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Welcome to the November edition of our newsletter
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News
Infant milk news
BFLG-UK news
Forthcoming
HR Update
Happy reading!
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Latest childhood obesity data: release of NCMP 2023/2024 academic year
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The National Childhood Measurement Programme Data for the school year 2023/24 was published on Tuesday 5 November. While there is a general trend of improvement for year 6 children, the opposite is the case for 4-5 year olds.
These are the overall stats for reception:
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Key findings include:
The prevalence of obesity in Reception children increased from 9.2% in 2022/23 to 9.6% in 2023/24. This is lower than in 2019/20, but similar to 2018/19.
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For children living in the most deprived areas, obesity prevalence was over twice as high compared with those living in the least deprived areas. For Reception children living in the most deprived areas the prevalence of obesity was 12.9%, compared with 6.0% of those living in the least deprived areas. There is a widening gap in obesity prevalence between least and most deprived areas.
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We will continue our advocacy with Government to prioritise actions in the early years to enable all babies to eat well from the start of life.
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Autumn budget: reflections from an early years nutrition perspective
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The budget was released on 30 October with some welcome commitments that will help address poverty and pressures on the NHS, but, not nearly enough to meet the Government’s pledges relating to ending reliance on food banks and ensuring the healthiest generation of children ever. And, despite the apparent rhetoric on ‘meaningful prevention’, there was a notable absence of any announcement on the public health grant. Our asks - which have not been addressed (with the exception of a commitment to look at extending the soft drinks levy to milk drinks and plant-based alternatives) - are here. The Food Foundation’s reactions are well worth a read, see here and here.
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New House of Lords inquiry report: Recipe for health: a plan to fix our broken food system
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This report was published on 24 October to overwhelming positive reaction from public health and food system advocates. It is the outcome of an inquiry into the role of ultra-processed foods (UPF) and foods high in fat, salt and sugar (HFSS) in driving ill-health and obesity, in to which our Director Vicky gave oral and written evidence.
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We strongly agree with the report’s findings and recommendations aimed at Government and the food industry, especially those seeking to better enable babies and young children to eat well from the start of life. Most align with those that we called for, and include:
- Regulating commercial baby/toddler food composition and marketing, and discretionary formula milk marketing (including upgrading UK laws in line with the Code)
- Necessary to stop parents/carers being misled in to buying inappropriate and unhealthy products marketed as good choices, which displace breastfeeding and less processed nutrient dense home-prepared foods
- Reforming the national nutrition safety net, ‘Healthy Start’, increasing the allowance value and increasing coverage
- Necessary to mitigate unacceptably high levels of food insecurity in the UK, which is especially acute among the most nutritionally vulnerable – pregnant women, breastfeeding women, and babies and young children on the lowest incomes
- Reviewing and mandating food standards for early years settings, and supporting and monitoring their implementation
- Necessary to ensure babies and young children are supported to eat well and develop healthy diets preferences and habits while at nurseries, pre-schools and childminders
- Development of a ‘comprehensive and integrated maternal and infant nutrition strategy’
- Necessary to bring in the health sector side of the equation, e.g. to address support for breastfeeding and complementary feeding, and the workforce and infrastructure to deliver this
It is only through intervening in the early years that reductions in the UK’s high levels of overweight and obesity will be achieved and sustained. Our challenge to Government: if they are serious about their pledge to create the healthiest and happiest generation of children ever, they need to prioritise acting on the inquiry’s recommendations urgently, especially those focused on babies and their families.
Read the report here and a summary here.
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New paper: Ultra-processed food intake in toddlerhood and mid-
childhood in the UK
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This study by Rana Conway and colleagues at UCL explores UPF intakes in a cohort of UK twins at 21 months (n=2,591) and seven years of age (n=592), with data collected in 2009/10 and 2014/15 (i.e. at least 9 years ago). They found that UPFs account for 47% of toddlers' total energy intakes and 59% of 7-year-olds. Of the 570 individuals who completed diet studies at both time points, UPF consumption increased by an average of more than 15% between 21 months of age and 7 years, and higher UPF intake at the first time point predicted higher intakes in mid-childhood.
