Not only has it become difficult to be a kid but it has become almost impossible to be a healthy kid. With the massive proliferation of fast food chains and the unnecessary "super sizing" of our food portions, how can kids-who have much less restraint than adults when it comes to food choices-wade through the ubiquitous unhealthy options and seek out the healthy ones? Although there is some degree of personal responsibility when it comes to food choices, the current environment, especially in the U.S., is not conducive to making healthy choices. As a result of this, and to some degree genetic factors, children are left to suffer the consequences.
Just to put it in perspective, the American Heart Association (AHA) says that 27 million children (19 and under) have a high cholesterol level. On top of this, millions of children are either overweight or obese, which in turn is fueling the rapid rise of type II diabetes. In fact, the Centers for Disease Control and Prevention (CDC) estimates that between 8-43% of children are being diagnosed as having type II diabetes. (Note: According to CDC, no data currently exist to definitively determine the extent to which type II diabetes has emerged among U.S. children and adolescents, so the 8-43%figure is only an estimate at this time.) Also alarming is the rising rate of asthma and allergies among children. CDC says 11% of children under 18 have been diagnosed with asthma and 12% suffer from respiratory allergies. Last but not least, the United States Department of Agriculture (USDA) says that 85% of children get less than five servings of fruits and vegetables per day, and a majority of intake comes from the consumption of potatoes (in the form of French fries) and ketchup. Add to this to the fact that 36% of children get NO exercise and it is obvious that this is an ugly situation.
Market Size & Growth Opportunities
The market for children's nutraceuticals, as broken down into vitamins and minerals, children's remedies and children's herbal formulas, in mainstream channels posted approximately $95 million in sales for 52 weeks ending January 25th, representing 5% growth from the previous year (Figure 1). Children's vitamins and minerals accounted for a majority of sales, mainly due to the popularity of mainstream products such as Flintstones® vitamins.
The greatest growth opportunities, however, lay on the functional foods side, according to most experts. This is because foods and beverages are mediums that are more familiar and seemless to children and parents when it comes to introducing nutritional ingredients (therefore fostering greater compliance). In addition, safety is not as much an issue with foods as with supplements. Companies have already started to take advantage of the functional foods trend by fortifying a number of their products for children with additional vitamins and minerals as well as other nutritional ingredients.
Dr. Elizabeth Sloan, president, Sloan Trends & Solutions, Escondido, CA, discussed other reasons to be excited about the children's market. For one, she said, "There are 79 million children aged 5-18 and the market will stay strong and stable for the next 10 years." In addition, she said, "The women that are moms now are the children of the health conscious baby boomers of years ago."
Commenting on hot ingredients was Janet Zand, who is a doctor of Oriental medicine, a licensed acupuncturist and a naturopath, who formulates products for Botanical Laboratories, Ferndale, WA, and is also the co-author of Smart Medicine for a Healthier Child. "The multivitamin is the mainstay in the children's nutraceuticals market. But the most talked about ingredients include essential fatty acid ingredients, which are the darling of the nutraceuticals industry right now because they are so pivotal, and pycnogenol and the flavonoids because of their potential use in products for attention deficit disorder (ADD) and allergy conditions," she said.
What Parents Want
The Hartman Group, Bellevue, WA, conducted The Children's Wellness Study in the latter half of 2001 in order to gauge how the wellness shopper lives, shops and buys with respect to their children. According to the study, most parents feel that food is the ultimate source of health and well-being and supplements generally come into play when parents feel that their children are not getting what they actually need. "Parents know when their children aren't getting what they need when there are obvious markers such as only eating barbeque potato chips for a month or refusing all fruits and vegetables for an extended period of time. In these instances, parents will consider giving their child a multivitamin once a day for 'peace of mind' or 'insurance," the report said. "They will often discontinue the supplement once they feel that the child has started including a greater variety of foods into their diet"
The study also said that even when a child is a "good eater" there is a tremendous amount of confusion about whether or not to supplement their diet with vitamins and/or minerals. If supplements are used at all, it does not extend much beyond a chewable multivitamin, vitamin C or calcium for most parents (Table 1). Parents also have yet to believe that supplementation is totally safe and effective for their children, but at the same time still have a certain amount of fear about not giving their child a daily supplement.
