stories about sneaking the fast food companies’ few health improvements into a small number of products make it seem uncannily like those moms who are so desperate for vegetables in their kids’ diets that they hide ground spinach in pancakes. But those moms, at least, are in the deception game on a temporary basis, until their child’s finickiness resolves or the kid goes off to college, whichever comes first.

On the other hand, if the fast food industry really can’t market healthier choices without turning off their customers, well, that’s a lot of sneakiness for marketing to conceal. A less enthusiastic cheerleader for industry than Freedman is might even see it as an upper bound — and not a high one — on the change that could come from that sector, especially given its historically keen interest in humdrum factors like profitability.

In the end, he makes the very mistake he accuses the Pollan-ites of making: he decides he knows what’s best for all of us, particularly the unwashed masses. “Let them eat crap,” Freedman says, while arrogantly, even angrily, prescribing what will work to change the eating habits of millions, because he knows what their problem is (too many fats and “bad” carbs) and he knows what they will eat (fast food). Problem solved.

Unfortunately for him, and despite publishing a book called “Food Rules,” Pollan is far more exploratory about which foods are best for us (though he does ask folks to, well, eat actual food). As I am an unrepentant devotee of Pollan’s, it just so happens that I recently finished his new book, Cooked, and it’s a far better read than Freedman’s screed.

Pollan’s latest tome is a love letter to the act of cooking, and to the historical, gustatory and communal aspects of food. The best passages in the book are the vivid descriptions of his adventures by the open-pit barbecue, his apprenticeship with a mistress of the braise, and his conversations with a spunky nun who dedicates herself to the art of traditional cheesemaking. There are a few recipes, and inspiring passages meant to open up the possibilities for your own kitchen, true, but nowhere does he suggest that we all need to turn our basements into cheese cellars, or that the ideas in the book are a policy solution to address, say, the crisis of poor nutrition afflicting children raised on fast food.

Instead, he proposes that cooking, and understanding the process and patience required to prepare foods, is a fundamental part of nourishing human connection in a family, or in a tribe, perhaps going back to the pre-historic period given the need to cook — and share — meat around a fire. Moreover, the very process of cooking or fermenting foods creates new substances in them, including flavanoids in aromatics like garlic and onions that ward off disease, or the biota that spring into existence in live yogurt and help to protect our gut.

More traditional modes of food preparation, as it turns out, may have benefits for health that we are only beginning to understand. It follows, sadly, that processed food is both microbially dead and likely incomplete: we can’t engineer nutritional components to add back into foods when we don’t even understand them, and much of how food operates for health is a mystery still grounded in a (beautiful) enigma.

Whatever is making us so sick since just the 1980s must be relatively new in our relationship with food. Yet I would wager we have yakked more about our health, as a species, over that same time period than for all of human history before: we have publishing empires dedicated to the latest news and trends on health and nutrition, and no shortage of advice on eating, health and (lord knows) body image. Despite all this, we are facing serious public health crises, many of which can be linked to food.

Perhaps we should spend less time and energy on prescribing how people should eat and spend more time making good food. We’ll likely figure out one day that the causes of our health challenges are both more surprising and more complex than we ever knew, and that the solutions were right in front of our mouth. In the no-duh category: yes, we should all, including me, exercise more regularly. And, sure, the big food companies have an important role to play, if they will do so.

But I can’t help feeling that Pollan is onto something compelling to both my stomach and soul, a practice essential for the act of being human and living more responsibility on this bountiful planet. Making time to make a decent braise — brown the meat, dice vegetables, brown them in the pan, add back the meat, the wine, the stock and herbs, and simmer for hours, while the house fills up with heavenly aroma — is a meditation on transformation just as Pollan promises. Food this slow becomes, in the cooking, an act of both respect and community.

And let’s give more credit where credit is due. Low-income people may be cash-strapped, but they also know good food. Listening more deeply to people who do this kind of cooking for their own communities — really getting the details down for how they make their particular heirloom recipe for delicious jerk chicken — well, it seems to me that beats either fast food or a nutrition class, every time.

