Raising awareness of the importance of starting weaning with vegetables

Foreword 3

Preface 4

Chapter 1 – Setting the scene 5

Chapter 2 – The Weaning ‘Window of Opportunity’ 7

Chapter 3 - Vegetables First, Vegetables Frequently and Vegetables in Variety 8

Chapter 4 – What We Want To See 9

Chapter 5 – Conclusion 11

Appendixi. About Ella’s Kitchen 13ii. About the British Nutrition Foundation 13iii. References 14

Contents

I founded Ella’s Kitchen in 2006, with the simple aim of helping babies and young children eat healthily. I began this journey by creating foods for kids that would be healthy, handy and fun, and importantly so that our brand could help improve children’s lives through developing healthy relationships with food.One in five children are now classed as either overweight or obese by the time they start primary school.1 To turn this around, we need to focus our attention on the eating habits of the under-fives and look at the very start of when babies start to explore food - as this is where relationships with food, both good and bad, are formed.Weaning is a key time for babies to develop their taste palate and food preferences. During this time, they’re more accepting of new foods and can quickly learn to like them. The evidence shows that a ‘vegetables first’ approach to weaning can help babies learn to like vegetables, which may help to prevent ‘fussiness’ around these foods as they get older, ensuring little ones receive the valuable nutrients they provide.However, only 36% of UK parents currently wean predominantly with vegetables during the first two weeks.2 As the UK’s leading baby and infant food brand, we want to raise awareness of the evidence that suggests a ‘vegetables first’, ‘vegetables frequently’ and ‘vegetables in variety’ approach to weaning is intrinsically linked to a long-term preference for vegetables.This is why we have launched ‘Veg for Victory’ - a campaign to raise awareness of the importance of vegetables throughout weaning and the impact this could have on little ones’ long-term health.This Greener Paper launches just a few weeks after the Government published its long-awaited Childhood Obesity Plan.3 We welcome any efforts to improve children’s health. However, we were disappointed that the Plan doesn’t include anything around the vital early years’ period, as our research4 has revealed that this is a crucial time for influencing children’s long-term health.We therefore consider this Greener Paper timely, as a complementary touchpoint of evidence-based policy and action recommendations to add to our national debate.This paper outlines the main aims and stakeholder asks of Veg for Victory, as well as the evidence that supports this vegetables first approach to weaning.As a first step, we are calling on Public Health England to enhance existing weaning guidelines to reflect the latest evidence around the importance of vegetables throughout weaning, by promoting a vegetables first, vegetables frequently and vegetables in variety approach.We know that there is no easy answer to addressing the issues surrounding early childhood nutrition, and for sustainable change to occur, we need a long-term co-ordinated strategy that crucially does not ignore the early years. However, introducing vegetables first, frequently and in variety is a simple step that mums and dads can take to help their little ones develop a healthy relationship with food from the very first taste.I’m asking you to join in our campaign and show your support by visiting ellaskitchen.co.uk and by tweeting #VegForVictory.

Paul Lindley Founder and Chairman, Ella’s Kitchen

Foreword

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PrefaceMany organisations, industry bodies and individuals have already taken steps towards helping children eat healthily and encouraging good eating habits, with nutrition-based programmes such as ‘5 A DAY’5 and ‘Change for Life’.6 However, more should be done focusing on the earliest years. We need to help parents and carers understand how infant food preferences develop and how weaning (also known as complementary feeding) is a key time for shaping future eating habits.

Existing scientific evidence7 indicates that repeated exposure to vegetables, offering a wide variety of vegetables and introducing vegetables as first foods during complementary feeding can increase acceptance of these in early life and in later childhood.

We wanted to better understand the complex situation so, in May 2016, we asked the British Nutrition Foundation (BNF) to develop an independent roundtable event, supported by Ella’s Kitchen, to gather the opinions of experts on this issue. A panel of leading academics in infant feeding were brought together to discuss vegetables first weaning and see if a consensus could be reached on the translation of the science into practical messages for parents, carers, policymakers, retailers and the food industry.

The panel’s recommendations were published in Nutrition Bulletin8 (September issue) and this Greener Paper outlines some of those outputs and what Ella’s Kitchen is calling for as a result of those discussions.

