by Marion Nestle

Currently browsing posts about: Infant-formula

Mar 3 2022

Infant formula marketing: an update

As the WHO/UNICEF report I posted yesterday makes clear, the marketing of infant formula—impossible for new mothers to avoid—interferes with breast feeding and, therefore, is a public health concern.

I posted about the Abbott Labs infant formula recall last week.

Here are some additional items I’ve collected on this topic.

I. What the marketing looks like.

II. Study finds no benefit of enriched infant formula on later academic performance: Children who are given nutrient or supplement enriched formula milk as babies do not appear to have higher exam scores as adolescents than those fed with standard formula, suggests a study published by The BMJ, leading researchers to argue renewed regulation is needed to better control infant formula promotional claims…. Read more

III. IBFAN, the International Baby Foods Action Network, writes that it is:

launching a PETITION calling for an immediate halt to a new study – funded by the Gates Foundation and led by researchers from the University of California – that is randomly allocating infant formula to breastfeed in low-birth-weight babies in Uganda and Guinea-Bissau on assumption that this might prevent wasting and stunting.

The study, which has been cleared by ethics committees in the USA, Uganda and Guinea -Bissau – uses purchased ready-to-use infant formula made by Abbott, a US pharmaceutical corporation operating in 160 countries. Abbott is a major violator of the International Code and is currently at the centre of a media storm in the USA because of contamination in its powdered formula. (NB. The formula used in the trial is liquid Ready-to-Feed).

IV. IBFAN issued an earlier statement: The baby food industry’s destruction of an irreplaceable natural resource.

The International Code of Marketing of Breastmilk Substitutes was adopted forty years ago by the World Health Assembly, the world’s highest health policy setting body…Today 70% of countries have adopted laws based on the Code, however far too many are limited in scope and full of loopholes as a result of industry interference. As a consequence predatory marketing of baby food products continues throughout the world. and the global Baby Food Drink Market is forecast to rise more than 30% in 5 years (from $68bn in 2020 to $91.5bn by 2026)….Aside from its crucial role in child survival (more than 800,000 children die each year because they are not breastfed and many more do not reach their full potential, breastfeeding is the most environmentally friendly way to feed an infant, resulting in zero waste, minimal greenhouse gases, and negligible water footprint. As a renewable natural food resource, mother’s milk makes an important contribution to local food and water security.…the baby food industry lost no time in exploiting the fear and confusion during the pandemic: falsely claiming their products build immunity; that their ‘donations’ are humanitarian; encouraging the needless separation of mothers and babies and pretending that they are essential ‘partners’ who are genuinely working to address the problems.

V. The Access to Nutrition Initiative (ATNI) assesses nine formula companies’ adherence to WHO recommendations. Its report is here.

According to its press release,

Despite the World Health Assembly (WHA) adopting ‘The International Code of Marketing of Breast-milk Substitutes’ forty years ago and passing 18 associated resolutions since (collectively referred to as ‘The Code’), the BMS/CF Marketing Index 2021 found that none of the companies it assessed fully abides by The Code’s recommendations and most fall well short.

The summary:

Danone retained first place with a score of 68%, up from its 2018 score of 46%

Nestlé, the market leader in sales value, retained its second place with a score of 57% – also a substantial improvement on its score of 45% in 2018

KraftHeinz achieved the greatest improvement, ranking third, with a score of 38% compared to in 2018 when it didn’t score at all

Reckitt (previously RB) substantially improved its BMS Marketing policies which led to a big jump in its score from 10% in 2018 to 32% in 2021 and climbing one place to fourth in the ranking.