Dinner.

Dinner.

###

I’m indebted to Tom Philpott of Mother Jones for his thoughtful replies to Freedman, including a half-hour radio debate, and for pointing me to the wonderful Berreby piece.

For the short ribs, I used this basic recipe, plus Pollan’s sound advice from the book. I poured in BioNaturae organic canned plum tomatoes from a BPA-free can, and short-cutted the laborious chopping process by leaving things chunky. I also added less salt and more stock than called for. Served over fried polenta.

Post-script:

A further note is required to reply to the unsubtle charges of elitism in Freedman’s article.

My personal perspective on food does play right into the hands of someone like Freedman, as my family prefers organic and beyond-organic foods, like the Polyface Farms beef in the photo. These foods are costly, there’s no two ways about it. And it’s more work, albeit pleasant work, to go to farmer’s markets, arrange for CSA deliveries or pick-ups, and to track down really fresh ingredients.

As I see it, we have the money to spend on these things, and we hope that our investment pays off, in part, by helping in a small way to generate more consumer demand at this end of the marketplace. Buying grass-fed beef is a luxury, certainly, but as far as luxury goods go, it feels more moral than most. We also buy less meat because of its higher price, and make it stretch further over a week.

It’s also the case that government subsidies for all the wrong kinds of commodities and farming practices keep some prices artificially low while smaller, multi-product farms suffer. So our purchase power is swimming upstream against some pretty powerful counter-pressures, making it all the more important to support the practices we prefer.

More importantly, the point about cooking — or even about anything you do for yourself — is that it builds an enduring skill, while making the best use of more wholesome ingredients. A bag of potatoes is still a far better use of a dollar than a bag of potato chips or a container of fast food fries. The costs are scalable to budget, and if more money comes along, you can always upgrade to, say, organic potatoes. Or try to grow your own in trash can (or better yet, wooden barrel), as I just saw on Pinterest.

After all, a drive in window asks nothing of us, while cooking is a valuable habit that must be acquired to make use of the world as it is. Freedman’s suggestion that our health problems can be solved if someone else will just fix (marginally) better food for us misses the point.

There’s a reason that the food industry has spent the last 20 years in the lab, manufacturing flavors, gums and additives and other substitutes to save itself the costs of actually feeding us. Taking back the power to feed ourselves real food affordably will require a considerable shift in government rules, consumer buying habits, and in our ability to take the time to cook and spend time with family. It will likely also require a raise in the minimum wage, better supports overall for families, and economic incentives for farmers to improve, rather than destroy, their local environment.

These changes may be hard to attain or even unattainable given the relentless economic pressures faced by so many families. But that’s a problem with the structure of our lives, and not just our food supply. It also, as it so happens, is the same problem the fast food companies have been profiting from for the past 30 years. The solution is unlikely to lie with them.

A Bodacious Valentine’s Day

Be still my heart
 (Photo credit: EraPhernalia Vintage)

Yesterday, in honor of V-day, I had the pleasure of attending a ground-breaking panel on boobies. Because this is 2013, when the subject of breasts arises, so to speak, the topic of breast cancer isn’t far behind.

The purpose of the gathering was to announce publication of an important new report that — really for the first time — sets out an agenda for prevention of breast cancer and points to the significance of environmental factors like chemicals, instead of focusing almost exclusively on treatment. The 200+ page report was the result of two years of work by a group of academics, advocates and government scientists called the Interagency Breast Cancer and Environmental Research Coordinating Committee. (Oddly, the link to the report is not working on the government Website. The New York Times coverage is here. Update: Link fixed!)

In 2012, more than 200,000 women and 2,000 men will be diagnosed with breast cancer, and 40,00 women will die from it. A large majority of breast cancer cases — some 85 percent — occur in women with no family history of breast cancer. We know that some environmentally widespread chemicals — including PFOAs, dioxin, the pesticide Atrazine, DDT, flame retardants, and hormone disruptors like Bisphenol-A (BPA) — are linked to breast cancer.