Claire Baseley Infant Nutritionist, Ella’s Kitchen

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Chapter 1

Setting the SceneWe are a nation facing an obesity epidemic. A quarter of people in the UK are currently obese and if nothing is done it is expected over half the population will be obese within 40 years.9

The World Health Organisation (WHO) regards childhood obesity as one of the most serious global – and local – public health challenges of today.10 29% of those aged between two and 15 are classified as overweight11 so it is crucial that more is done to improve childhood eating habits.

Whilst there are a number of forces driving these numbers up and waistlines out, poor diet is a key factor, including a low intake of fruit and vegetables.12

Evidence suggests that diets high in fruit and vegetables are associated with reduced risk of obesity as well as cardiovascular disease, hypertension, stroke and some cancers in adulthood. 13

Whilst there is a drive for British children to consume the recommended five portions of fruit and vegetables per day, a typical child eats an average of only 2.9 portions of fruit and vegetables daily.14

The ‘early years’ of childhood lay the foundations for health, growth and development15 and a dislike for and rejection of fruit and particularly vegetables can stem from the early weaning years when we first build our food preferences.

Babies are born with an innate preference for sweet, salty and umami tastes, and tend to dislike bitter or sour flavours16, meaning some foods are less-liked and even rejected from a very young age. Given that the flavour profile of vegetables is more consistent with innate dislikes than likes, they are frequently rejected.17 Conversely, foods that contain higher levels of sugar and salt may be naturally favoured by infants, which could direct them to preferring them over potentially healthier options.

A typical British child eats an average of just 2.9 portions of fruit and vegetables each day.24

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Although children’s food preferences have a genetic component18, evidence indicates that they are strongly influenced by the food environment and the child’s experiences.19 This implies that most children have the potential to learn to enjoy eating fruit and vegetables when they are given the opportunity and encouragement to do so.

When it comes to introducing vegetables, an infant’s initial expression of interest or surprise in response to the food can be misinterpreted as disgust, and as a consequence, parents and carers may cease to offer it.20 Their reaction is often a response to the flavour and texture being new to them and not necessarily an indication that they do not (and never will) enjoy the new type of vegetable. Repeated exposure to a new vegetable flavour is key.

The evidence suggests that delaying introduction of vegetables can make their acceptance more difficult once infants enter the neophobic or picky phase. Many infants from around the age of 12 months will show evidence of neophobia (the fear of new foods), pickiness (eating only a limited number of foods) or both, with vegetables commonly being rejected.21 It is therefore imperative to capitalise on the willingness of young infants to try new foods – such as vegetables – by exposing them to a wide variety of tastes in order to ‘educate the palate’.22

Long-term observational studies follow a child’s eating behaviour for several years, from weaning age upwards. A number of these studies suggest that the food preferences that are established during the complementary feeding phase track into later childhood23, meaning that the relationships children build with certain foods in early years may stay with them for life.

However, current complementary feeding advice from The Department of Health does not focus on the importance weaning plays in shaping children’s long-term food preferences or provide a focus to the importance of vegetables specifically. We are calling for this to change.

Research by Ella’s Kitchen found that only 20% of

babies are given vegetables as their first solid food.25

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The window of opportunity is from the start of weaning up to 9 – 12 months,

when infants acquire and develop their taste preferences. During this period,

it is possible to shape their taste preferences, therefore it is important to introduce them to a broad range of

healthy foods.

The roundtable of experts agreed that babies should be familiarised with a wide

variety of vegetable tastes, as early as possible, once they are ready for

complementary feeding.

Chapter 2

The Weaning ‘Window of Opportunity’During the complementary feeding period, when foods other than breast or formula milk are first offered to a child, there is a distinct ‘window of opportunity’26 for parents and carers to influence food preferences. From the start of weaning to age one, whilst babies may prefer sweet and salty flavours27, it is clear they are willing to consume most new foods.28 The foods that they are exposed to and try during these months can set their food preferences and habits for life.

It is therefore important that infants are offered vegetables as their first weaning foods and then given plenty of vegetables during this crucial period. By following a vegetables-first approach, they can learn to enjoy vegetables and develop good eating habits throughout their childhood and then into later adult life.

Repeated exposure and perseverance is the key to ensuring a broad acceptance of vegetables in these early months and can also help to reduce the risk of neophobia or fussiness later on in childhood.

Ensuring that children develop healthy relationships with food from an early age is an integral step to improving and safeguarding their future health. The complementary feeding period offers a window of opportunity to familiarise taste buds with a wide selection of healthy foods and the preferences formed can track into later childhood.