VI. A study: Conflicts of interest are harming maternal and child health: time for scientific journals to end relationships with manufacturers of breast-milk substitutes. Pereira-Kotze C, et al. BMJ Global Health. 2022 Feb;7(2):e008002. doi: 10.1136/bmjgh-2021-008002

The promotion and support of breastfeeding globally is thwarted by the USD $57 billion (and growing) formula industry that engages in overt and covert advertising and promotion as well as extensive political activity to foster policy environments conducive to market growth. This includes health professional financing and engagement through courses, e-learning platforms, sponsorship of conferences and health professional associations and advertising in medical/health journals…journal publishers may consciously, or unconsciously, favour corporations in ways that undermine scientific integrity and editorial independence—even perceived conflicts of interest may tarnish the reputation of scientists, organisations or corporations. Such conflicts have plagued infant and young child nutrition science for decades.

Comment: As I mentioned yesterday, we now have more than enough evidence to put a stop to this.

Tags: Infant-formula, Marketing to kids

Mar 2 2022

Marketing infant formula: an important report from WHO and UNICEF

WHO and UNICEF have issued a new report: “Examining the impact of formula milk marketing on infant feeding decisions and practices.”

The website summarizes the main message: “More than half of parents and pregnant women [are] exposed to aggressive formula milk marketing.

The report finds that industry marketing techniques include unregulated and invasive online targeting; sponsored advice networks and helplines; promotions and free gifts; and practices to influence training and recommendations among health workers. The messages that parents and health workers receive are often misleading, scientifically unsubstantiated, and violate the International Code of Marketing of Breast-milk Substitutes (the Code) – a landmark public health agreement passed by the World Health Assembly in 1981 to protect mothers from aggressive marketing practices by the baby food industry.

The press release explains:

The largest ever study of its kind, it draws on surveys with over 8 500 pregnant women and mothers of young children (aged 0-18 months) across eight countries, and more than 300 health professionals. The study…conducted in eight countries…exposes the aggressive marketing practices used by the formula milk industry, and highlights impacts on families’ decisions about how to feed their infants and young children.

The report begins with this prose poem:

The report’s main findings:

Formula milk marketing is pervasive, personalized, and powerful.
Formula milk companies use manipulative marketing tactics.
Formula milk companies distort science and medicine.
Industry systematically targets health professionals.
Formula milk marketing undermines parents’ confidence in breastfeeding.
Counter-measures can be effective.

Videos posted on Twitter.

For Infographics, scroll down on this link.

Comment: This is an important, timely report. Advocates have been complaining about the ways infant formula companies market their products for decades. It’s way past time to intervene.

More on infant formula marketing tomorrow.

Tags: Infant-formula, marketing

Feb 22 2022

Urgent! Recall of infant formula: check those product numbers now

The FDA is advising consumers not to use Similac, Alimentum, or EleCare powdered infant formulas if:

the first two digits of the code are 22 through 37; and
the code on the container contains K8, SH or Z2; and
the expiration date is 4-1-2022 (APR 2022) or later.

The FDA and CDC are investigating.

[They have received] four consumer complaints of infant illness…All of the cases are reported to have consumed powdered infant formula (IF) produced from Abbott Nutrition’s Sturgis, MI facility. These complaints include three reports of Cronobacter sakazakii infections and one report of Salmonella Newport infection in infants. All four cases related to these complaints were hospitalized and Cronobacter may have contributed to a death in one case.

Bill Marler’s Food Poison Journal has more about Cronobacter sakazakii (formerly known as Enterobacter sakazakii) in infant formula.

The FDA reports:

On 2/17/2022, Abbott Nutrition initiated a voluntary recall of certain powdered infant formulas. Products made at the Sturgis facility can be found across the United States and were likely exported to other countries as well. Canadian health officials have also issued a recall warning.

Helena Bottemiller Evich, writing in Politico, is right on top of this situation.

The FDA first received a report of a foodborne illness suspected to be linked to infant formula in September — four months before issuing a recall of three major brands this week after four babies were hospitalized and one died, according to a state agency.

The [recall]…comes after reports of illnesses came to FDA and the Centers for Disease Control and Prevention between September and January. The Minnesota Department of Health investigated a case of an infant who was sickened by Cronobacter sakazakii in September 2021, the state agency told POLITICO.