We also know — most recently from shocking and sad reporting by the Center for Public Interest (CPI) of a published, peer reviewed study of plastics auto suppliers and other workers in Ontario that there is very strong evidence linking acute exposures to plastics and chemicals to cancer rates: women working in the auto supplier and canning jobs had cancer rates of 5 times the control group.

Here’s CPI’s summary of the report’s list of chemical exposures related to breasts:

At least 216 chemicals, including endocrine-disrupting substances like bisphenol A, have been associated with mammary gland tumors in animals. Endocrine-disrupting chemicals, or EDCs, are used to make plastics and pesticides and found in products such as furniture, metal food cans and cosmetics.

Ergo, it would nothing short of dunderheaded to talk about preventing cancer without looking at environmental factors in the mix, alongside genetic, diet and other risk factors. We badly need the kind of paradigm shift the report tees up, as well as the focused attention on environmental risks from regulators and researchers that it recommends.

The arrow on this mammogram points to a small ...

The arrow on this mammogram points to a small cancerous lesion. (Photo credit: Wikipedia)

In honor of the holiday, let’s get back to knockers for a sec. On the panel, author and reporter Florence Williams returned our attention to the physical facts by pointing out a number of novel features that uniquely describe the twin wonders on a woman’s chest.

She pointed out that breasts are among the fattiest organs in the body and that many chemicals are drawn (like men) to these fatty tissues, that breasts are filled with hormone receptors, and that they change over the course of women’s lives as biologically needed. Williams called them, rightly, a “sentinel organ,” noting that what happens to our breasts is an early signal for our overall environment and health. (I picked up a copy of Williams’ book, “Breasts: A Natural and Unnatural History,” and am excited to read it because she tests the level of flame retardants in her own breast milk, among other unpleasant but informative discoveries.)

Jeanne Rizzo, head of the Breast Cancer Fund, spoke next and highlighted the fact that we know that there are critical stages — called windows of susceptibility — that impact life-time risk for breast cancer, beginning in utero, and that due to the emerging science of epi-genetics, it’s now clear that genes and the environment interact throughout our lives in a complex dance of possibilities. Her wonderful op-ed is also well worth a read. (It’s for this reason that I do think a focus on reducing environmental risks for pregnant women and young children is important, and that consumers need help in this area.)

Linda Birnbaum, the Director of the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH), and National Toxicology Program (NTP) was also powerful. I was particularly struck by her description of an ongoing “sister study” pairing women who are diagnosed with breast cancer with their sisters who have not been.

As she pointed out, we may have been over-emphasizing genetic factors when we see diseases linked in families, because although it’s true that they share genes, siblings also tend to share environmental influences. This study will attempt to distinguish genetic factors from the other shared conditions, including chemical exposure levels, thus helpfully sorting out what we can fix, given sufficient political will, from what we really can’t.

This got me thinking about obesity as another confounding factor in the research. We all know — and it was reiterated by panelists — that obesity is major risk factor for breast cancer, heart disease, and basically every other major health problem. Yet we also know that mice exposed to a teensy amount of BPA get much fatter than other mice. As Nicholas Kristof noted:

Among chemicals identified as obesogens are materials in plastics, canned food, agricultural chemicals, foam cushions and jet fuel.

They’re everywhere, in other words. Yet the national report on obesity a big government panel issued last year barely mentioned the issue, instead focusing its major recommendations entirely on nutrition and exercise. Ditto with the President’s “Let’s Move” action plan.

Now, I’m not disputing that healthy foods and regular activity likely play an important role in obesity. But, as Jeanne Rizzo said the founder of the Breast Fund Center asked about breast cancer, I would still ask why we are so much fatter now than we used to be, and why Americans, who have far more chemicals in their diet and environment, are so much heavier than Europeans, when we eat basically the same types of foods.

The staggering rate of increase in obesity should be another indicator. A recent report found that adult obesity rates could exceed 60 percent in 13 states by 2030, and that:

If states’ obesity rates continue on their current trajectories, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis could increase 10 times between 2010 and 2020—and double again by 2030.

