April 24, 2024
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Baby formula: does it deliver on the health claims of the manufacturers? | Children

Tubs the supermarket shelves formula line; their packaging full of promises to satisfy hungry, affected or regurgitated children. The wide range of products – offered at an even wider range of prices – may leave any new parent scratching their head for choice. And even more confused? The IS NHS website says there is “no evidence” to support many of the claims many of them make in the first place.

So is the world of baby formula marketing in Britain, where companies have learned to artfully dodge regulations, many in the industry believe, knowing that enforcement is unlikely to ever come. The industry has raised prices by up to 45% during the cost of living crisis, leading to such an increase in thieves that many supermarkets now put security tags on the tubs, or put them behind the tills. Less discussed, however, is how big business lobbying is allowing false claims to grow in an industry estimated to be worth up to $109bn worldwide by 2027.

In February, study published in British Medical Journal (BMJ) found that each of the 757 formulas analyzed had at least one health or nutrition claim – but these were often not supported by scientific references. When they are, the evidence is often weak and biased”, the authors wrote; where clinical trials were conducted, at least 88% were partially funded by or affiliated with industry.

In a paper published online a month earlier, researchers at University College London concluded that the formula “manufacturers are marketing their products in ways that violate the directive from the Council. Department of Health and Social Care (DHSC), with a health claim appearing on 18% of packages, and 41% with nutritional promises that are not approved”.

The DHSC did not respond, saying that enforcement of unauthorized claims was the responsibility of the local authority. The rules state that infant formulas cannot be advertised or subject to special promotions, or any text or images that appear to discourage breastfeeding, or make unsubstantiated health claims.

But there have long been loopholes in our bottle-feeding culture, says Robert Boyle, a reader in pediatric allergy at Imperial College London, who was involved in the BMJ study. Britain has the lowest breastfeeding rates in the world; 1% of mothers exclusively feed their baby in this way by the NHS six month point praises. Although the NHS says that “breastfeeding into your baby’s second year or beyond, along with other foods, is ideal”, this figure drops to 0.5% after one year (compared to 23% in Germany or 27% in the US), and eight out of 10 women in the UK stop breastfeeding before they want to, according to Unicef. The charity is of the view that breast is best, citing studies which suggest that babies who are breastfed are less likely to develop diabetes or obesity later in life, do better on intelligence tests, and that their mothers have a lower risk of breast and ovarian cancer.

However, poor support for breastfeeding before birth has helped to dilute its benefits – and spurious products also play a role, says Boyle, by “falsely convincing. [women] that formula is better than it really is, or that breastfeeding isn’t as good as it really is. The claims companies make about their products are part of a wider picture that undermines women’s confidence and competence to do their best to treat their baby.”

Although the ingredients in all formula products are largely the same, ever-increasing ranges and price variations “make it seem like there are endless variations and very exciting differences between them,” says Boyle. A study 2019 by charity First Steps Nutrition Trust found that 40% of parents who use formula felt that the more expensive types were better.

Brands such as Cow & Gate and SMA sell formulas for problems such as reflux or colic for around £14 per 800g tub. Colic (or “comfort”) formula contains cow’s milk protein that has already been partially broken down, which is supposed to make it easier to digest – but the NHS website says “there is no evidence for this”. So why is it marketed like that?

You could ask the same question about “growing up milk” aimed at children over the age of one, and the NHS declares that there is “no evidence” of necessity; ditto “hungry-baby formula”. Again, despite the claims of “hungry baby” formulas, the NHS website asserts that there is “no evidence that babies settle better or sleep longer when fed this way”.

Danone, the parent company of Cow & Gate (the UK’s largest formula supplier; it also owns Aptamil and Nutricia), said its formulas were “based on over 50 years of breast milk research … Our ‘hungry’ milks are fully nutritious and made with a special balance of milk protein to keep hungry babies feeling fuller for longer.” Pressing for studies to show this, he reiterated that his offer was “completely nutritious”.

Concerns are now rising that not only will the industry’s claims fail to deliver, but they could exacerbate other health concerns. Infant nutrition charity Feed has found that the cost of living crisis has seen an increase in parents asking for formula for hungry babies from health visitors, “because they believe the companies’ claims are unfounded”, says Erin Williams, its co-founder. “This false sense of security created by the formula company can lead to underfeeding babies.”

For many parents, picking the “right” formula is still very difficult. Rachel Evans still feeds her 16-month-old son some formula “because he’s quite picky and I don’t think he gets everything he needs from what he eats”, but only recently learned – while listening to a podcast – [manufacturers’] promises that are “often not based on evidence”. Evans, a psychologist, says she is “really confused about whether he needs the formula or whether I would be better off giving him a multi-vitamin”. Meanwhile, bowel health practitioner Frankie Jones agrees she felt “completely clueless” when choosing a formula for her son and tried three within 10 weeks – including an anti-reflux variety which helped him settle down, but resulted in “terrible constipation. So [that] milk helped one problem but caused another.”

Alison Thewliss MP has raised the issue of infant formula advertising in parliament through debates and a private member’s bill, and says she has seen “little interest in enforcement” of existing legislation, presumably because “the formula industry is too close to government”. The current situation “of course should not be allowed to continue”, says Thewliss, referring to concerns about products that promise to clear up allergies (as parents should be told that this requires a diagnosis, rather than thinking they can “[buy] something off the shelf without medical advice”). She also says that “ideal images of these beautiful, healthy children” are younger than the age group they are designed for, “because the industry is guilty of selling more products” in advertisements for products aimed at older people (the age at which marketing is allowed).

Evidence countering formula companies’ claims and spotlighting spiraling costs have produced no legislative crackdown, a sign to many that the government’s priority is business over children. “The only solution is to ban claims [on packaging] absolutely,” suggests Boyle. Until that happens, “I don’t think you can have a level playing field.”

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