World Nutrition

Volume 3, Number 11, November 2012

Journal of the World Public Health Nutrition Association
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Correspondence: Ultra-processed products. Formula

How to protect US children

Access pdf of these letters here
Access pdf of October's commentary here

Sir: Thanks to George Kent for reminding us of the role of infant formula in the broad context of child health (1). Formula is usually forgotten when childhood obesity is addressed. It should be identified and emphasised, along with sugared soft drinks and junk food in general, as well as lack of physical activity, as a major cause of the obesity pandemic, which is currently out of control.

Specifically, George Kent rightly identifies the federal government's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), as the largest purveyor of infant formula in the USA. About half the infants in the country, whose mothers are offered the products for free, are thus in effect doomed to receive largely formula, with all this implies for their health at the time and also later.

The WIC programme does promote breastfeeding. But this obviously does not overcome the attraction of the 'free lunch'. Most studies support common sense and show that low-income mothers offered free formula on the WIC programme, breastfeed their babies less than women not on the programme.

This could be easily redressed, and at no cost to the programme, indeed at a savings. The excuse for providing the formula in the first place, lobbied for in the early 1970s by an infant formula industry that had given up on selling its products directly to low-income Americans because they made low-cost evaporated milk formulations at home, was that it replaces inferior products. Let's suppose this is indeed the goal, rather than enriching the infant formula industry. Then why does it need to be free? All that is needed is to price it slightly below the cost of the cheapest alternative.

I believe this would enable the breastfeeding promotion messages to be effective and dramatically increase the chances for low-income infants to be breastfed.

Ted Greiner
Hanyang University, Seoul, South Korea


  1. Kent G, Ultra-processed products. The trouble starts with baby formula. [Commentary]. World Nutrition, October 2012, 3,10, 450-455. Obtainable at

Please cite as: Greiner T. Ultra-processed products. Formula. How to protect US children. [Letter] World Nutrition, November 2012, 3, 11, 517-518. Obtainable at www.wphna.orgg

Geoffrey Cannon adds: As George Kent indicates and Ted Greiner advocates, the food classification Carlos Monteiro and colleagues at the University of São Paulo including myself have devised, does indeed include baby formula, along with ready-to-consume fatty sugary or salty snacks and sugared soft drinks, as an ultra-processed product (1,2). This is a correct positioning, because all three and other such products are concoctions of industrial and other ingredients.

The issue is vitally important. Yes, being fed on formula does of itself increase the changes of overweight and obesity in childhood and later life. But more than that: being weaned on to formula produced by transnational corporations whose brands include weaning and post-weaning products, and also products aggressively advertised and promoted at older children, altogether creates the habit of constant consumption of ultra-processed products. The transnationals 'want to teach the world to snack' (3,4) and they are succeeding. Given what George Kent states, the US federal government's Special Supplemental Nutrition Program for Women, Infants, and Children is indeed prejudicial to the health of the children of low-income families, at the time, in later childhood, and inasmuch as formula feeding increases the risk of overweight and obesity, throughout life.

Geoffrey Cannon
Centre for Epidemiological Studies in Health and Nutrition
School of Public Health, University of São Paulo, Brazil


  1. Monteiro C. The big issue is ultra-processing.[Commentary] World Nutrition, November 2010, 1, 6:237-269. Obtainable at
  2. Monteiro C, Cannon G. The big issue is ultra-processing. What are ultra-processed products. [Commentary] World Nutrition, June 2012, 3, 6: 257-268. Obtainable at
  3. Monteiro C, Gomes F, Cannon G (2010) Can the food industry help tackle the growing burden of under-nutrition? The snack attack. American Journal of Public Health 2010, 100: 975-981.
  4. Monteiro CA, Cannon G. The impact of transnational 'Big Food' companies on the South: a view from Brazil. PLoS Medicine 9(7): e1001252. doi:10.1371/ journal.pmed.1001252. Published 3 July 2012.

Please cite as: Cannon G. Ultra-processed products. Formula. How to protect US children. [Letter] World Nutrition, November 2012, 3, 11, 518-519. Obtainable at

2012 November. WN4. Correspondence.
Ultra-processed products. Formula

How to protect US children
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