Government urged to act as ultra-processed foods dominate diets of UK babies and toddlers

In the news and media this week there have been many articles about the impact of ultra-processed foods on health, including a shocking Panorama documentary on this topic. A new report published today by First Steps Nutrition Trust outlines why this significant threat to our nation’s health needs to be taken seriously for babies and young children too.

The report ‘Ultra-processed foods (UPF) in the diets of infants and young children in the UK: What they are, how they harm health, and what needs to be done to reduce intakes’ exposes how ultra-processed foods (UPF) are widely consumed, from the first weeks and months of life, raising serious concerns about the ways that they are impacting on babies’ and young children’s health and contribute to the growing obesity crisis.

The key findings from the report are stark, with evidence that all commercial formula milks and a high proportion of ‘finger foods’, snacks and baby cereals are ultra-processed. The extent of this ‘ultra-processing’ is underestimated by most people due to poor product labelling that makes it harder for parents to spot the ingredients and processing methods that are linked to health and environmental harms.

Worrying data from the report show that by 2 to 5 years of age, UPFs account for nearly two thirds (61%) of the total mean energy intake of UK children – this is higher than Australia and the USA. It is clear from the growing evidence that the impact of UPFs on our health cannot be underestimated, some of these negative health outcomes include: the promotion of overeating; disruption of developing taste preferences early in life; interference with the healthy development of the gut microbiota; and wider harmful effects due to UPFs containing certain additives and contaminants with known harmful effects.

Despite this evidence, the UK currently lacks a clear position on UPFs and companies are allowed to use aggressive and misleading marketing to promote these foods and drive high consumption levels.

Vicky Sibson, Director First Steps Nutrition Trust, called on the government to act and said:

“It is now commonplace that many babies and young children in the UK are being fed large amounts of ultra-processed foods from the start of their lives. There is robust evidence that this will be harmful to their health in the short and long term, including promoting excess weight gain.

“The Government needs to do more to enable parents and carers to feed their children diets which support healthy growth and development – based on real foods – not dominated by commercial products marketed as ‘good’ choices.

“A first step would be to explicitly address the extent to which food is processed in public health recommendations. At the same time, action to curb inappropriate and misleading marketing by the baby food industry is long overdue. The Government also needs to invest meaningfully in the health visiting service, and other facilities and benefits, to ensure that all families can get the independent, expert advice, guidance and financial support they may need to feed their children healthy diets.”

Alison Morton, CEO for the Institute of Health Visiting, said:

“Our nation is sleepwalking into a health crisis that is largely preventable, with current and future generations condemned to an increase in unhealthy life expectancy and lives cut short due to unhealthy diets and ultra-processed foods. This important report by First Steps Nutrition clearly sets out the reasons why we need to take this seriously for our babies and young children who are currently the innocent victims of the ruthless marketing of these unhealthy products that are produced specifically for them.

“Healthy foods are needed to build healthy bodies and minds. If we are to break this trajectory of declining health for our nation, we need to change the beginning of the story and ensure that all babies and young children can eat healthy and affordable food. We fully support the recommendations outlined in this report and join the call on the Government to act – our children cannot wait any longer.”

First Steps Nutrition Trust makes these seven recommendations to the UK Government:

Acknowledge the NOVA classification and update public health recommendations on infant and young child feeding to explicitly address food processing
Regulate and enforce the composition, labelling and marketing of commercial baby and toddler foods and drinks
Ensure parents/carers have easy access to independent information and practical guidance and support on complementary feeding, and feeding from one to five years of age. This requires proper investment in the health visiting service and services like Family Hubs
Ensure parents/carers on low incomes can afford to feed their infants and young children nutritious diets based on real foods by reforming the Healthy Start benefit scheme
Enable women who want to breastfeed by increasing support, and by increasing legal protections for breastfeeding and against inappropriate marketing of commercial milk formula
Invest in research on UPF consumption in the early years, including on additives in commercial baby and toddler foods
Acknowledge and promote the environmental benefits of diets based on minimally processed foods

To read First Steps Nutrition Trust’s full report including the Forward by Dr Chris Van Tulleken, click here

Health visitors have an important role to play in supporting parents with infant feeding and healthy diets for the whole family. iHV members can access our comprehensive ‘Healthy Weight, Healthy Nutrition Toolkit’ to support their practice here – please ensure you log into the iHV website first, to gain access.

