The Infant Feeding Survey 2023 (IFS) for England is underway. Surveys are being sent out to 20,000 mothers randomly selected from those who gave birth this summer. The DHSC have commissioned Ipsos to run the survey.

What is the survey about?

The aim of the survey is to understand more about how mothers in England feed their babies and will provide information on infant feeding behaviours and related factors including:

• Internationally comparable data on prevalence and duration of breastfeeding

• The use of foods and drinks other than breastmilk in infancy

• Infant feeding help and information received by mothers

• Information about bottle and breast feeding in public places

• Parental leave, return to work, working hours and facilities provided for expressing and storing breastmilk, or breastfeeding at work

It has been 13 years since the last survey and this new data will provide vital insights into the infant feeding decisions parents are making today. It will also give a much needed evidence base for policy and practice and will facilitate the monitoring of progress towards achieving improved breastfeeding prevalence and duration in England.

The DHSC wish to raise awareness among potential survey participants and also ensure that health professionals and volunteers working with new mothers are aware of the survey and have requested that stakeholders support them in this by sharing the OHID X/Twitter and DHSC Facebook posts with their networks.

Latest National Childhood Measurement Programme (NCMP) data from England show a mixed picture

Published on 19 October, this data shows:

• An encouraging positive trend for prevalence of obesity in Reception children, with a decrease from 10.1% in 2021/22 to 9.2% in 2022/23, which is lower than in 2018/19 and 2019/20.

• The prevalence of obesity in Year 6 children also decreased from 23.4% in 2021/22 to 22.7% in 2022/23, but this is still higher than in 2018/19 and 2019/20.

• However, there are still huge inequalities in terms of deprivation and ethnicity. For Reception children living in the most deprived areas the prevalence of obesity was 12.4%, compared with 5.8% of those living in the least deprived areas. Black children have the highest rates of overweight and obesity whilst Asian children have the highest rates of underweight. 

• Of huge concern, underweight prevalence in Year 6 children has increased from 1.5% in 2021/22 to 1.6% in 2022/23 and is the highest recorded rate in NCMP, since 2009/10.

This mixed picture highlights the importance of Government action both to prevent overweight and obesity from the start of life (see recommendations in our 2019 report “Enabling children to be a healthy weight: What we need to do better in the first 1,000 days”) AND to ensure reliable and equitable access to healthy diets based on unprocessed and minimally processed foods, particularly given the ongoing cost of living crisis (see recommendations in our 2023 briefing “What the Cost of Living Crisis means for the diets of infants and young children and recommended actions Updated: May 2023”).  

New parliamentary briefing: Impact of ultra-processed food on children’s health

Baroness Jenkin led a short debate in the House of Lords on 24th October, to ask the government what assessment it has made of the impact of ultra-processed foods on children’s health; read the full transcript here (the opening and closing sections of Baronness Jenkin’s speech are shown below). Preceding the debate, the House of Lords published a new parliamentary briefing. Both the debate and the briefing reference our report on Ultra-Processed Foods marketed for infants and young children in the UK.

In the UK, current Government policy to tackle diet-related ill-health focuses on specific nutrients, aiming to reduce salt, saturated fats and sugar consumption. This policy approach is supported by SACN, whose recent position statement on processed foods and health stated that evidence regarding ultra-processed foods should be treated with caution.

The parliamentary briefing and several participants in the debate questioned the appropriateness of the current nutrient-focused strategy, particularly with respect to children's health. However, and despite evidence that the association between diets rich in UPFs and ill-health persists when the nutrient profile is taken into account (as explained on page 42 of our report), the closing remarks of the debate by Lord Markham (Parliamentary Under Secretary of State for Health and Social Care) continue to suggest that re-formulation is the key to solving the health harms of UPF dominated diets: “Mostly importantly of all…the real prize of course is the reformulation of food”.

We welcomed this debate on the impact of ultra-processed foods on children’s health, recognising the critical role that Governments must play in improving the food environment for parents and carers with infants and young children. We will continue to advocate that dietary recommendations and policies put a special emphasis on making sure that all families can reliably access minimally and unprocessed foods that are known to support optimal nutrition and health. More information on our specific policy recommendations listed below can be found in our report here.

Our suite of (free to access) Eating Well resources provide practical guidance on how to meet nutrient recommendations from pregnancy to age 5, by eating diets based on unprocessed and minimally processed foods. 

New paper: Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait

On 9th October, a review on ultra-processed foods and cardiometabolic health was published in the BMJ, to answer the question ‘do we have enough evidence to take concrete action on ultra-processed foods from a government policy and public health standpoint?’ This is a particularly pertinent question for infants and young children in the UK, where there are currently no policies directly addressing ultra-processed foods, despite the fact that they make a significant contribution to the diet, as described in our recent report on ultra-processed foods in the diets of infants and young children.