She also Tweeted:

I’ve gotten a bunch of reports that the formula recall includes these (often unsolicited) packs that formula companies send new parents. So check those, too!

Warning to parents: if you are using any Abbott formula products, check the labels. Do not feed recalled products to your infant.

Comment: Anything wrong with infant formula is a terrible problem because that’s all infants are fed and they are completely dependent on those products. We will have to wait and see why the FDA:

Did not push Abbott to recall these products four months ago.
Did not mention the gift pack of formula given to new mothers.

And Bill Marler writes: “I have some questions about the Cronobacter and Salmonella infant formula outbreak: Why are illnesses not universally reportable and why was there a two year gap in FDA inspections at plant?”

Also worrying is that the FDA still does not have the authority to demand immediate recalls of potentially harmful products.

The Food Safety Modernization Act gave the FDA recall authority, but tied its hands.

FSMA’s mandatory recall authority allows the FDA to mandate a recall when a responsible party chooses not to conduct a voluntary recall when the criteria under section 423 of the FD&C Act are met. The FDA can use its mandatory recall authority when the FDA determines that there is a reasonable probability that an article of food is adulterated under section 402 of the FD&C Act and/or misbranded under section 403(w) of the FD&C Act and where there is a reasonable probability that the use of or exposure to such food would cause SAHCODHA.

You will be amused to know that SAHCODHA stands for Serious Adverse Health Consequences or Death to Humans or Animals.

Tags: FDA, Food-safety, Infant-formula

Oct 7 2021

Yes, you can make ice cream from infant formula and breast milk

Last week, I posted a list of articles about odd ice cream flavors, mostly Lithuanian. Several readers pointed out that the links all went to the same article (oops, my bad).

They particularly wanted to see the ones about ice cream made from infant formula and breast milk.

Really? People do this? Yes, they do.

Especially in the UK.

If you are in the UK, you can buy commercial products, like one “made with love in the Lake District.”

Or you can make your own with breast milk or formula. A company tried this in 2011, but got into trouble over safety issues.

It’s pretty easy to do this at home.

Have on hand:

A banana or other fruit, sliced.
2 ounces of breast milk or formula.
A blender.

Freeze the fruit.

Place frozen fruit in the blender. Slowly add breast milk or formula.

Blend until the mix reaches a soft serve texture.

Serve immediately or store in freezer.

Note: no unhealthy additives. Teething babies might like it.

Tags: Baby food, Breast-feeding, Infant-formula

Aug 2 2021

Unethical food marketing ad of the week: infant formula, organic no less

When my partner, Mal Nesheim, showed me this ad in Sunday’s New York Times, I had two immediate questions.

Question #1: Who paid for this?

The answer: Bobbie’s Infant Formula “inspired by a mom’s choice.”

When I went to the website, I learned that Bobbie’s infant formula is organic. I am greatly in favor of organics, but just as organic junk food is still junk food, organic infant formula is still infant formula.

Breast feeding isn’t easy in today’s society and yes, some mothers (and fathers, of course) can’t do it.

But breast feeding is unquestionably best for babies. Mothers who can breast feed need all the help and encouragement they can get.

That’s why this week has been designated World Breastfeeding Week.

Breastfeeding mothers do not need to be undermined by infant formula marketing.

If Nestlé (no relation) or the other leading infant formula manufacturers put an ad like this in the paper, the result would be worldwide outrage. This leads to my second question.

Question #2: Doesn’t this ad appear to violate the World Health Organization’s International Code of Marketing of Breast-milk Substitutes?

OK, so the ad does not display infant formula products or even say that Bobbie’s is an infant formula company, let alone an organic one. But it doesn’t take much to figure both out.

Recall the Nestlé boycott of the 1980s, a worldwide boycott of the company because of the way it marketed infant formula to women in low-resource countries without clean water supplies. The women were unable to use the products safely; contaminated or improperly diluted infant formula sickened and killed babies.

Opposition to Nestlé’s marketing strategies led to development of Marketing Code, now ratified by all WHO member nations (the United States and South Africa were the two holdouts, but both eventually agreed).