First Steps Nutrition responds to the Government Food Strategy

First Steps Nutrition, the country’s leading early years public health nutrition charity, has shared their response to the Government Food Strategy published on 13 June 2022. The response has been sent to Sajid Javid, the Secretary of State for Health and Social Care, and Chris Whitty, the Chief Medical Officer for England and warns that, without improving diets in the early years, the rising national tide of obesity will not be reversed. The response also sets out the charity’s concerns that the Food Strategy does not make explicit, or address, the food and nutrition needs and vulnerabilities of infants and young children, stating,

“We are pleased to finally see a ‘Food Strategy’ for England released, to “start the conversation” about how best to deliver “healthier, more home-grown and affordable diets for all…”. However, this is not the comprehensive strategy we were hoping for. In particular, we believe it is misleading to state it is applicable to all, because the food and nutrition needs of babies (aged 0-12 months old) are ignored and those of young children (aged 1- 5) are barely considered…”

The early years of life set the trajectory for future health; excess weight gain in infancy affects later child weight and once established, obesity is harder to reverse. The Government recognises this and has set a target to reduce obesity prevalence by half by 2030 – but unless the nutritional needs of babies and young children are addressed, this target will not be achieved. Over 14% of children who started school in England in 2020 were already living with obesity, and among those from the most deprived households, the prevalence was 20.3%.

The charity also raises concerns that the Food Strategy pays disproportionate attention to individuals’ food choices in an environment in which families are not enabled to eat well – and this includes support to breastfeed.

To enable more children to maintain a healthy weight as they grow, First Steps Nutrition set out some key recommendations for the Government in their report published in May 2021: Enabling children to be a healthy weight. This contained 7 priority recommendations for babies and young children:

Invest in leadership and strategy on maternal, infant and young child nutrition
Collect data on infant and young child feeding practices and ensure better measurement and population surveillance of nutritional status in the early years
Invest in universal breastfeeding support
Strengthen and enforce regulations on the composition, labelling and marketing of formula and commercially-produced foods and drinks aimed at infants and young children
Protect and expand universal health visiting services
Review and refresh the Healthy Start scheme & increase the payment value
Make food and drink standards in early years settings mandatory

The iHV is delighted to see that the recommendation to ‘Protect and expand universal health visiting services’ has been included. The response highlights the central role that health visitors play in enabling families and their babies and young children to eat well, stating:

“Statutory family support services need to be made fit for purpose if we are to stem the rising tide of obesity. Babies and children under two are the most vulnerable of all our children to the consequences of inadequate nutrition, and are also least likely to have engagement with public services. Health visitor numbers have been decimated since health visiting was transferred to local authority commissioning, and yet, alongside GPs, these specialist community public health nurses are often the only professionals who have contact with babies and young children and their families.”

The Healthy Child Programme sets out how health visitors can work with parents from preconception, through pregnancy and to their child starting school. Health visitors are therefore uniquely placed to support families with healthy weight and nutrition and identify children at risk of obesity. The evidence is clear that families are more likely to engage in this topic if they have a trusted relationship with a practitioner who is able to build on their strengths and support them to be in control of the things that matter to them and help them stay healthy– it takes skill to do this work well because obesity is a very sensitive topic. To achieve this, we need more health visitors, and a service built around relationships through continuity of care with an increased number of universal contacts for all families, and targeted support when needed.

The iHV welcomes this response from First Steps Nutrition and supports its recommendations. We would like to extend our heartfelt thanks to the team at First Steps Nutrition for continuing to advocate for better services and support for babies, young children and families, and also for their ongoing support of health visiting.

Thank you – and we look forward to continuing to work with you!

To read First Steps Nutrition's response click here

iHV welcomes RSPH calls for better routes home from school to tackle childhood obesity

A new report published today (13 September 2019) outlines a raft of measures aimed at overhauling the after-school street environment for children in the UK. Routing Out Childhood Obesity, a report by the Royal Society for Public Health (RSPH), found that despite wider efforts to support kids’ healthy eating in school and at home, the world they experience between the school gates and the front door can still have a disproportionate effect on diet and lifestyle.

With nine children in every year 6 class overweight or obese, childhood obesity in the UK poses a serious, yet fixable, public health challenge. Backed up by widespread public support, this report identifies four key aspects of the street environment that should be disrupted to give children a healthier route home from school:

Addressing the junk food offer around schools – including
- using a mixture of licensing and planning tools to ban unhealthy fast food outlets (FFOs) from within a 5-minute walk of school gates (backed by 65% of the public);
- ending discounts targeted at school children (backed by 80%);
- ending app-based food delivery services to school gates (backed by 80%).
Building better places to go – including better quality parks with teen use in mind, and physical signage outside schools directing kids to their nearest park.
Transforming active travel – including a radical upgrade to cycling and walking infrastructure for young people, and scrapping burdensome regulations on lighting for zebra crossings, to allow many more ‘European-style’ crossings to be painted on our streets at low cost.
Limiting the reach of junk food adverts – including banning the advertising of unhealthy food products across all council-owned advertising sites (backed by 80% of the public).