Then there’s the stunning increase in childhood incidence of Type 2 diabetes. From a September 2012 article in the Times:

Before the 1990s, this form of diabetes was hardly ever seen in children….There were about 3,600 new cases a year from 2002 to 2005, the latest years for which data is available.

What has changed from before the 1990s until now? As a child of the 1970s and ’80s, I can tell you: our diets were no paragon of health. We ate junk food, nutrient-poor school lunches, and canned green beans, white rice and pork chops for dinner. We binged on Halloween candy while playing Atari for hours. But this disease was for the full decade of my adolescent decadence still virtually unknown in kids. In fact, we know a lot more about healthy eating and healthier foods are much more widely available today, yet we’re still in deep trouble.

Researchers are basically at a loss to explain the obesity increase, as in this comically uninformative paper where they more or less throw in the towel. Could it be, instead, that the ubiquitous chemicals, drugs and fillers in food and industrial agriculture, along with the plastics that package virtually all of our foods, are at least in part to blame? That cheap calories from a degraded and ever-more industrialized food supply — eaten by people across the socioeconomic spectrum — come at a very high cost? What are those fat mice trying to tell us?

As in the breast cancer sister study, when we treat obesity as an inert risk factor — “don’t get fat, you!” — we are missing an opportunity to shift the paradigm to environmental health factors and instead substituting a far less helpful blame-the-victim mentality.

We should not fail to acknowledge obesogens may be a confounding factor in the data — that the same people who are obese are more likely to get breast cancer because the cause of both conditions could be related to the same chemical exposures (or chemical-epigenetic interactions that reflect a sensitivity to environmental influences). If it turns out this is right, and chemicals are a major factor in all of these kinds of health conditions, then the solutions are also shared, and the public health costs of inaction virtually incalculable.

Please don’t misunderstand me. I care deeply about preventing breast cancer, having seen its terrible toll on close family friends. And I am so excited for the publication of this major report that talks clearly and for the first time about the impact of chemicals on cancer rates, though I wish there was a least a small section on consumer can-dos, to counteract the doom and gloom.

But we also must be uncompromising as we outline the possible damage from toxins, and push this powerful new paradigm to its logical conclusions. To meaningfully address a host of public health threats, we will need one day soon to take the full measure of what our ongoing, uncontrolled experimentation with biology-altering chemicals has actually accomplished, in both our bodies and our brave, sentinel breasts.

Breast cancer. Image made by Itayba

Breast cancer. Image made by Itayba (Photo credit: Wikipedia)

Does Extended Bottle-Feeding Really Cause Obesity?

Obesity Campaign Poster

Obesity Campaign Poster (Photo credit: Pressbound)

At 21 months, Maya still really likes hitting the bottle. It’s a ritual — the first bottle of the morning — and a request as soon as I get home from work. She sits on my lap, we cuddle, and she relaxes a bit, her body getting softer and less tense. In the evenings, I don’t give her much milk because it will ruin her dinner. We both know it’s just the pose that matters, and the snuggles that are part of that nice, quiet pause.

So of course I was immediately concerned and even a bit perturbed when my pediatrician rather abruptly told me at our last visit to stop using bottles “cold turkey” because their use is linked to obesity. Her less-than-insightful suggestion was to just get rid of all our bottles at once, and thereby make it physically impossible for Maya to keep using one. At the time, I should have asked her if she wanted to come visit for that little period of self-inflicted hell, even if just to explain to my daughter that we are only depriving her of this small comfort in order to make sure she won’t eventually become overweight.

Regardless of her apparent cluelessness about the importance of easing children into changes in their lives, I had to take seriously the problem she raised about bottles. So I went and read what I could about the study linking bottle usage to obesity (the actual text of the study is $31, and IMHO, not such a good investment).

The study, from the Journal of Pediatrics in May of last year, made headlines at the time that carried its message, including articles titled like this one: “To Avoid Adult Obesity Stop Bottle-Feeding at 18 Months,” from Medical News Today, which intoned darkly:

If you want to reduce your baby’s chances of becoming an obese adult you should not continue bottle-feeding him/her beyond 12 to 18 months.