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*When starting weaning at six months, it is important that iron-rich foods, such as leafy green veg, red meat and pulses, are also offered

Chapter 3

Vegetables First, Vegetables Frequently and Vegetables in VarietyThe complementary feeding period offers a unique window of opportunity for a child to develop a broad, varied and healthy set of food preferences. The scientific evidence indicates that introducing vegetables first, vegetables frequently and vegetables in variety throughout this period can increase vegetable acceptance in early life and in later childhood.30

Vegetables firstThe roundtable participants agreed that introducing a variety of single vegetable tastes at the start of weaning is important for developing acceptance of these flavours and textures in the short and long term.31 Single vegetable tastes should be offered before introducing fruit, as fruits are more typically accepted during complementary feeding due to their sweet flavour. Instead, start by offering small amounts of mashed vegetable tastes, before introducing fruit or cereal mixed with milk.*

Vegetables frequentlyIt can take up to eight tries32 for babies to learn to like vegetable flavours, so perseverance is key. The roundtable agreed that there is good evidence that repeatedly offering a variety of single vegetable tastes throughout weaning and beyond can help infants learn to accept a wide range of vegetable flavours, both immediately and later in childhood.33

Vegetables in varietySweeter vegetables such as carrot or sweet potato are typically easier to introduce to infants, as the flavour profile is closer to that of fruit.34 In order to develop healthier relationships with vegetables, the roundtable participants recommended that mums, dads and carers should try introducing a ‘rainbow’ of vegetables, prioritising less sweet flavours e.g. cauliflower and broccoli to add variety to the diet.35 The panel agreed that offering a wide variety of vegetables during weaning is an effective way to promote acceptance of both vegetables and other new foods in the short term and beyond.36

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Chapter 4

What We Want To SeeIn this paper, we’ve outlined how the complementary feeding period offers a unique window of opportunity to help babies learn to accept new foods. By adopting a vegetables first, vegetables frequently and vegetables in variety approach, they may develop better food preferences, which in turn can improve their health.However, in order to create change and shift the nation’s weaning habits to this approach, we are proposing the following set of recommendations.

We are calling for:

Public Health England to enhance its current guidelines

We’re calling on Public Health England to enhance existing weaning guidelines on the NHS Choices website and in its Start4Life communications to reflect the latest evidence around the importance of a vegetables first, vegetables frequently and vegetables in variety approach to complementary feeding.

The NHS booklet ‘Introducing Solid Foods’ is a key resource for mums, dads and carers and should also be updated to include advice on encouraging babies and infants to accept vegetables.

The Scientific Advisory Committee on Nutrition (SACN) is currently reviewing the literature on complementary feeding and it is expected that government guidance, including the ‘Introducing Solid Foods’ booklet, will be updated after the publication of their report.

We therefore also ask that SACN includes advice on establishing acceptance of vegetables during the complementary feeding period within its forthcoming report.

UK retailers to promote the importance of vegetables in weaning

The Veg for Victory campaign calls on retailers to ensure that there is a wide variety of vegetable-only baby and infant food products available to parents and carers. We also call on retailers to promote a vegetables first approach across all their platforms.

We are calling on Public Health England to enhance its existing weaning

guidelines to reflect the latest evidence around the importance of vegetables throughout weaning, by promoting a

vegetables first, vegetables frequently and vegetables in variety approach.

We ask retailers to promote a vegetables first approach

to weaning in their marketing communications, baby clubs and in-store, providing clear signage and

information to the public.

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Baby food industry to introduce more vegetable only products and update messaging to promote a vegetables first, vegetables frequently and vegetables in variety approach to weaning

The Veg for Victory campaign calls on the baby food industry including parenting websites and baby and children’s food authors and publishers to promote a vegetables first, vegetables frequently and vegetables in variety approach to weaning across their products and communications.

Health organisations to provide more information to health visitors on the vegetables first approach to weaning

The Veg for Victory campaign is calling for relevant health organisations to ensure that health visitors receive more information and training on the importance of a vegetables first approach.

We call upon the nation to help us spread the word about a vegetables first, vegetables frequently and vegetables in variety approach to weaning. Visit ellaskitchen.co.uk for more information and show your support for the campaign by tweeting #VegForVictory

Further support should be given to health visitors, providing them with information, training and guidance on supporting a ‘vegetables first’

approach to weaning.