The review outlines more than 70 epidemiological studies, published since 2015, that have consistently observed that consuming ultra-processed foods is linked with weight gain and increased risk of cardiometabolic conditions. Based on the available evidence, and studies that explain how ultra-processed foods could drive adverse health effects beyond their nutrient profile, the authors conclude that public health measures to reduce population level exposure to ultra-processed foods are justified. The review also includes nine studies in children or adolescents and six in pregnant women which show that a high intake of ultra-processed foods during childhood was linked to higher levels of cholesterol as well as adiposity, and that a high intake of ultra-processed foods during pregnancy is linked to a higher rate of gestational weight gain and blood sugar levels. We believe this evidence warrants specific policy actions to reduce exposure to ultra-processed foods during pregnancy and the early years, as per our recommendations above.

The authors identify practical challenges in regulating ultra-processed foods, including that the term UPF comprises a large and heterogeneous group of products, each of which may have a different impact on health and that national and international regulatory agencies currently authorise many UPF-markers, such as sweeteners and emulsifiers, as safe using toxicology studies. This highlights the importance of policy solutions that focus on reducing the contribution that UPFs make to the overall diet and studies to assess the cumulative intake of UPF-markers on health, and not focussing on individual foods.

The review concludes with policy recommendations to support a dietary shift away from ultra-processed foods throughout the population. Actions that encourage individuals to identify and limit their consumption of ultra-processed foods would have limited impact in the current UK food environment due to inappropriate and misleading marketing and the limitations in access to minimally and unprocessed foods for some groups, particularly in the current context. However, we support the authors recommendations to transform the current food system using fiscal measures, marketing and labelling regulations, developed without industry involvement or commercial conflicts of interest.

New paper: Non-sugar sweeteners: helpful or harmful? The challenge of developing intake recommendations with the available research

Non-sugar sweeteners (NSS) are consumed by many children from a young age. For example, as we highlighted in our 2019 report “Sweet enough already? Artificial sweeteners in the diets of young children in the UK”, 65% of 1.5-3 year olds in the UK drink low calorie soft drinks, and drink, on average, the equivalent of a whole can each day.

In May 2023 the WHO issued guidelines advising against the use of non-sugar sweeteners for the prevention of non-communicable disease, despite the evidence on the health effects of NSS being considered uncertain. Read more on this in our May newsletter.

In June, the UK Scientific Advisory Committee opted not to advise immediate action to reduce sweetener consumption, but proposed further scrutinising the WHO report. Read more on this in our July newsletter. This means that at present there remains a lack of clear public health guidance in the UK on NSS use among pregnant women and children in their early years.

This paper published in the BMJ earlier this month, sought to review current evidence on non-sugar sweeteners to determine whether they are helpful or harmful. The authors conclude that current evidence on non-sugar sweetener intake is inadequate, and further research is needed to determine their health effects especially in specific population subgroups, including children and those who are pregnant or breastfeeding. The study discusses how, despite epidemiological studies suggesting that early-life exposure to NSS is associated with elevated body fat and cardiometabolic risk factors, existing research on NSS intakes among children is insufficient. However, due to their increased relative exposure in terms of intake per kilogramme of body weight and their ongoing development, children are more vulnerable to the effects of NSS. The authors also highlight the need for further research on NSS use among pregnant women, as evidence shows that NSS are transferred through amniotic fluid and breast milk. This has potential consequences for development of infant taste preferences, lifelong dietary patterns, and metabolic risk factors.

Despite acknowledging the lack of evidence and the need for more research, importantly, the report reaches the same view we did in 2019, which WHO also adopt in their guidelines:

“…the precautionary principle should be applied, which emphasises caution in the absence of conclusive scientific evidence, particularly regarding use in specific populations, such as pregnant and lactating women, young children, and those with diabetes. This is particularly important because evidence of potential harm exists; and, as highlighted in the WHO guideline, non-sugar sweeteners are not essential dietary components”.

We have shared this paper with the SACN secretariat and look forward to the outcome of their scrutiny of the WHO report. 

You can find out more about artificial sweeteners in the diets of infants and young children in the UK here.

New research: Breastfeeding rates in England during the Covid-19 pandemic and the previous decade: Analysis of national surveys and routine data

This paper was published in October 2023 by Maria Quigley and colleagues. It compares breastfeeding rates in England during and after the pandemic using data from the National Maternity Surveys (NMS) from 2018 and 2020. The prevalence of breastfeeding initiation and ‘any’ breastfeeding and exclusive breastfeeding (EBF) at 6 weeks and 6 months were compared and the data was then interpreted in the context of underlying trends in prevalence from previous NMS from 2010 and 2014 and annual routine data for England from 2009/2010-2020/2021. 


How did breastfeeding rates compare pre-pandemic and during the pandemic?

According to the NMS and routine data, breastfeeding initiation and any breastfeeding remained relatively constant (initiation 85%; any breastfeeding 64% pre-pandemic and 64.6% during the pandemic), although rates were consistently higher in the NMS than the routine data.