Average sugar and salt intakes exceeded recommendations for both age groups and were associated with higher UPF consumption. Toddlers who ate more UPFs had less saturated fat and protein in their diets, and children who consumed more had less fibre in their diets. High consumption of unnecessary commercial milk formulas (CMF) seem to drive this trend. Aside from CMF, toddlers' most consumed UPFs were yoghurts, wholegrain bread and high-fibre cereals. Children’s most consumed UPFs were puddings, sweet cereal products and white bread. Toddlers consumed commercial products from the baby food aisle that the researchers chose not to classify as UPF because they did not contain ingredient markers, but they do note that these snacks can be defined as ultra-processed by their form as they are extruded and puffed.
It should be noted that the data are old and reliance on UPF could well be higher currently, added to which the cohort are not representative of the general population and socially disadvantaged groups are also more likely have poorer diets.
This research further highlights the urgent need for action to reduce UPF consumption in the early years (which would also reduce HFSS food consumption) and to rebalance the diet towards the nutrient-dense, less processed/whole foods necessary to meet dietary requirements and lay the foundation for healthy dietary preferences and habits. Our recommendations are in our report 2023 report here.
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Our ‘Eating Well’ guides provide pictorial, practical advice on how to meet nutrient requirements in pregnancy, while breastfeeding, for infants (under 1) and young children between the ages of 1 and 5, cost effectively and avoiding too many highly processed products. You can download or buy hard copies here.
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New editorial: Ending health care professional association conflict of interest with the nutrition industry
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Last month, the World Health Organisation (WHO) published new resources to support Healthcare Professional Associations (HCPA) to avoid conflicts of interest in relation to nutrition companies marketing foods for infants and young children. The new WHO resources include a model policy, suggestions for alternative funding sources and case studies of good practice.
This editorial, co-authored by our Director Vicky, debunks arguments used to resist the WHO recommendation and outlines why doing so is important. It shines a spotlight on the allergy HCAPs many of which have a long way to go despite evidence that conflicts of interest can drive overdiagnosis and unnecessary use of specialised formula products which carry health and nutrition risks.
The aims of the baby formula/baby food industry are often directly opposed to public health aims, and the impact of nutrition industry sponsorship of HCPAs over many years can be seen in the debate about the updated 2023 WHO complementary feeding guidelines summarised in the figure.
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Figure: Comparison of public health recommendations and nutrition industry funded HCPA recommendations for feeding infants and young children
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The new WHO resources illustrate that culture change is possible, and that the missions of HCPAs can be successfully accomplished without nutrition industry sponsorship. Read the editorial here.
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New paper: Stakeholders’ views of the Baby Friendly Initiative implementation and impact
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This paper by Frankie Fair and colleagues at Sheffield Hallam university was published earlier this year. It aimed to explore multinational stakeholders’ views of the Baby Friendly Initiative (BFI) programme in the UK, the barriers and facilitators to accreditation and its perceived impact. It used mixed methods including an online survey sent via professional networks in late 2020 and completed by 322 respondents in varied roles, and 17 interviews with ‘key stakeholders’ and maternity service users; most were from the UK. Data was analysed thematically.
In terms of findings, several respondents felt all the standards were equally important while some felt some were more important than others. There was no clear pattern or consensus. The authors assert that additional evidence for the effectiveness of each element and the importance of the whole package need to be established and communicated. However, it is important to note that respondents had limited experience of implementation of Baby Friendly, including in the UK. In addition, the researchers used the Ten Steps to Successful Breastfeeding and Seven Point Plan for Sustaining Breastfeeding in the Community as a basis for their enquiry. In the UK, these standards were superseded in 2012 with ones which include support for parents who are bottle-feeding and for close and loving relationships. In addition, the neonatal standards introduced in 2015 were not considered.
Overall, the study showed the BFI to be viewed by most respondents as an intervention that could improve breastfeeding and health outcomes in the UK as part of a wider package of interventions: “The BFI is not a magic bullet intervention. To create a more supportive breastfeeding environment within society a holistic approach is required. This includes social and cultural changes, increased education ideally starting at school age, and advancing positive messaging around breastfeeding within the media, as well as fully banning breastmilk substitute advertising”.
We do not find this conclusion surprising and would concur that Unicef BFI is an important part of a package of interventions needed to enable breastfeeding and safe and appropriate formula feeding where needed.
Read the paper here.
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Updated nutritional standards and practical guidance for early years settings in Scotland: “Setting the Table”
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In early October the Scottish Government published its updated nutritional standards and practical guidance for supporting eating well and creating a ‘whole setting’ approach to food in early years settings. Find them here: ‘Setting the Table’.