Who wants a fat kid, really? Or this one, from U.S. News, “Prolonged Bottle Feeding Boosts Kids’ Obesity Risk,” which begins:

Nearly one-quarter of 2-year-old bottle feeders were obese at age 5, researchers say.

Well, I suppose that’s clear enough. But what did the research really say? Here’s more detail from the abstract:

Data from the Early Childhood Longitudinal Study, Birth Cohort were analyzed for 6750 US children born in 2001. The outcome was obesity (body mass index ≥95th percentile) at 5.5 years, and the exposure was parental report of the child using a bottle at 24 months. The prevalence of obesity at 5.5 years was 17.6%, and 22.3% of children were using a bottle at 24 months. The prevalence of obesity at 5.5 years was 22.9% (95% CI, 19.4% to 26.4%) in children who at 24 months were using a bottle and was 16.1% (95% CI, 14.9% to 17.3%) in children who were not.

Prolonged bottle use was associated with an increased risk of obesity at 5.5 years (OR, 1.33; 95% CI, 1.05 to 1.68) after controlling for potential confounding variables (sociodemographic characteristics, maternal obesity, maternal smoking, breastfeeding, age of introduction of solid foods, screen-viewing time, and the child’s weight status at birth and at 9 months of age). [Emphasis added.]

I’m struck by several things right off the bat. First, although nearly 23 percent of bottle-feeders were obese at the age of 5 1/2, 16 percent of the rest of the population (i.e., not bottle users) also were, which is only a 7 point difference (though it’s true that the association appears to hold at this level of the analysis).

Second, the sample size is on the small side in terms of who’s left — i.e., 22 percent of the sample used a bottle, 23 percent of whom ended up overweight. That’s a total of 341 kids. If we subtract out the 16 percent that is the general rate of obesity in the remaining population, we’re down to 55 kids whose habits and body weight are driving the conclusions (because they make up that 7-percent spread). The authors say that is a statistically significant number, though, so let’s look at their assumptions more closely.

They used a data set with limited inputs, to be sure. The first glaring omission is that the study did not account for what was in the bottles. Apple juice, for example, does not fill the stomach the way that milk does, and it creates a taste for sugary drinks in children, making it easy to consume to excess. It also contains a significant number of calories (117 per cup).

Whole milk, on the other hand, may be higher in calories, but offers a host of essential fats, vitamins and calcium. It is harder (though certainly not impossible) to over-consume because it is both filling and satisfying. Water, obviously, has no calories.

Formula, much of which is loaded with sugars that stimulate appetite, unsurprisingly is also linked in previous studies to obesity. Researchers here indicate they controlled for breastfeeding as a variable. But the formula versus breastfeeding research is complicated by studies that show bottle-fed infants gain more weight even if the bottles contain breastmilk, meaning that merely controlling for breastfeeding may not be enough.

Given that children are frequently given juices (or even worse beverages like Kool-Aid) to drink, and the small number of families whose habits are driving the conclusions, this seems like an important caveat to the findings, and one that was notably missing from the official conclusion or from the reported coverage of the study.

Instead, the authors publicly suggest the opposite, as here, where one of them claims that the study accounted for “feeding practices during infancy.” Um, I don’t think so. The two variables “age of introduction of solid foods,” and “breastfeeding” are certainly tangentially related to overall infant feeding habits (and perhaps, health), but when a study is attempting to measure the impact of bottle-feeding, controlling for the contents of that bottle strike me, at least, as one of the more important variables to be included in the equation. After all, what a child is actually consuming has just got to be more important than whether it’s being delivered by bottle or cup.

In USA Today’s piece on the article, another expert is quoted on the need to cease bottle use:

“Drinking your calories may not be as filling as eating them,” says Jennifer Shu, a pediatrician in Atlanta and the editor of HealthyChildren.org, a consumer website of the pediatrics academy. “That’s where the obesity problem comes in. It’s so easy to drink the calories, but people often are still going to eat the same amount of food.”