“I support #vegforvictory promoting the importance of veg in weaning! Helping little ones learn to love veg for life @PHE_UK”

We ask key influencers within the baby food industry from food

manufacturers to parenting websites to commit to promoting a vegetables

first approach to weaning.

Show Your Support

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Chaper 5

ConclusionTo achieve sustainable change, we need a long-term co-ordinated strategy. But it is not just the responsibility of government, we must also see the industry and parents and carers come together to collaborate and help to influence behavioural changes. We are a business that puts social responsibility at its heart. Our mission is to improve children’s lives through developing healthy relationships with food.

We want Veg for Victory to galvanise the nation and inspire everyone about why starting weaning with vegetables is best for little ones. This simple approach helps steer them towards a taste for vegetables which can stay with them throughout childhood and beyond.

We passionately believe that every baby has the right to a great start in life. There is no doubt that there are benefits to starting weaning with vegetables and we’re committed to the cause.

Together, we must ensure that the next generation grows up having a healthy relationship with food so please join us on our mission and support #VegForVictory

Paul Lindley Founder and Chairman, Ella’s Kitchen

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Appendix

i. About Ella’s Kitchen® BrandElla’s Kitchen® Brand mission is to improve children’s lives through developing healthy relationships with food. Set up in 2006 by Ella’s Dad, Paul Lindley, the company prioritises health and nutritional value, but never at the expense of taste or convenience. Ella’s Kitchen® Brand strives to be good in every sense, offering healthy, handy and fun food that doesn’t cost the earth.

Visit www.ellaskitchen.co.uk or www.facebook.com/ellaskitchen for more information.

The Hain Celestial Group, Inc.The Hain Celestial Group (NASDAQ: HAIN), headquartered in Lake Success, NY, is a leading organic and natural products company with operations in North America, Europe and India. Hain Celestial participates in many natural categories with well-known brands that include Celestial Seasonings®, Earth’s Best®, Ella’s Kitchen®, Terra®, Garden of Eatin’®, Sensible Portions®, Health Valley®, Arrowhead Mills®, MaraNatha®, SunSpire®, DeBoles®, Casbah®, Rudi’s Organic Bakery®, Gluten Free Café™, Hain Pure Foods®, Spectrum®, Spectrum Essentials®, Walnut Acres Organic®, Imagine®, Almond Dream®, Rice Dream®, Soy Dream®, WestSoy®, The Greek Gods®, BluePrint®, FreeBird®, Plainville Farms®, Empire®, Kosher Valley®, Yves Veggie Cuisine®, Europe’s Best®, Cully & Sully®, New Covent Garden Soup Co.®, Johnson’s Juice Co.®, Farmhouse Fare®, Hartley’s®, Sun-Pat®, Gale’s®, Robertson’s®, Frank Cooper’s®, Linda McCartney®, Lima®, Danival®, Joya®, Natumi®, GG UniqueFiber®, Tilda®, JASON®, Avalon Organics®, Alba Botanica®, Live Clean® and Queen Helene®. Hain Celestial has been providing A Healthier Way of Life™ since 1993. For more information, visit www.hain.com

ii. About The British Nutrition Foundation The British Nutrition Foundation (BNF) was commissioned by Ella’s Kitchen to conduct an independent review of the scientific literature on the development of preferences for vegetables during complementary feeding. Following the publication of a peer-reviewed paper in Nutrition Bulletin presenting the evidence-base on this topic, BNF invited leading infant feeding experts to a roundtable event to gather views on the translation of the science into practical messages for parents/carers. The consensus report from this meeting is also published in Nutrition Bulletin.

The BNF a registered charity, delivers impartial, authoritative and evidence-based information on food and nutrition. Its core purpose is to make nutrition science accessible to all, working with an extensive network of contacts across academia, education and the food chain, and through BNF work programmes focusing on education in schools and nutrition science communication.

The key role of BNF’s Council and Trustees is to ensure that the Foundation delivers its charitable aims, is impartial, transparent and acts with integrity. BNF’s Articles of Association require a majority of Council’s members to be leading academics from the nutrition science community, supported by leaders in education, communication and the food chain.