First Steps resources (including Eating Well: The first year; Eating Well: Vegan infants and under 5s and our infant milks for parents and carers webpage) are recommended within.
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The resource was developed in partnership with a range of organisations across public health, education and childcare and food standards, and is clearly situated in the context of the full range of relevant policies. As well as setting standards and providing practical guidance, there is information within on expectations for implementation; settings will need to apply the guidance by August 2025 and the Care Inspectorate will assess this.
This is an accessible and technically sound guideline which has been created in a manner which will clearly really facilitate its application. Once again, the Scottish Government provides a best practice example on early years nutrition! Bravo!
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Update: Healthy Start for groups who have no recourse to public funds
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In May 2021, the Department of Health and Social Care expanded Healthy Start eligibility to British children under 4 from families with no recourse to public funds (NRPF) or without immigration status through a non-statutory scheme, allowing them access to payments and vitamins. DHSC now aims to formalise this scheme into law and launched a consultation in July to explore the benefits, challenges, and potential impacts of extending eligibility for Healthy Start to NRPF families, especially regarding individuals with protected characteristics.
It is our view that access to adequate nutrition should not depend on immigration status. All pregnant and breastfeeding women, infants, and young children have specific nutritional needs that require a nutrient-dense diet to prevent ill health and support proper growth and development. Those unable to meet these needs should be entitled to a nutritional safety net, consistent with the UK Government’s commitment to the International Covenant on Economic, Social and Cultural Rights, which requires securing the right to sufficient food for everyone in the UK. Furthermore, expanding Healthy Start eligibility to British children under 4 from families with NRPF or without immigration status would ensure that the scheme achieves its aim of reducing health inequalities by ensuring that women and children “most in need” have access to essential vitamins and nutritious food.
Our full consultation response can be found here.
Food insecurity remains a critical issue for families with young children, with Trussell Trust data showing that 24% of households with children under four are experiencing hunger—the highest risk of any age group. First Steps is collaborating with the Healthy Start Working Group to push for essential improvements to the Healthy Start scheme, aiming to strengthen it as a vital nutrition safety net. However, we are concerned about the lack of progress on these issues at the Government level (including no commitment to improve this scheme in the Autumn Budget, see above).
Our practical guide to Healthy Start and Best Start Foods is designed to help families make the most of the Healthy Start scheme in England, Wales, and Northern Ireland, and the Best Start Foods scheme in Scotland. It includes a range of healthy family recipes using ingredients that can be bought through the Healthy Start or Best Start Foods schemes and shows how these can feed the whole family.
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New and discontinued products
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Similac Gold
Having been unable to find Similac® Gold First Infant Milk and follow-on milks for sale in high street retailers, we can confirm that these products are being discontinued.
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We recently found out that a number of new formula products have been introduced, although it’s unclear how widely available they are at this time. We’re examining the product marketing and labelling and the extent of compliance with the UK law and the Code, and will respond to any contraventions in due course.
Lidl Lupilu infant formula
Lidl introduced their own-brand infant and follow-on formulas in September. Lulipu infant formula costs £7.09 for an 800g tin, making it the same price per unit as Aldi’s Mamia first infant milk. Lulipu follow-on formula also costs £7.09 for an 800g tin.
Kendamil Bonya infant formula and follow-on formula
Kendal Nutricare launched these two new products on the 1 November. The products come in 2 x 400g cartons and are priced at £8.45. The manufacturers describe the products as ‘low price’, but there are several more affordable products on the market, see below.
We are updating our Infant Milks website with information on the composition and cost of these new products.
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Infant milk cost report update and latest price trends
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Costs of infant formula, follow-on formula and milks marketed as foods for special medical purposes available over the counter in the UK
Our latest review of the cost of infant milks reveals the following:
The cost difference between the most and least expensive cows’ milk-based first infant formula is £10.91 per 800g. Since all infant formulas in the UK are regulated, ensuring they are safe and suitable for babies from birth through the first year, parents can make substantial savings by switching brands.
The NHS states:
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Current pricing strategies mean that the least expensive way to buy infant formula is in powdered format. Aldi Mamia and Lidl Lupilu are the least expensive infant formula powders in standard size formats. Since April 2024, Aldi have launched an 800g tin with a retail price of £7.09. This is 90p cheaper than their 900g tin (£7.99), but works out at 12p per 100ml of made-up formula. Lupilu is also £7.09 and 12p per 100ml of made-up formula.
