Nestlé has been criticised for adding sugar and honey to infant milk and cereal products sold in many poorer countries. The Swiss food giant controls 20% of the baby-food market, valued at nearly US$70 billion.
Nadine Dreyer asked public health academic Susan Goldstein why extra sugar is particularly bad for babies and why she thinks multinationals target low-income countries with sweeter products.
Why has Nestlé been criticised?
Public Eye, a Swiss investigative organisation, sent samples of Nestlé baby-food products sold in Asia, Africa and Latin America to a Belgian laboratory for testing. The laboratory found in many cases that baby formula with no added sugar sold in Switzerland, Germany, France and the UK contained unhealthy levels of sugar when sold in countries such as the Philippines, South Africa and Thailand.
As the Public Eye investigation revealed, one example of this is Nestlé's biscuit-flavoured cereals for babies aged six months and older: in Senegal and South Africa they contain 6g of added sugar. In Switzerland, where Nestlé is based, the same product has none.
In South Africa, Nestlé promotes its wheat cereal Cerelac as a source of 12 essential vitamins and minerals under the theme "little bodies need big support". Yet all Cerelac products sold in this country contain high levels of added sugar.
Obesity is increasingly a problem in low- and middle-income countries. In Africa, the number of overweight children under five has increased by nearly 23% since 2000.
The World Health Organization has called for a ban on added sugar in products for babies and young children under three years of age.
Why is extra sugar particularly unhealthy for babies?
Adding sugar make the foods delicious and, some argue, addictive. The same goes for adding salt and fat to products.
Children shouldn't eat any added sugar before they turn two. Studies show that adding sugar to any food for babies or small children predisposes them to having a sweet tooth. They start preferring sweet things, which is harmful in their diets throughout their lives.
Unnecessary sugar contributes to obesity, which has major health effects such as diabetes, high blood pressure and other cardiovascular diseases, cancer and joint problems among others.
The rate of overweight children in South Africa is 13%, twice the global average of 6.1%.
These extra sugars, fats and salt are harmful to our health throughout our lifetime, but especially to babies as they are still building their bodies.
Children eat relatively small amounts of food at this stage. To ensure healthy nutrition, the food they eat must be high in nutrients.
Read more: How South African food companies go about shaping public health policy in their favour
How do multinationals influence health policies?
Companies commonly influence public health through lobbying and party donations. This gives politicians and political parties an incentive to align decisions with commercial agendas.
Low- and middle-income countries often have to address potential trade-offs: potential economic growth from an expanding commercial base and potential harms from the same commercial forces.
Research into how South African food companies, particularly large transnationals, go about shaping public health policy in their favour found 107 examples of food industry practices designed to influence public health policy.
In many cases companies promise financial support in areas such as funding research. In 2023 a South African food security research centre attached to a university signed a memorandum of understanding with Nestlé signalling their intent to "forge a transformative partnership" to shape "the future of food and nutrition research and education" and transform "Africa's food systems".
What happens in high-income countries?
Most high-income countries have clear guidelines about baby foods. One example is the EU directive on processed cereal-based foods and baby foods for infants and young children.
Another is the Swiss Nutrition Policy, which sets out clear guidelines on healthy eating and advertising aimed at children.
The global food system is coming under scrutiny not just for health reasons but for the humane treatment of animals, genetically engineered foods, and social and environmental justice.
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What should governments in developing countries be doing?
South Africa already has limits on salt content but we need limits on added sugar and oil.
Taxing baby foods as we do sugary beverages is another way of discouraging these harmful additions.
We need to make sure that consumers are aware of what's in their food by having large front-of-package warning labels. Take yogurt: many people assume it is healthy, but there is lots of added sugar in many brands.
Read more: Bad food choices: clearer labels aim to help South Africans pick healthier options
Consumers should be calling for front-of-pack labels that the Department of Health has proposed so that parents can easily identify unhealthy foods.
Susan Goldstein, Associate Professor in the SAMRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the Witwatersrand