The full report and recommendations are based on research done in partnership with urban health foundation Guy’s and St Thomas’ Charity, which included mapping the street environments of Lambeth and Southwark to gauge their impact on childhood obesity, and a series of interviews and focus groups with school children from the boroughs.

The full report can be accessed here, and a short film exploring the opinions of school children on the after-school environment can be accessed here.

Push on with plans to tackle childhood obesity

86% of public say childhood obesity is a ‘serious problem’ as leading health campaigners warn faster progress is needed to protect children from health risks of obesity

One year on from the publication of the Government’s landmark childhood obesity plan: chapter 2, the Obesity Health Alliance (OHA) has issued a scorecard to assess the progress, with the majority of vital policies stalled at the amber lights.

OHA Score card June 2019

Childhood obesity continues to be a key priority for the public. ComRes polling data among 2,058 adults in Great Britain shows:

69% agree the new Prime Minister should continue to prioritise reducing childhood obesity
86% agree childhood obesity is a serious problem
76% say they are supportive of government action to reduce levels of childhood obesity
80% say they are worried about the impact of obesity on NHS resources

The Obesity Health Alliance (OHA), which is made up of over 40 leading health charities, medical royal colleges and campaign groups and includes the Institute of Health Visiting, recognise the work that been done by the Government in the last year, despite a complex political environment. But they warn that faster progress is needed in order to have any chance of meeting the Government’s target of halving childhood obesity by 2030.

The Institute commented:

Health visitors are in an ideal position to promote healthy weight, healthy nutrition with all families with babies and pre-school children. However, the current variation in capacity and service models has led to many families not receiving this support. Without in investment in front-line provision such as health visiting, childhood obesity will continue to be a serious public health problem.

Lack of consistent advice on healthy weight and nutrition in the early years has been compounded by closure of child health clinics across England where parents and carers would previously have been offered support and guidance from their health visiting service. The iHV calls for urgent action to consider the impact of the current closures and cuts to front-line health visiting services.

The most recent trends in life expectancy in England present a slowdown in the reduction of mortality rates for heart disease and stroke, which are strongly associated with being overweight and obesity. It is therefore a serious concern that there is a stall in the reduction of childhood obesity. Our children are our future and without investment in front-line public health services like health visiting, as part of a whole system approach to tackle childhood obesity, we will continue to see life expectancy fall for those in the most deprived parts of our society.

Read the full OHA press release

iHV welcomes Childhood obesity: a plan for action, chapter 2

Part 2 of the government’s plan for action to significantly reduce childhood obesity by supporting healthier choices was published this week.

This publication outlines the actions the government will take towards its goal of halving childhood obesity and reducing the gap in obesity between children from the most and least deprived areas by 2030. Building on the first chapter of the childhood obesity plan, the new measures include proposals to counter ‘pester power’ by preventing stores from displaying unhealthy food at checkouts or including it in buy-one-get-one-free deals.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The Institute of Health Visiting welcomes the tightening of the update plan for Childhood Obesity. It is crucial that the preventative measures outlined are actioned with speed to ensure that all children in the UK are able to thrive and develop to their full potential.

“Tackling the wider factors that impact on obesity is crucial and we applaud the move to target advertising. The need to work across all sectors who provide “food away from home” is crucial and proposals to work with schools are well placed, we trust that these actions will also include early years providers – both state and private nursery provision, as the early years are crucial in the development of healthy weight in the later years.

“Whilst it is not explicitly stated there is a need to ensure that the revised actions have a focus on the early years (0-5 years) as we know from research that the influence of early nutrition and eating patterns is directly correlated with obesity in later years. To support this it will be crucial to consider the early year’s health and social care work force in the development of training proposed in this update.”

The government is calling on industry to recognise the harm that adverts for foods high in fat, sugar and salt can cause. It will consult on introducing new TV and online advertising restrictions to prevent children from being targeted by these unhealthy products, and to incentivise companies to reduce the sugar and calories in the products they sell.

The second chapter of the plan also promotes a new national ambition for every primary school to adopt a daily ‘active mile’ initiative, such as the Daily Mile.