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Five lowest-cost first infant formula products (per unit)
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Five lowest-cost first infant formula products (per 100ml)
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The cheapest formats of Cow & Gate First Infant Milk, SMA Pro First Infant Milk and Aptamil First Infant milk per 100ml are their ‘big packs’ (2 x 600g packs), which are 4p cheaper per 100ml than standard size formats. However this requires families to pay a greater up-front cost, and these packs are not available in all retail contexts.
There continue to be differences in the price of same brand infant formula and follow-on formula across different retailers, indicating that it is worthwhile shopping around for infant formula.
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Follow-on formula, advertised for children aged 6-12 months, provides no additional nutritional benefits over infant formula and is not recommended by the NHS. While many believe that switching to follow-on formula after six months might save money—especially since UK regulations allow promotional offers on follow-on formula—our cost analysis reveals this may not be the case. In fact, powdered follow-on formula can be slightly more expensive than the same brand's infant formula when prepared.
Additionally, our review of promotions found that offers on follow-on formulas in April were no longer available by October 2024. This variability highlights that promotions are not a reliable foundation for families on a budget when making feeding decisions, leaving them exposed to price increases once promotions end.
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Cost of powdered infant formulas in the UK: How have they changed since January 2021?
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Our latest infant formula cost trend analysis reveals that since April 2024 the majority of infant formula prices have remained static, with the exception of Aldi’s Mamia 900g tin which has decreased in unit price by a further 6%, continuing the small downward trend observed between November 2023 and April 2024, when prices dropped by 1.8%. However, this decline is minimal compared to the 22% average price increase seen across products between March 2021 and April 2023 (and the 24% increase of the seven ‘standard’ powdered first infant formulas sold by market leaders Danone and Nestlé in the same time frame), which started from an already high baseline.
Unit cost of market leaders’ powdered first infant formula (all 800g), Aldi's Mamia (800g & 900g) and Lidl’s Lupilu (800g), compared to the weekly Healthy Start allowance
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As explained in our report, we have taken prices from Boots the Chemist website, Tesco, Sainsbury's, Asda, Morrisons, Aldi, Lidl and Ocado online supermarkets and the manufacturers' online shop, prioritising our sources in that order. Where a product is not available at Boots we look for it on the Tesco website and so on until we find a current price. Prices for infant formula vary between retailers (for example, SMA Little Steps is available in some supermarkets for £7.95), but the prices shown in this graph represent typical prices in October 2024.
Price differentials between different brand’s ‘standard’ and ‘premium’ powdered first infant formula products (where these exist), show no clear trends. The popularity of more expensive branded products demonstrates the effectiveness of commercial milk formula marketing, which fosters trust among parents and carers, leading them to purchase higher-priced options, even though UK regulations ensure all infant formulas are safe and suitable for babies from birth through their first year.
Prices for "starter packs" have not remained stable. Between April 2023 and November 2023, Danone reduced prices for their Aptamil Advanced, Aptamil, and Cow & Gate starter packs of ready-to-feed infant formula, but these reductions have now been reversed, with the starter pack prices returning to their April 2023 levels. This highlights the importance of regulatory measures to protect parents from unexpected price increases.
Overall, infant formula remains an expensive and yet essential food item for many. Government action is needed to bring prices down more meaningfully across the board and in the long term, and to ensure accessibility for those families on low incomes that need it, while protecting and supporting breastfeeding. Both Aldi and Lidl serve as an example of the cost savings achievable through the availability of a supermarket's own-brand infant formulas.
For healthcare professionals advising parents/carers on economical formula and food choices for their babies and young children, our infographics may be of use:
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We have also worked with Unicef Baby Friendly Initiative to update this two-pager on responsive bottle feeding and what infant formula to choose.
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For infant milk information please visit our website www.infantmilkinfo.org. If you can’t find what you’re looking for, please email rachel@firststepsnutrition.org
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Baby Feeding Law Group UK News
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Latest news from the Competition and Markets Authority: Interim report on the infant formula market study due in “Autumn 2024”
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We were hoping that the Competition and Markets Authority (CMA) interim report on the infant and follow-on formula market study would be published by the end of October 2024, as indicated on their webpage. The administrative timetable indicates that the interim report (with provisional recommendations) will be available by the end of Autumn 2024. Any updates will be shared on the CMA webpage on the Infant formula and follow-on formula market study.