This argument seemed reasonable to me at first glance, but actually doesn’t really hold up. Certainly, the regular visits I made to Jamba Juice during law school likely explain why my exercise regimen at the time yielded disappointingly paltry results. Yet I don’t observe that Maya eats the same amount of food if she is full from a bottle — in fact, I worry that milk will displace other calories because she won’t be hungry, and so we limit the amounts she can drink around meals.

And all this likely misses the point. Above, Shu appears to suggest that children will, in a sense, over-drink (or over-eat because they drank too much). But so long as what children are drinking is good for them, and they are drinking and eating solid foods in the right balance, it seems to me that we wouldn’t want them to drink less. In other words, if the issue is amount, what should it matter if the drink comes from a bottle or cup? Again, parental monitoring of what is consumed, and how much, should matter far more.

Two mice; the mouse on the left has more fat s...

Two mice; the mouse on the left has more fat stores than the mouse on the right. (Photo credit: Wikipedia)

Second, the study variables omit consideration of the kind of bottle being used, whether glass or plastic. Before you think I’ve gone off the deep-end on this one, consider that studies have shown that Bisphenol-A (BPA) likely plays a significant role in obesity, both by making our bodies produce insulin as though we are consuming twice the calories we actually are, and by helping to flip a genetic switch that predisposes us to be fat.

The study’s data-set spans from 2001 to 2006, a period in which most parents were unaware of the pernicious BPA-in-baby-bottles issue and most bottles still had BPA in them, and in which plastic bottles were the norm, as they still are today. It would need far more study, of course, but in my view it’s at least possible that this is yet another instance of a simplistic analysis of behavioral factors that leaves the possibility of harmful chemical influences utterly undiagnosed.

Third, the authors’ recommendations fail to account for countervailing values in child development that may lead some families and children to benefit from extended bottle use, at least as part of their repertoire. Here’s how one of them breezily put it in an article on the study:

Rachel Gooze [] notes that weaning children from the bottle by the time they are 1 year of age is unlikely to cause harm and may prevent obesity. The authors suggest that pediatricians and other health professionals work with parents to find acceptable solutions for stopping bottle use at the child’s first birthday.

Yet research unequivocally shows that strong bonding with caregivers and relaxation (i.e., low anxiety) is essential to healthy brain development, particularly in young children ages 0 to 3 years. While extended use of a bottle is certainly not an essential part of creating these bonds and a relaxing atmosphere, the act of feeding a child is intrinsically a nurturing moment, and so it may not be irrelevant either. The researchers should have at least considered the possible downsides here.

For our family, Maya never breastfed (which is another story entirely), and so our bonding over a bottle has replaced a rather fundamental missing piece. I’m not eager to let this go based on one study showing she could, maybe, have a slightly greater chance of being obese four years from now, especially given the care and intention I take with her overall diet and the monitoring we do generally of her health, including her weight.

Obesity Campaign Poster

Obesity Campaign Poster (Photo credit: Pressbound)

For example, back on what goes into the bottle (and the baby), Maya almost never has juice, or really concentrated sugar of any kind, including the supposedly “kid-friendly” (non)foods: fruit leather, sweetened yogurt or those mushy fruit slurries in suck-down containers. (I’ll write a post on the re-joined debate over sugar and it’s impact on the body soon.)

If continuing to use a bottle appeared to be causing cavities or hampering her speech development, that would be another issue entirely, and is a legitimate concern raised by dentists (those sugary beverages again) and speech pathologists. In Maya’s case, she now has (I would guess) about 300 words and more every day. She’s also never been very interested in a pacifier or thumb-sucking, either of which can also be a speech development blocker. Moreover, she eats a wide variety of fruits, proteins and vegetables, uses both sippy cups and regular cups, and is learning to use a straw, pursuant to the advice of speech experts.

The bottle is merely a respite from these other ways for her to drink, and I assume will drop away sometime when she’s moved beyond the need for that to be our daily form of checking in. If not, we’ll ease it out of use and replace it with another important bonding ritual we can invent.

