There is not much that seems more docile than store-bought baby food. It’s soft, smooth… and sweet. Therein lies the problem. While sugary beverages and advertising to children is regulated, the sugar in their first store-bought solid meal is not.

South Africa’s rate of childhood obesity is double that of the global average, yet the vast majority of processed baby foods on its supermarket shelves have unacceptably high levels of sugar as defined by international recommendations. Consistent exposure to these high levels of sugar may have an impact on the infant’s physical and mental health far beyond their childhood.

Babies are born with two taste preferences – one is sweet, the other is savoury. It’s lucky then that breast milk is naturally sweet and is also all a baby needs to survive in the first six months of life. They do not need water nor solid food as they get all the nutrients and fluid they need from this milk. Even in hot climates, the breast milk contains all the water the baby requires.

Breast milk is not forever. After six months, babies are introduced to complementary foods to get them used to different tastes, smells and textures while being weaned off the milk. They begin to eat soft cooked starch such as potato, vegetables like butternut, fruit like avocado and meat like boneless fish.

Through a teaspoon or two a day of different food they begin to experience different variations on sweet and salty. Although they are drawn to these two tastes, it doesn’t mean they won’t or shouldn’t eat anything else.

“Food for babies is a combination of taste, smell and texture and they will get used to it,” explains Dr Anthony Westwood, an associate professor at the University of Cape Town who heads the Department of Paediatrics at New Somerset Hospital and sits on provincial and ministerial paediatric committees.

“In general, most children will try most non-bitter and non-sour tasting food although they might not like it the first time. So, that sweet preference doesn’t equal sweet is best. Sweet could be the easy way out, but that is not what a responsible parent should be doing for their child.

“The sweet preference is there but is adaptable and does adapt pretty easily over that second half of the first year of life.”

However, home-cooked baby food is often replaced by their processed, store-bought counterparts.

“People buy it [baby food] mostly for convenience and also because they have lost faith in their own abilities to cook and feed their children properly,” explains Dr Lisanne du Plessis, an associate professor in Community Nutrition in the Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences at Stellenbosch University. Her research focuses on maternal, infant and young child nutrition.

Dr Westwood concurs.

“Processed baby food is popular because it is convenient – someone else has done the hard work. They have done the breaking down, mixing and putting it in a bottle so that you can put in the teaspoon and out it comes.”

While it may save time, it may cost an infant’s health. Researchers from PRICELESS SA and the School of Public Health at the Faculty of Health Sciences at the University of Witwatersrand analysed the sugar content data on the packaging of over 200 commercial baby food products aimed at children under the age of 12 months sold in South African supermarkets. While reducing sugar consumption has been high on the public agenda, they argued that sugar in baby food had been overlooked.

They found that almost three quarters of the baby foods did not have added sugar. However, total sugar content was high in 78.7% of the products. They point to the fact that more than 30% of the baby food sampled was pureed fruit. Fruits are high in natural sugars, so this is expected, but it does not necessarily waive the potential health risks.

Beyond sugar levels, the researchers also analysed the level of ease to interpret and compare the information on the packaging. They found that most products adhered to South African labelling standards, but none had front-of-pack nutritional information and did not break down the different types of sugar in the product.

Dr Karen Hofman, a contributing author on the research paper and the director of PRICELESS SA and a paediatrician who has consulted for the World Health Organisation (WHO), explained:

“One of the biggest problems is that the current labels are on the back of the item, in tiny font and aren’t comparable. I can barely read it, understand it and compare it. You have to do a whole lot of mental arithmetic. It is unreasonable to expect the general public to just swallow whatever they’re given,” Dr Hofman said.

They concluded that most baby foods are sweet in taste and have high amounts of sugar. This creates an environment that encourages a sweet-taste preference with few regulations in place to make labels easier to understand to allow consumers to make better informed decisions.

The WHO’s first and foremost recommendation to prevent childhood obesity is to manage a child’s diet so that it is not high in sugar, salt and fat. Reducing sugar intake to less than 10% of total daily energy intake for children and adults has been on WHO’s agenda since the 1980s.

“We have solid evidence that keeping intake of free sugars to less than 10% of total energy intake reduces the risk of overweight, obesity and tooth decay,” says Dr Francesco Branca, Director of WHO’s Department of Nutrition for Health and Development.

So much so that they have strongly recommended the above, meaning that this guideline can be adopted as policy in most situations around the world. Nonetheless, only one in five baby foods on South African shelves have acceptable levels of sugar as defined by the WHO.

These highly sugary foods give the infants more energy than they can expend with little nutrients to boot.

“The sugar will be converted into fat, unless they are using a large amount of energy by jumping up and down which babies of that age are not yet doing,” says Dr Westwood.

‘The baby will be less satisfied with those sugars and be hungry again sooner because they metabolise so quickly. You’re likely to end up with a child which has too many calories in general, so they end up putting on too much weight.”

The WHO explains that obese children are more likely to develop health problems such as cardiovascular disease, insulin resistant, osteoarthritis and come cancers.

Dr Westwood explains that an obese child is much more likely to become an obese adult.

“The body would have maladapted to sugar and the ‘sweet tooth’ becomes a learnt thing particularly if sweet food was given as a reward. The sweetness is seen as a reward and becomes associated with pleasure and delight. They wouldn’t yet know about the diabetes. The overeating becomes habitual for the rest of life,” he explains.

However, carbohydrates and fruit still need to form part of complementary food in the first 12 months of life.

“Carbohydrates in general are essential for growth and takes up the biggest proportion of most diets… Our bodies are designed to break down starch slowly. Large amounts of sucrose and glucose make it more difficult for the body to control the sugar levels in the blood and so it has to put out hormones to deal with that all the time and that can be bad for a child who has a whole life ahead of them,” explains Dr Westwood.

“Fruit contains fructose which is metabolised in a different way to pure sugar. They take it at the same time as fibre which slows down the absorption. This means they don’t get those peaks in their glucose levels. Pairing them with other foods means the stomach is not just dealing with one easy to assimilate food. It’s a question of moderation and balance,” he adds.

The Road to Health booklet given to parents by the Department of Health when a baby is born recommends giving the infant home-made food and no sugar water, cool drink, chips, sweets, tea or coffee. They state that “…it is not necessary to buy baby food or baby cereals”.

In addition, the Regulations Relating to Foodstuffs for Infants and Young Children of 2012 aimed “to protect and support optimal infant and young child feeding practices” by encouraging and helping exclusive and sustained breastfeeding while making sure that commercially processed foods are safe and comply with quality standards. It also limits marketing of formula, complementary foods, drinks and feeding equipment which may be misleading.

“Making food for your child is a greatly positive thing for your self-esteem and self-compassion, it is efficient if you are counting the pennies and you know what’s in there,” says Dr Westwood.

Dr Du Plessis agrees.

“The reliance on processed food and especially processed baby food should be questioned. All processed baby foods are not necessarily cheap. Parents can prepare food that the whole family can enjoy. We should rekindle our relationship with home-prepared food and home-cooked meals, as often as is viable and possible in our busy lifestyles.” DM