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New paper: Outcomes of implementing the International Code of Marketing of Breast-milk Substitutes as national laws
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On 27 September 2024, Chompoonut Topothai and colleagues from the National University of Singapore, Ministry of Public Health Thailand and London School of Hygiene and Tropical Medicine published a systematic review of outcomes of implementing the International Code as national laws in the International Breastfeeding Journal. The systematic review aimed to synthesise evidence on implementation outcomes in countries implementing the Code as national law. Articles published from 1982-2022 and in English were included in the review, resulting in 60 eligible articles (from 12,075 screened) from 28 countries (of 144 which had any Code legislation in 2022). Most articles (57) focused on legal compliance, while five considered acceptability and only 1 considered feasibility. Over half (55%) were quantitative, cross-sectional studies. Most studies (88%) were single country studies with 12% evaluating multiple countries. Studies were included from three different countries in Europe: one from Poland, one from Turkey and six from the UK.
The results from the review showed good compliance for media promotion of CMF for infants 0–12 months (i.e., infant formula), but lower compliance for promotions at points of sale, within health facilities, and among health workers across different countries. Similar industry tactics were used across countries, with an emphasis on digital marketing, cross-promotion (with products not covered by laws), and premiumisation. Compliance was assessed across 57 included studies and according to five main sources:
· Mothers (n=25 articles): Maternal exposure to commercial milk formula (CMF) promotion was widespread, including mothers receiving free samples and coupons, and encountering CMF advertising in the media.
· Health workers and healthcare settings (n=22): Compliance of health workers with national laws and exposure to CMF marketing varied across countries, with many health workers reporting contact with CMF companies despite legal prohibitions. Public facilities generally showed better adherence to national laws than private ones.
· Media (n=22): While implementing the Code as national law effectively regulated the promotion of infant formula in public settings and the media, the promotion of unregulated products like growing-up or toddler milks was widely reported and often marketed through cross-promotion and digital platforms.
· Point-of-sale (n=15): Compliance was inconsistent across countries, with many reporting non-compliant price-related promotions.
· Product labels (n=13): Articles reported CMF labelling (n=7) but also the labelling of commercial complementary foods (n=6) and bottles and teats (n=1). Among studies evaluating CMF labels, most labels were non-compliant with at least one Code provision, most commonly relating to the use of text/images idealising product use and the absence of a statement on the superiority of breastfeeding.
The review concludes that implementing the Code as national law has improved regulation of CMF promotions. However, challenges persist in addressing promotions for unregulated products (especially through cross-promotion and digital marketing) and promotions at points of sale and in healthcare facilities. To strengthen legal compliance, robust monitoring and reporting systems are necessary, including using technology-assisted solutions for monitoring compliance in countries with limited human resources.
While the UK still scores only 40 out of 100 on 2024 Code Status Report, implementation outcomes of national legislation will remain limited.
Read the full paper here and supplementary material here.
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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 X (formerly Twitter) account @BflgUk. You can also email katie@firststepsnutrition.org
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Unicef Baby Friendly Initiative Conference (online), Wednesday 20 - Thursday 21 November
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This year’s annual conference is virtual and will take place on 20 and 21 November. There’s an exciting and packed agenda, including our Director Vicky who will be presenting on “Formula prices: Greedflation, its impacts, and progress towards mitigation”. Booking closes 5pm Wednesday 13 November so if you haven’t got your tickets yet, get them here now. See the full agenda and find out more here.
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We’re both sad and excited to announce that our nutritionist Rachel will be going on maternity leave in the new year. But, joining the team as a nutrition officer to support our ongoing work, is Jasmine Brand-Williamson. Jasmine is a registered Nutritionist with an MSc in Human Nutrition from the University of Glasgow where she specialised in Public Health. She is passionate about communications and presenting scientific research in an accessible and engaging way. Since completing her undergraduate degree in Zoology from the University of St Andrews in 2017, she worked in marketing and communications and developed an interest in food security and its intersection with public health. For her MSc research project, she focused on commercial foods aimed at children under 36 months. This sparked an interest in maternal and infant nutrition and practices, and the policies which underpin them. As such, she is keen to contribute to the meaningful work of First Steps Nutrition Trust.
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