The obesity time bomb is not just ticking; it’s exploding. If we keep piling on the weight, our already overstretched health services will soon become unsustainable and unaffordable.
In August, the UK government released its childhood obesity strategy. The proposals were met with universal condemnation from everyone except the food industry. Even retailers Sainsburys and the British Retail Consortium complained that the strategy ‘did not go far enough’, and called for the voluntary approach to be replaced by a mandatory one.
If current trends continue the number of overweight or obese infants and young children globally will increase to 70 million by 2025. The reader may be surprised to learn that the vast majority of these children live in developing countries, where the rate of increase has been over 30% higher than in developed countries.
The situation is largely preventable, but supportive policies, environments, schools and communities are fundamental in shaping parents’ and children’s choices.
The problem starts in the first year of life. When my daughter gave birth to her twins, she decided to breast feed. The WHO has long recommended exclusive breastfeeding for the first six months of an infant’s life, so her decision met with my wholehearted approval.
This is not to say that a mother who cannot breast feed is failing her child. Formula is based on cow’s milk, but this has been engineered to be closer to human milk (still way off, but closer). Despite this, many infants have problems with formula (allergies, GI problems, etc.).
When my very healthy grandchildren were nearing 6 months, my career daughter was keen to stop breast feeding. She asked me what milk she should use while she was weaning them. Without hesitation, I replied, “Cow’s milk.” My daughter expressed surprise, as all the health authorities advise no cow’s milk until after the first birthday. She had clearly done her homework, and she was leaning towards a follow-on milk.
Before tackling the cow’s milk issue, I need to discuss follow-on and toddler milks. These milks have been introduced by companies to circumvent restrictions on the advertising of infant formulas for use from birth, and to lead parents through a sequence of milks from 6 months to 3 years of a child’s life, so that they continue to profit from parents. The manufacturers have been very clever making these milks seem like a natural progression.
But the WHO advises that, from 6 months, local, nutritious foods should be introduced, while breastfeeding continues for up to two years or beyond. Follow-up formula is unnecessary. In addition, the WHO states that follow-up formula is not a suitable substitute for breast milk. In 2010, the World Health Assembly stated that the ‘promotion of breast-milk substitutes and some commercial foods for infants and young children undermines progress in optimal infant and young child feeding’.
Baby Milk Action has been highlighting for many years that follow-on milks and toddler milks are unnecessary products. In 2013, the European Food Safety Authority (EFSA) stated that these milks provide no additional value to a balanced diet, and that their scientific experts could identify no unique role for them in the diet of young children.
So, from 6 months to 1 year, breast feeding remains the best, and for those formula mums, continue with the infant formula. I will come back to this 6-month window, but what about the period from one year onwards?
Should parents buy toddler milks? These milks are aimed at children aged one to three and are the fastest growing sector of the formula market. In a Which? survey, 46% of mothers with children aged between one and three years had used them, even though the UK government says they are not necessary.
In 2013, Which? research showed that toddler milks contain more sugar and less calcium than cow’s milk, and that parents could save over £500 a year by giving their child cow’s milk instead of toddler milk.
The recommended daily serving of 300ml of cow’s milk contains three teaspoons of sugar, whereas 300ml of toddler milk contains up to seven teaspoons. 300ml of cow’s milk provides all the calcium a one to three-year-old needs, whereas several of the toddler milks do not.
These higher levels of sugar encourage a preference for sweet things and in the long-term can lead to dental cavities. Ensuring that these toddler milks are sweet is ideal for preparing kids for a life of eating junk food.
The results of two studies, the EU Childhood Obesity Project (CHOP) and the Early Nutrition Programming Project (EARNEST) show that the composition of these formulas on the European market has played a significant role in the exacerbation of childhood obesity, confirming what WHO and many health bodies have been saying for many years that breastfeeding provides an ideal window of opportunity for obesity prevention and may help in the development of taste receptors and appetite control.
Although toddler milk is advertised as containing more iron than cow’s milk, this is misleading. Cow’s milk contains very little iron, but this is not where you or your baby get iron from in the diet. Iron is found in red meat, eggs, lentils and pulses and green leafy veg.
Toddler milks are also expensive, costing 4 to 9 times more than cow’s milk. When so many household budgets are squeezed, parents could be saving a small fortune avoiding a product that governments say is unnecessary.
The First Steps Nutrition Trust has produced an objective analysis of fortified milks marketed for children over 1 year. In this worldwide review it states:
- Fortified milks are frequently high in sugar and are likely to contribute to higher energy intakes, which may contribute to chronic disease.
- There is increasing evidence that giving additional nutrients to those who do not need them may have adverse consequences.
- Fortified milks for older children are being irresponsibly marketed to vulnerable population groups worldwide
Yet the likes of Nestlé and Danone see these milks as a cash cow and continue to promote them aggressively around the world. So much for voluntary codes!
In conclusion, it seems clear that, from birth to 6 months, breast is best, and that, after 1 year, cow’s milk is fine. Toddler milks are advertised as ‘specially designed to meet the needs of your toddler’, but their nutritional value is compared solely with cow’s milk, and not cow’s milk plus food, which your toddler would in reality be eating.
Unfortunately, none of this helped the discourse between me and my daughter about the period from 6 months to 1 year. Use of cow’s milk before a year remains controversial among experts, and the advice is varied and inconsistent.
The belief that cow’s milk should only be used as the main milk drink from 1 year of age has been in place since 1980. The recommendation was based on the need for adequate iron in the first year. But, as we have already seen, a weaning infant is not depending on milk for its iron.
Cow’s milk does contain high concentrations of protein and minerals, which, in theory, could tax a baby’s immature kidneys, but there is actually no evidence to suggest adverse effects associated with this in healthy infants.
It has also been argued that the early introduction of cow’s milk might lead to more milk protein allergy, but this is specious because all follow-on and toddler milks contain the same milk protein.
With no other significant evidence that I could find, I persisted in my advice to use cow’s milk from 6 months. It has actually been the practice in many agrarian communities for millennia – long before the food industry felt the urge to re-engineer our food! The twins thrived on it, and my daughter saved a small fortune.