In the end, I’m unconvinced by this study, and disappointed that both my pediatrician and the mainstream press appear to have taken its limited data and recommendations as gospel. Clinical advice from most doctors rarely seems to take account of the havoc that would be wreaked on families’ emotional lives by following their rigid approach. And the discourse around the obesity issue has reached such a fever pitch that, as parents, it seems we’re now in a position, essentially, to be bossed around by experts on “slim” evidence indeed.

I hope that parents think through the issue for themselves before feeling guilted into suddenly dropping the bottle, at least based only on this latest — and in my view rather dubious — pronouncement.

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How does your family come down on this issue? Am I just making up excuses because I don’t want to face the music (or really, screaming)?

Did I miss something important about the study or its implications? Or do you agree with me that this is just another in a too-long line of simplistic anti-obesity messages that fail to grapple with the real issues?

My Daughter Will Be Fine. How’s Yours?

Preschool

Preschool (Photo credit: Wikipedia)

Like an inversion of Project Runway, we were “out,” but now we’re “in.” This week, we learned that Maya could move off the wait list into a spot for the neighborhood’s co-op preschool, which only takes 12 children in her age group.

We were thrilled by this, obviously. The Co-op is close to our house and follows a Reggio-inspired curriculum, with a ton of fantastic literature, music and art.

Of course, getting in, as random as it was (a family is moving), also made us officially feel like Good Parents. We had checked the boxes, found the right school, gotten a babysitter, attended the two information sessions, submitted the application and the check. And, with perseverance and luck, we did it! At 20 months, our daughter is now on the Road to Success. (And we will have ample chance to prove our dedication to the model, as the co-op’s parental contributions are no joke.)

As ridiculous as this seems, for achievement-oriented parents, such ability to deliver the goods does feel, truthfully, like at least one important measure of how well we are doing.  It’s a lot of pressure to put on parents when really terrific resources are scarce, and makes parenting into a far more competitive sport than it should be.

When we were on the “outs,” I’ll admit to feeling a mild despair, along with the exhaustion of having to look around for a suitable alternative. We’d visited several other preschools over the past year, none to our liking. I had also been compiling a mental list of back-ups, including the local Waldorf school, and the Audubon Society’s preschool that I blogged about last week (which is lovely, but not that close to us).

The lack of really strong preschool options stunned me, actually, as we began this search. And it’s a sad statement, really, of how we have not updated our educational systems to take full account of the research, which, for more than 20 years, has pointed unequivocally to preschool (and pre-preschool) learning and environment as the foundation for educational attainment for kids.

For just a few examples, we now know that:

Contrast that with the bad news on this front that I heard on the radio in just the past few days: DC high schools fail to graduate (on-time) 60 percent (!!) of students. And Marketplace, a show I normally loathe for its pro-market bias and triviality, ran a decent series this week on projects happening around the country, some financially doomed, to engage low-income children in learning earlier in order to close educational gaps.

Along with everyone else, I’ve also followed the work in Harlem of Geoffrey Canada in creating the Harlem Children’s Zone. (I recommend the book by Paul Tough describing his efforts, “Whatever It Takes” which is a fascinating read.) Canada set up a system for students that was intended to provide the safety. security and growth of a suburban upbringing. As Tough writes, his supports are “designed to mimic the often-invisible cocoon of support and nurturance that follows middle-class and upper-middle-class kids through their childhoods.”

One of Canada’s many key innovations was his recognition that parenting classes – for parents of newborns – and access to high-quality preschool programming, would make kids far more ready to attend school, and would create the building blocks for success even among very low-income families with lower educational levels among the parents.

Canada’s pioneering work has been successful in moving children to become academic successes. And he’s been at it for almost a decade. What’s really amazing is that his set of comprehensive tools, commonsense as it is, and his focus on the critical period of infancy and early childhood, remain largely disregarded in practice elsewhere in the country.