Giving birth during the pandemic was associated with a small decrease in EBF at 6-8 weeks in the routine data which was consistent with year-on-year fluctuations, whereas EBF at 6 weeks declined by 3% in the NMS. In contrast, giving birth during the pandemic was associated with a 3% increase in any breastfeeding at 6 months in the NMS data – unfortunately there were no comparison data at 6 months from previous NMS or routine data to confirm or refute this finding.

Routine data collected in Wales, Scotland and Northern Ireland indicate a similar pattern of no marked changes in breastfeeding prevalence resulting from the pandemic.

The authors offer two possible explanations for the lack of substantial change to breastfeeding trends observed during the pandemic. Firstly, some of the negative aspects of the pandemic may have been offset by other aspects that facilitated breastfeeding, such as women having more uninterrupted time at home; partners may have been around more and for longer and working from home may have facilitated ongoing breastfeeding. The second explanation may be that although there was a reduction in in-person breastfeeding support, some women may have been more likely to receive ‘remote’ support which has the advantage of being easier to access and available ‘out of hours’.


Did inequalities in breastfeeding increase during the pandemic?

The small changes observed between pre-pandemic and pandemic NMS data were broadly similar across the sociodemographic factors examined, indicating that existing inequalities did not increase disproportionately during the pandemic. The strongest sociodemographic determinants of not initiating breastfeeding or shorter duration of breastfeeding were young age, having lower levels of education, living in a deprived area, White British ethnicity and being born in the UK. The authors recommend that services should continue to aim to reduce the stark and persistent inequalities in breastfeeding that have been documented since the 1970s. They also highlight that whilst the number of women who breastfed changed very little during the pandemic, the numbers do not necessarily reflect quality of care of breastfeeding experiences more generally .

New guidelines: WHO Guideline for complementary feeding of infants and young children 6-23 months of age

On 16 October 2023, the World Health Organization (WHO) shared its revised Guideline complementary feeding of infants and young children 6-23 months of age. This guideline provides global, normative evidence-based recommendations on complementary feeding of infants and young children 6–23 months of age living in low, middle- and high-income countries. It considers the needs of both breastfed and non-breastfed children. The guideline supersedes the earlier Guiding Principles for Complementary Feeding of the Breastfed Child and Guiding principles for feeding non-breastfed children 6-24 months of age. The guideline is intended for use by a wide audience, including policy-makers, and technical and programme staff at government institutions and organizations involved in the design, implementation and scaling of programmes for infant and young child feeding. They may also be used by caregivers, health-care professionals, clinicians, academic and research institutions, and training institutions.

Key points of note:

• The age of introduction of complementary foods remains at 6 months.

• Follow-up formulas are not recommended after 12 months (i.e., products marketed in the UK as growing-up or toddler milks).

• The review of evidence recognised that children are consuming “increasing amounts of unhealthy foods and beverages, often referred to as highly processed or ultra-processed, that contain high amounts of free sugars, salt, and unhealthy fats such as saturated fats and trans fats” and that consumption of ultra-processed foods in children is associated with higher BMIs and higher fat mass.

Baby Feeding Law Group UK news

Department of Health and Social Care (DHSC) Consultation submissions

The BFLG-UK submitted responses to the following two DHSC Consultations:

• The consultation on the disclosure of industry payments to the healthcare sector response was submitted on 16 October 2023 and it is available here.

•  The consultation on nutrition and health claims on food response was submitted on 31 October 2023 and it is available here. 

For more information about the Baby Feeding Law Group UK please visit our website Baby Feeding Law Group UK (bflg-uk.org) and sign up to our twitter account @BflgUk. You can also email katie@firststepsnutrition.org

Forthcoming

Deadline for abstracts for World Public Health Nutrition Association Conference 2024: Monday 20 November 2023

The World Public Health Nutrition Association (WPHNA) Conference will be taking place from 10-13 June 2024 in London, at the University of Westminster.

The closing date for submission of abstracts has been further extended to Monday 20 November 2023 and more information is available here.

Shared Learning Webinar: Developing the ‘Breastfeeding Collective’: Coproduction and partnership working, Thursday 30 November 2023 

Small Steps Big Changes (SSBC) will be hosting a shared learning event on Thursday 30 November 2023 from 10:00-11:30 which aims to share knowledge gained through the ‘Feed Your Way’ public health campaign. The aim of this campaign has been to transform Nottingham into a “breastfeeding-friendly city”. The campaign has already developed some wonderful resources that can be downloaded and used (by health care workers, breastfeeding families and community members) to support breastfeeding in communities.

The webinar will also be an effort to frame infant feeding as a civil issue, to share how you can further promote breastfeeding as well as what success looks like in the breastfeeding agenda. The organisers suggest this is also an opportunity to form the ‘Breastfeeding Collective’ by reflecting on the next steps required to create breast/chest-feeding friendly cities in other areas and discuss the role that various stakeholders can take in this. You can register here.

iHV Leadership Conference: Wednesday 6 December 2023