Go to DHSC Guidance - Childhood obesity: a plan for action, chapter 2

PHE – National Child Measurement Programme (NCMP) Local Authority Profile

The NCMP Local Authority Profile online data tool for child obesity for England was updated on 9 January 2018. This annual update adds data for the academic year 2016 to 2017 at local authority (LA) level. It also includes a new ‘severe obesity’ indicator, not reported on separately before. Severely obese children are at risk of developing a number of serious acute and chronic health problems. These children therefore pose a significant concern in terms of their health and well-being, and may require the provision of specialist services. Although in relative terms the prevalence of severe obesity is low, in absolute terms this represents a large number of children nationally (14,787 Reception children and 22,646 Year 6 children). Severe obesity prevalence in children has strong associations with ethnic group, deprivation and sex and there is significant variation in prevalence across the country.

The NCMP tool displays prevalence of obesity, overweight, healthy weight and underweight at local, regional and national level over time, for children in Reception (aged 4 to 5 years) and Year 6 (aged 10 to 11 years). Users can compare LA data by region or between ‘CIPFA nearest neighbours’ (LAs with similar characteristics). The tool also presents inequalities in obesity prevalence by sex, deprivation and ethnic group by LA. In addition trend data for England, for obesity prevalence and overweight (including obese) prevalence in boys and girls has been brought together in one place. A short statistical commentary can be found here

Go to NCMP Local Authority Profile online data tool

PHE Guidance – Health matters: obesity and the food environment

New guidance published today (31 March) by PHE on obesity and the food environment.

Nearly two-thirds of adults (63%) in England were classed as being overweight (a body mass index of over 25) or obese (a BMI of over 30) in 2015. Nearly a third of children aged 2 to 15 are overweight or obese and younger generations are becoming obese at earlier ages and staying obese for longer.

PHE Obesity in Children infographic

Obesity is a complex problem with many drivers, including:

behaviour
environment
genetics
culture

New Guidance

This guidance covers:

Health Committee: Government is missing important opportunities to tackle childhood obesity

The Government needs to take more robust action to tackle the impact of deep discounting and price promotions on the sales of unhealthy food and drink, says the Health Committee in its follow up report into childhood obesity.

The Government’s plan to tackle childhood obesity was published in August 2016. Although the Health Committee welcomes the measures the Government has announced on the sugary drinks levy, they are extremely disappointed that several key areas for action that could have made the strategy more effective have not been included.

The soft drinks industry levy

The Committee also calls on the Government to ensure that manufacturers pass on the cost of the levy to ensure that there is a price differential at the point of sale between high- and low- or no-sugar drinks.

The report welcomes the Government’s positive response to the Committee’s recommendation that the proceeds of the soft drinks industry levy should be directed towards measures to improve children’s health including through increasing access to school sports and to breakfast clubs.

Read full news story on Parliament website

3 in 5 of England’s most deprived boys will be overweight or obese by 2020

Stark new figures from the Obesity Health Alliance, released on World Obesity Day, show a looming significant weight gap between the poorest and wealthiest primary-school aged boys living in England. Three in five (60%) of the most deprived boys aged 5-11 are predicted to be overweight or obese by 2020, compared to about one in six (16%) of boys in the most affluent group [1].

The most deprived girls didn’t however show the same trend, and are projected to have similar obese and overweight prevalence rates to their more affluent counterparts with an average of 1 in 5 girls predicted to be obese or overweight by 2020.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“The Institute of Health Visiting, a member of the Obesity Health Alliance, is concerned about the health outcomes and inequalities for young children. World Obesity Day is an opportunity is an opportunity to shine a light on a hugely important public health issue. Health visitors with enough time resource can have a significant impact on the development of positive family eating habits.”

Eating or drinking too much sugar is a key reason for consuming extra calories and therefore a cause of obesity. Sugar currently makes up 13% of children’s daily calorie intake, while the official recommendation is no more than 5% [2]. This is why the Obesity Health Alliance fully supports the Government’s Soft Drinks Industry Levy, which is an important step to help make our children healthier. The alliance is also calling on food manufacturers to comply with the Government’s programme to reduce the sugar in food eaten often by children and wants to see loopholes closed to protect children from exposure to junk food marketing online and on TV.

Read the full Obesity Health Alliance press release

PHE: Child Obesity Local Authority Profile Tool

Child obesity data from 2006/07 to 2014/15 are now available in an online child obesity local authority data tool from PHE.

The tool provides local authority level child data (underweight, healthy weight, obese, excess weight – overweight including obese) for Reception (aged 4–5yrs) and Year 6 (aged 10–11yrs).

The tool also presents trend data and enables easy comparison of local authority data, allowing users to compare regional neighbours and local authorities with similar characteristics. For the first time, the tool now includes inequality data (sex, deprivation and ethnic group).

Go to NCMP Local Authority Child Data Profile Tool on PHE Obesity website

baby being weighed