BNF’s funding comes from a variety of sources including EU projects; contracts with national government departments and agencies; conferences, publications and training; membership subscriptions; donations and project grants from food producers and manufacturers, retailers and food service companies; funding from grant providing bodies, trusts and other charities. BNF is not a lobbying organisation nor does it endorse any products or engage in food advertising campaigns. More details about BNF’s work, funding and governance can be found at www.nutrition.org.uk/aboutbnf

iii. References

Reference Number/s Reference

1 ‘National Child Measurement Programme: Detailed Analysis of the 2006/07 National Dataset’, http://www.noo.org.uk, 2006 (accessed 24 June 2016)

2, 25 YouGov Results / ‘Veg for Victory’, Commissioned by Ella’s Kitchen, April 28 20163 Childhood obesity: a plan for action, HM Government, https://www.gov.uk/government/

publications/childhood-obesity-a-plan-for-action, 2016 (accessed 23.08.16)4, 7, 30 Chambers L, Complementary Feeding: Vegetables first, frequently and in variety, 2016,

Nutrition Bulletin, 41: p. 142 – 465 National Health Service Choices 5 A Day, http://www.nhs.uk/livewell/5aday/

Pages/5ADAYhome.aspx, (Accessed 24.06.16)6 National Health Service Choices Change for Life, http://www.nhs.uk/change4life/Pages/

change-for-life.aspx (Accessed 24.06.16)8, 26, 29, 31, 33, 34, 35, 36 Chambers L, Hetherington M, Cooke L, Coulthard H, Fewtrell M, Emmett P, Lowdon J,

Blissett J, Lanigan J, Baseley C & Stanner S, Reaching consensus on a ‘vegetables-first’ approach to complementary feeding, 2016, Nutrition Bulletin. p. 271 - 76

9 Butland B, Tracking Obesities: Future Choices Project Report, 2007, Government Office for Science, 2: p. 6

10 Information On Childhood Obesity, http://www.noo.org.uk/NOO_about_obesity/child_obesity , 2016 (Accessed 27.06.16)

11 World Health Organisation: England Health Survey, 2013, Children’s BMI, Overweight And Obesity, 1: ch. 11, p. 3

12 World Health Organisation: Global Strategy on Diet, Physical Activity and Health http://www.who.int/dietphysicalactivity/fruit/en/index2.html , 2016 (Accessed 27.06.16)

13 Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, Leschik-Bonnet E, Müller M J, Oberritter H, Schulze M, Stehle P & Watzl B, Critical Review: vegetables and fruit in the prevention of chronic diseases, 2012, European Journal of Nutrition, 51: p. 639

14, 24 National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009 – 2011/2012). Public Health England, 2014

15 BNF (British Nutrition Foundation), Nutrition and Development: Short and Long Term Consequences for Health, 2013, Task Force Report

16 Beauchamp GK & Manella JA, Early Flavour Learning and its Impact on Later Feeding Behaviour, 2009, Journal of Paediatric Gastroenterology and Nutrition, 48: p. 26

17 Cooke LJ & Wardle J, Age and Gender Differences in Children’s Food Preferences, 2005, British Journal of Nutrition, 93: p. 744

18 Fildes A, van Jaarsveld C H, Llewellyn C H & Wardle J, Nature and nurture in children’s food preferences, 2014, The American Journal of Clinical Nutrition, 4: p. 99

19 Birch L & Fisher J O, Development of eating behaviours among children and adolescents, 1998, Paediatrics, 101: p. 24-29

20 Barends C, de Vrites J H M, Mojet J & de Graaf C, Effects of repeated exposure to either vegetables or fruits on infant’s vegetable and fruit acceptance at the beginning of weaning, 2013, Food Quality and Preference, 29: p. 157

21 Dovey T M, Staples P A, Gibson E L & Halford J C, Food Neophobia and ‘Picky/Fussy’ Eating in Children: A Review, 2008, Appetite, 50: p.181

22 Schwartz C, Chabanet C, Lange C, Issanchou S & Nicklaus S, The role of taste in food acceptance at the beginning of complementary feeding, 2011, Physiology and Behaviour, 104: p. 646

23 Coulthard H, Harris G & Emmett P, Long-term consequences of early fruit and vegetable feeding practices in the United Kingdom, 2010, Public Health Nutrition, 5: 75-85

27, 28 Schwartz C, Issanchou S & Nicklaus S, Developmental changes in the acceptance of the five basic tastes in the first year of life, 2009, British Journal of Nutrition, 102: p. 1375 – 85

32 Maier A, Chabanet C & Schaal B, Effects of repeated exposure on acceptance of initially disliked vegetables in 7-month old infants, Food Quality & Preference, 18: p. 1023

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For more information, visit ellaskitchen.co.uk@EllasKitchenUK @VegForVictory #VegForVictory