The boycott was so damaging to Nestlé’s sales and reputation that the company discusses it and defends its current marketing practices on its website.

If you have any concerns about our breast milk substitutes marketing practices, we encourage you to raise them with us so that we can continue to improve.

I’d say this Bobbie ad is morally and ethically wrong on four counts:

It undermines breast feeding
It directly undermines the intent of World Breastfeeding Week.
It violates the spirit if not the letter of the International Marketing Code.
It organic washes—it implies that because its products are organic, this company is above the Code.

This is the kind of marketing that gives organics a bad name.

Bobbie’s should not be doing this.

Time for another boycott?

Tags: Breast-feeding, Infant-formula, Organics

Jun 21 2021

Danone-funded consensus statement: “Growing up” formulas, Brazil style

The Consensus Statement: Consensus of the Brazilian Association of Nutrology on Milky Feeding of Children Aged 1–5 Year Old. International Journal of Nutrology. 2020; 13 (01): 002-016.

Purpose: “To publish a consensus on the milky feeding of children aged between 1 and 5 years old, in the face of the nonuniformity of indication and the lack of standardization, in Brazil, on the nomenclature and classification of milky products produced for this stage.”

Method: Literature review and members discussion.

Result: Nutritional deficiencies are common among Brazilian children.

Recommendations (among many others)

Recognize milk-based weaning products as a category separate from infant formula.
Consider milk-based weaning products as a strategy for providing additional nutritional advantages over cow’s milk (they they are fortified with essential nutrients).

Conflicts of interest: The Brazilian Association of Nutrology has received financial support from the company Danone Nutricia to enable this consensus to be achieved by supporting the expenses inherent to the execution of the project. The authors expressly state that there was no interference by the company Danone Nutricia in the content of the material and all the information contained in the consensus represents exclusively the views of the authors and of the Brazilian Association of Nutrology, based on the bibliographic review used for its execution.”

Acknowledgments: The Brazilian Association of Nutrology thanks the company Danone Nutricia for the financial support that allowed this consensus to be reached.

Comments: Danone paid for a consensus statement that conveniently promotes its formula and weaning products. The company markets its products (overtly and by implication) as having nutritional advantages over breastfeeding and traditional foods.

The consensus statement supports that implication, even though it also recommends promotion of breastfeeding and control of misleading marketing.

Some other points to note:

The Brazilian Association of Nutrology members are not nutritionists; they are medical professionals who specialize in nutrition.
The statement does not say much about healthy diets for children or the need to minimize kids’ intake of ultra-processed foods. Instead, it mandates Danone’s milk-based products, which meet the definition of ultra-processed (industrially produced, made with ingredients unavailable in supermarkets, cannot be made in home kitchens).
Here, for example, is the ingredient list for Aptamil 2.

Dairy-based blend (of which 28% is fermented) [Lactose (from milk), Vegetable oils (Palm oil, Coconut oil, Rapeseed oil, Sunflower oil, High oleic sunflower oil), Skimmed milk, Demineralised whey (from milk), Whey concentrate (from milk), Calcium phosphate, Fish oil, Potassium chloride, Potassium citrate, Calcium carbonate, Choline chloride, Vitamin C, Sodium citrate, Emulsifier (Soy lecithin), Inositol, Magnesium chloride, L-Carnitine, Antioxidant (Ascorbyl palmitate), Nicotinamide, Panthothenic acid, Vitamin E, Riboflavin, Thiamin, Vitamin B6, Potassium iodide, Folic acid, Vitamin K1, Biotin, Vitamin B12], Galacto-oligosaccharides (GOS) (from milk), Fructo-oligosaccharides (FOS), Whey protein (from milk), Magnesium hydrogen phosphate, Oil from Mortierella Alpina, Sodium chloride, Taurine, Ferrous sulphate, L-Tryptophan, Zinc sulphate, Cytidine 5′-monophosphate, Uridine 5′-monophosphate sodium salt, Adenosine 5′-monophosphate, Inosine 5′-monophosphate sodium salt, Guanosine 5′-monophosphate sodium salt, Copper sulphate, Vitamin E, Vitamin A, Manganese sulphate, Sodium selenite, Vitamin D3.

