Chocolate Formula: Baby Doesn't Know Best

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The Mead Johnson company, makers of a leading line of infant formulas (Enfamil), has reached, as Marion Nestle wrote here last month, a new low point in the nation's nutrition history by introducing a product called Enfagrow Premium Chocolate. This is a chocolate-flavored version (it also comes in vanilla) of formula designed for toddlers—ages 12 to 36 months, according to the company—as they transition from infancy to early childhood. The can says "Toddler Formula," which is odd since there is no way children 12 months to 36 months even need formula.

Touting its health benefits, the company sells this as follows:

As your child grows from an infant to a toddler, he's probably becoming pickier about what he eats. Now more than ever, ensuring that he gets complete nutrition can be a challenge. That's why we created new Enfagrow PREMIUM Chocolate with Triple Health Guard™. With over 25 nutrients, Omega-3 DHA, prebiotics, and a great tasting chocolate flavor he'll love, you can help be sure he's getting the nutrition he still needs even after he outgrows infant formula.

Triple Health Guard? It sounds like car wax or water proofing for a couch.

Formula companies have long used direct and aggressive consumer advertising to suggest the health benefits of formula feeding, including brain and eye development, to pregnant and new mothers, and they have expanded their market to include toddlers. There are two major concerns. First is that formula marketing undermines breastfeeding, and second, mother's milk cannot be replicated in a laboratory and is uniquely superior for babies, even protecting them against obesity later in life. The American Academy of Pediatrics recommends breastfeeding infants until they turn one year old. Health professionals and child advocates concerned with giving children the best possible start in life—and now those concerned with the prevention of obesity—are working hard to encourage as many mothers as possible to breastfeed without formula supplementation as long as possible.

One after another, health organizations note the proven benefits of breastfeeding, with the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the World Health Organization just beginning the list. Promotion of infant formula undermines a woman's informed decision about how to feed her infant, and therefore can damage the public's health. Moreover, the health claims made for formula products are just that: claims not always backed up by definitive proof. A recent report by the Institute of Medicine made clear that there can be glaring problems with nutrition claims and called for tighter standards. There is special concern over marketing in developing countries by groups like Baby Milk Action.

Far back in time (1981), the World Health Organization developed the International Code of Marketing of Breastmilk Substitutes (click here for a PDF) for these very reasons. The U.S. signed on in 1994. Part of this code involves specific language on the protection and promotion of breastfeeding.

As recently as this week, additional calls have been made for breastfeeding, this time from the White House in a report entitled "Solving the Problem of Childhood Obesity Within a Generation." This report was the work of a task force made up of the top officials in an array of government agencies. The report singes out breastfeeding as a key obesity prevention strategy in saying:

Children who are breastfed are at reduced risk of obesity. Studies have found that the likelihood of obesity is 22% lower among children who were breastfed.

Despite these health benefits, although most (74%) babies start out breastfeeding, within three months, two-thirds (67%) have already received formula or other supplements. By six months of age, only 43% are still breastfeeding at all, and less than one quarter (23%) are breastfed at least 12 months.

The protective effect of breastfeeding likely results from a combination of factors. First, infant formula contains nearly twice as much protein per serving as breast milk. This excess protein may stimulate insulin secretion in an unhealthy way. Second, the biological response to breast milk differs from that of formula. When feeding a baby, the mother's milk prompts the baby's liver to release a protein that helps regulate metabolism. Feeding formula instead of breast milk increases the baby's concentrations of insulin in his or her blood, prolongs insulin response, and, even into childhood, is associated with unfavorable concentrations of leptin, a hormone that inhibits appetite and controls body fatness.

So, along comes Enfagrow Premium Chocolate for toddlers after they "outgrow infant formula." This is a terrible idea. Infants and toddlers do not need formula—they need to transition from mother's milk to eating nutritious table foods, drinking milk, and developing healthy eating behaviors. Furthermore, Enfagrow Premium Chocolate has additives such as DHA (a fatty acid) and prebiotics for digestive health—additives with no proven health benefits. Parents' vulnerabilities are exploited as they worry about their toddlers' growth and health during a critical developmental stage.

Toddlers are unpredictable, and the foods they like one day may be different the next. They may eat a lot some days and very little on others, and tend to be leery of new foods. What toddlers need are understanding and plenty of fruits and vegetables, whole grains, protein, and dairy, presented in a pleasant environment. They do not need an expensive formula supplement drink fortified with 25 nutrients, antioxidants, and prebiotics.

The fact that this product is chocolate-flavored and sweetened with sugar is dreadful. Enfagrow Premium Chocolate has 19 grams of sugar (4.5 teaspoons) per seven-ounce serving. With obesity rampant around the world, we do not need children being introduced at young ages to hyper-sweet and hyper-palatable foods like sugar-sweetened fortified chocolate milk. It is not likely to bode well for subsequent eating habits and food preferences.

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Presented by

Kelly Brownell and Mary Story

Kelly Brownell is a psychology professor at Yale University, where he also serves as director of the Rudd Center for Food Policy and Obesity. Mary Story is a professor in the Division of Epidemiology and Community Health at the University of Minnesota. More

Kelly Brownell is a professor in the Department of Psychology at Yale University, where he also serves as Professor of Epidemiology and Public Health and as Director of the Rudd Center for Food Policy and Obesity. In 2006, TIME magazine listed him among "The World's 100 Most Influential People" in its special TIME 100 issue featuring those "whose power, talent or moral example is transforming the world."

Dr. Brownell was elected to membership in the Institute of Medicine in 2006 and has served as President of several national organizations, including the Society of Behavioral Medicine, Association for the Advancement of Behavior Therapy, and the Division of Health Psychology of the American Psychological Association. He has received numerous awards and honors for his work, and he has published 14 books and more than 300 scientific articles and chapters. One book received the Choice Award for Outstanding Academic Book from the American Library Association, and his paper on "Understanding and Preventing Relapse" published in the American Psychologist was listed as one of the most frequently cited papers in psychology. Dr. Brownell has advised the White House, members of congress, governors, world health and nutrition organizations, and media leaders on issues of nutrition, obesity, and public policy.

Mary Story PhD, RD is a professor in the Division of Epidemiology and Community Health at the University of Minnesota, Associate Dean for Student Life and Leadership in the School of Public Health, and an adjunct professor in the School of Medicine's Department of Pediatrics. She is director of the national program office for the Robert Wood Johnson Foundation Healthy Eating Research program that supports research on environmental and policy strategies to promote healthy eating among children to prevent childhood obesity. Dr. Story's PhD is in nutrition science and her interests are in the areas of child and adolescent nutrition, and childhood obesity prevention.

Dr. Story has conducted numerous school and community-based obesity prevention studies. She has over 350 scientific publications in child nutrition and obesity prevention. Dr. Story was a member of the Institute of Medicine, Committee on Food Marketing and the Diets of Children and Youth; Committee on Nutrition Standards for Foods in Schools; Committee on Childhood Obesity Prevention Actions for Local Governments; and is currently on the IOM Standing Committee for childhood obesity prevention and the Committee on Examination of Front-of-Package Nutrition Rating Systems and Symbols. She has received numerous awards for her research and work in the field of child and adolescent nutrition.
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