Parents also have a list of health concerns that are top of mind when it comes to their children. Each age segment carries a unique set of health issues that parents think about. These concerns, as broken down by 0-2 years of age, 2-6 years of age, 6-10 years of age and 10-13 years of age, are provided in Table 2.
Children, 'Tweens' & Teens
It is important to know that parents are not the only ones calling the shots when it comes to buying health products. In fact, children are starting to play an increasingly important role in purchasing decisions. The Hartman Study found that children are involved in making food choices and most of the time will choose their own multivitamin as well. Their choice of products, whether it be a multivitamin or food, was largely dependent on characters, images and taste.
The children interviewed for The Hartman Group's study were also able to discuss their own opinions of health and wellness, depending on age. Children under age four were unable to talk about and/or draw images of what health and wellness meant to them but children under the age of eight thought of health and wellness in terms of carrots, broccoli and apples. Their favorite individual fruits and vegetables came to mind first and were followed by foods low in sugar and brushing teeth. Children over age 10 obviously had a much more concrete understanding of health and wellness and included the following in their definitions: a broader range of foods related to the food pyramid; multivitamins; drinking water; brushing teeth; exercising; getting rest and avoiding smoking and drugs. This group was also aware of meat alternatives, low-fat and low-sugar foods, and a few even mentioned organics.
Let's not forget the teen market. According to a 2002 Gallup Study of Teen Food & Beverage Consumption & Shopping Habits, two-thirds of teens felt they were not getting enough of certain nutrients (Table 3). At the top of the list were calcium, iron, protein and vitamin C.
More teens are also taking responsibility for their health by dieting for specific reasons. The top reasons for going on special diets, according to the 2002 Gallup study, included building muscle and improving sports performance, losing weight and preventing acne (Table 4).
Most of the issues in the children's nutraceuticals market center around the safety of supplements and the need for better information for parents.
Bob Rountree, MD, medical herbalist, Boulder, CO, and co-author of Smart Medicine for a Healthier Child, commented on the dietary supplement side of things. "The biggest issue is whether or not kids should even take supplements. There are a lot of parents that have gotten the impression that especially herbs are dangerous and most doctors see supplements as a waste of time and money," he said. "Most parents are in a holding pattern when it comes to giving supplements to their children because there is no good education campaign out there about what kids need specifically, outside of the traditional vitamins and minerals. As a result, there is only a small group of progressive, informed parents who really know how to use herbs and vitamins," he said.
Ms. Zand also commented on the education issue. "First of all, when a parent goes to their medical doctor they say there is no research. Parents have a lot of reserve and trepidation about nutraceuticals because they are not informed enough. The more information a parent has, the easier it is to use supplements."
Falling into the functional foods camp was Denise Devine, president,Devine Foods, Media, PA. "I view supplements very differently. You can eat whole foods that provide fiber or a high source of vitamin A and to me that is always the better approach; I think the clinical studies support that," she said. "If you have some severe problems or conditions then supplements are better than nothing. But the body does not assimilate the supplements as well it assimilates vitamins from a whole food source. Functional foods is definitely the way to go."
Ms. Zand also said the supplement use right now is issue-driven. "Most natural substances given to children outside of the multivitamin are issue-driven. For example, I think the condition of ADD and attention deficit hyperactivity disorder (ADHD) has driven a lot of people to the health food store. Parents are looking for something that their child can take that is not Ritalin," she said. "Furthermore, parents may be nervous about the side effects of certain medications or, in some cases, disenchanted with the conventional medicine side of things."
Taste will always be an important driver in the creation of nutraceuticals for children. As a result, Dr. Rountree said delivery systems will become increasingly important in the future in order to get children to take/eat these products. "I think functional foods will be the way to go in the future in terms of finding ways to get nutrients to children in a good tasting, efficacious and convenient manner. I also see functional confectionery playing a bigger role in children's nutrition in the future."
The U.S. Government's Role In Children's Health & Nutrition
The U.S. government has made some effort to try and reverse the rising rates of disease amongst America's children, especially in the areas of diet and exercise.