There isn’t the money, nor is there the political commitment, to ensure that every child in America gets a learning-friendly environment at home, and that every child attends a quality preschool. In fact, the new budget fight being waged this week by Rep. Paul Ryan (R.-Wis.) would slash and burn supports for low-income families in order to pay for military spending, which is just sickening, really. According to Rep. Chris Van Hollen (D.-Md), a report by the Congressional Budget Office “found some 22 million households with children would lose aid to buy food, 300,000 children would be cut from school lunch programs, and 300,000 children would lose health insurance under the House plan.” To pay for bombers, literally. It’s like a bad joke on a bumper sticker.

In short, we have a long fight ahead of us. But the costs of not doing this are astronomical, both as measured in the quality of children’s lives and in the social and economic price.

Of course, if Maya had not gotten into our preferred school, there would have been another preschool, perhaps less convenient or ideal, but still high quality. And her home environment is nurturing in every way I know to make it, based on both my reading and on how my parents raised me.  Put that with the quality of the food she eats and my persistent (albeit quirky) efforts to provide a healthy environment for her, and the advantages compound quickly.

But even as I do what it takes to ensure her health and growth, I also recognize that for every child like Maya, many more children lack basic things, like enough food to eat, or a caring and attentive adult in their lives. (Case in point: I once spent several days sweeping broken glass and wires out of a DC elementary school classroom, helping to get it ready for a teacher friend. The computers given to the school by some foundation were being used as doorstops, because there was no one that could be spared to maintain a network and lab.)

When you have a child, and must engage in the current, demanding contest for resources directly on their behalf, these sharp distinctions become far more real. And it’s far too easy to “get yours” and move on, being happy because this time, you happen to be on the list instead of off.

But if all the more resource-rich parents merely wangle a way for their family, it will never create the urgency we need for change on a much more fundamental level. Simply put, it’s clear that we will never address the underlying causes of poverty unless we take far more seriously what we must do to provide a strong foundation for very young children, from infancy through kindergarten.

We’re falling far short now, both on addressing poverty and on challenging families to do what they can to develop strong foundations in early childhood. Almost one-third of children 2 and under have television sets in their bedrooms. In their rooms! Which makes them more sedentary and emotionally stunted, studies show. And a shocking one-half of preschool-age children do not get a chance to be outside and play daily, meaning that some of that mental mapping is just … missing. Combine that with the chemicals and sugar in children’s foods and it’s easy to see where the obesity epidemic is coming from.

(And I think the official explanations on this point are facile: chemicals likely play a much larger role than anyone is admitting. The Institute of Medicine’s report this week on childhood obesity focuses on diet and exercise, but fails to explain why those factors alone could possibly be enough to cause Type 2 diabetes in children to go from ZERO in the 1970s to far too common today. Having grown up in the 70s, I remember kids eating a lot of Little Debbie snackcakes while watching Three’s Company all afternoon. If those kids didn’t have diabetes, I’ll submit that there must be something more to it.)

To my larger point on early childhood: perhaps it’s hubris, but I can tell you right now, sitting here today, I firmly believe that Maya will be fine. (Or at least as “fine” as someone can be with nutjobs like us for parents.) But that doesn’t mean I’m ok letting all the other two-year-olds who didn’t make the list, or, more likely, weren’t on any list, just watch TV, inside, eating crap, instead of playing outside and attending a really good preschool that will make them into the kind of kids who will be good pals to Maya and help me cross the street in my old age.

It’s as though the project we all started more than a hundred years ago – this task of publicly educating children – remains half-done. What we now know is that the period before kindergarten is just as critical, and may be even more critical, to a child’s success in life than the time after.

So why isn’t there more urgency on this question? There should be a school like our Co-op on every other corner – so many that there aren’t any lists to get in. And if government funds are needed to make it happen, this modest investment would likely pay for itself many times over, in more productive and valuable workers, artists, and innovators (and fewer prison cells).

Sure, most parents want the best for their children. But there’s a lot stacked against their ability to deliver nurturing and challenging opportunities. What I take away from our own relief at now, as of this week only, being on the “inside” of a good preschool for our daughter, is that what we really need is for parents – and the politicians they vote for – to want the best for every child.

How do we get there? I’m eager to hear your thoughts and ideas…