The statement appears to be in response to Brazil’s dietary guidelines, which urge avoidance of ultraprocessed foods.
More specifically, the statement responds to Brazil’s dietary guidelines for children under the age of 2. (the English version is here). These say: “Ultra-processed foods should not be given to children and should be
avoided by adults” (p. 68) and:

Attention: There are products called “growing-up milks” that should not be mistaken for infant formula or
whole-fat cow’s milk…Although the packaging carries the information that these products should not be used to feed children under 1 year of age, in fact they are not intended for children under 2 years of age because of the presence of sugar and food additives. They do not replace breast milk or infant formula. Growing-up milks have packaging and labels that are very similar to those of infant formula, are usually placed next to infant formulas on supermarket and pharmacy shelves and have lower prices. Read the labels carefully.

My conclusion: These products are designed to keep parents buying name-brand products by marketing them as “healthier” than cow’s milk or relatively unprocessed family foods. Avoid.

Many thanks to Brazilian nutritionist, Maria Birman, for alerting me to this one and sending documents and photos.

Tags: Children, Infant-formula

Apr 7 2021

The vintage Coke parody ad strikes again

A reader, Ken Kaszak, sent me a link to a post on Quora Digest featuring this “advertisement,” which I put in quotes because it is not, in fact, an actual Coca-Cola ad; it is a joke at Coca-Cola’s expense.

I know this because I wrote about it in Soda Politics. For starters, the ad says it is produced by “The Soda Pop Board,” but no such trade association exists. Here’s the page from Soda Politics.

I included a footnote that explains where this parody came from: “The origins of the Parody ad are explained by Dryznar J. Favor from clever dudes, March 4, 2004. http://jdryznar.livejournal.com/64477.html. The “Not parody” image was constructed from information from AND at www.eatright.org/corporatesponsors. The parody ad was created by RJ White, as he explains at http://rjwhite.tumblr.com/post/472668874/fact-checking. It was posted at The City Desk: Fictional Urbanism. http://thecitydesk.net/baby_soda_ad.”

Once something like this starts going around, there’s no stopping it, not least because this ad seems so plausible, given the kinds of marketing I describe in my book.

Remember these? They were for real, but fortunately are not around any more. Parents who used these bottles put in them what was on the labels.

Tags: Infant-formula, Marketing to kids, Soft drinks

Jun 9 2020

WHO issues status report on infant formula marketing

he WHO has launched the 2020 Status Report on the National Implementation of the Code of Marketing of Breast-milk Substitutes.

The launch announcement begins:

The COVID-19 pandemic highlights the importance of protecting optimal nutrition, including breastfeeding, to improve child health and survival. Formula manufacturers are exploiting the panic and fears of contagion to intensify their aggressive marketing practices.

In this context, government action to regulate the marketing of breast-milk substitutes has never been greater. The International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions (“the Code”) spell out key legal safeguards against industry practices that undermine breastfeeding.

The summary report provides data on what countries are doing to enforce the Code. For example:

IBFAN, the International Baby Food Action Network, documents how infant formula companies are exploiting the Covid-19 pandemic to push their products. Its press release says:

A new report by WHO, UNICEF, and the International Baby Food Action Network (IBFAN) reveals that despite efforts to stop the harmful promotion of breastmilk substitutes, countries are still falling short in protecting parents from misleading information. WHO and UNICEF call on governments to urgently strengthen legislation on the Code during the COVID-19 pandemic. Governments and civil society organizations should also not seek or accept donations of breast-milk substitutes in emergency situations.

Coronavirus is no excuse for allowing inappropriate marketing of infant formula and weaning food products to continue.

Tags: Coronavirus, Infant-formula

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