David Schmidt, senior vice president-Food Safety, International Food Information Council (IFIC), Washington, D.C., discussed the physical activity component. "There has been a Surgeon General's call to action for obesity and the CDC has set up a division of physical activity and prevention and a division of adolescent school health. They have also launched a youth media campaign called Verb™ carrying the tagline 'It's what you do,'" he said. The purpose of this media campaign, according to the U.S. Department of Health and Human Services (HHS), is to promote physical activity and community involvement and displace unhealthy, risky behaviors among nine to 13-year-olds, an age group known in marketing terms as "tweens." The campaign uses mass media, interactive media, partnerships and community events to help tweens increase their levels of physical and positive behavior. Commenting on this campaign, Mr. Schmidt said, "Initially I didn't think kids picked it up too well but they are starting to come around."
Also geared toward "tweens" is a website called kidnetic.com, which was launched last August by IFIC and five other partner organizations, including the American Academy of Family Physicians, the American College of Sports Medicine, the American Dietetic Association (ADA), the International Life Sciences Institute Center for Health Promotion and the National Recreation and Park Association, as a component of ACTIVATE, which is a healthy eating and active living initiative. Similar to the Verb campaign, kidnetic.com also conveys a strong physical activity message to address the growing concern of overweight and obesity in children. In addition, the research-based website is designed to promote healthful eating, fun and family.
The USDA is also playing its part in children's health through a Fruit & Vegetable Pilot Program, which was launched in September last year. Jean Daniel, public affairs director for the Food & Nutrition Service at USDA, Washington, D.C. commented on the program. "Congress allowed us to have four states-Iowa, Ohio, Indiana, Michigan (25 schools in each state)-and an Indian reservation in New Mexico participate in a pilot program to assess fruit and vegetable intake among children using a variety of delivery mechanisms. The schools chosen represented both rural and urban settings in elementary and middle schools," she said. "At the end of the school year a report is due to Congress on what the findings were and what delivery mechanisms worked best. It will be up to Congress at that point to decide if they want to continue the pilot."
Commenting of the larger purpose of the program, Ms. Daniel explained, "The fruit and vegetable pilot fits very nicely into several high priorities for us. The first being the epidemic of obesity and overweight among the nation's children. We are also working with other key organizations and institutions to promote the 'five-a-day' message and this pilot program fits very nicely into that as well."
Ms. Daniel maintained that USDA does not have a position on functional foods or dietary supplements for children. "Whether or not supplements and/or functional foods have a role to play in children's nutrition is out of my purview to comment," she said. "Our regulations are set by Congress and only cover what we are to serve and what we talk about in terms of basic nutrition." She did say, however, that the child nutrition programs are up for reauthorization this year, so any changes that are going to be made will be happening between now and September. "Everything that has to do with the child nutrition programs, including what is working and what is not, in addition to the dietary guidelines for children will be evaluated," she said.
A Little Help from the Medical Community?
In terms of recommending or supporting nutritional supplements, Dr. Rountree said that he does not see much changing in terms of increased acceptance by the medical community over the next five to 10 years. "I don't foresee huge change in the conventional medical community because I think doctors are swamped and their tendency is to only use or prescribe products backed by really solid research," he said. "The only nutraceutical out there that has really solid research at this point is probiotics because the benefits are indisputable. The folic acid story is also starting to reach a lot of people. However, beyond folic acid and probiotics there are not a lot of new nutritional ingredients for children's health garnering support from the medical community."
IFIC's Mr. Schmidt offered a similar perspective. "There is some skepticism amongst the medical community because doctors prefer to advise on an overall diet and moderate intake," he said. "However, I do think that there are examples of physicians urging consumption of probiotics through yogurt, especially when taking antibiotics. There is also a lot of consensus around calcium intake in terms of tablets, fortified juices or milk."
Ms. Zand said that recommendationsfromthe medical community on nutraceuticals are very individually driven. "I think there are a lot of doctors out there that feel overwhelmed by the amount of medication that they prescribe and they don't want to continue to prescribe the antibiotics relentlessly. At the very least, if doctors are not prescribing an alternative, they will not prescribe anything for a virus because it is not a bacterial infection," she said, adding, "By the mere act of not prescribing medication for something that is not bacterial is helping not only that child but all of us."NW