Bringing nutritional labels to the forefront (of the package)
By Erika Luna Pérez and Laura Castrejón Violante
SUMMARY
The world is currently facing multiple health crises. One that has worsened over time is obesity, which is now a serious epidemic in many countries [1]. In contrast to viral diseases (like COVID-19) for which a vaccine is the cure, treatment for obesity comes in the form of healthier eating and having an active lifestyle. However, this is easier said than done, especially when there is an overabundance of food to contend with and a voracious food industry dictating what we eat [2]. Countries around the world are taking actions and using a diversity of instruments to give the control back to the consumer. In this post, we discuss the use of front-of-pack (FOP) labels on processed foods as an effective tool for consumers to make better decisions on the products they purchase.
BACKGROUND
Society’s over-consumption habits have led the world to experience the highest rates of obesity in history [1]. Moreover, obesity is directly related to other diseases like cancer, type II diabetes and cardiovascular diseases [3]. Together, these diseases are responsible for killing 2.8 million people every year [4]. In almost the same time period, COVID-19 has taken the life of around 2.4 million people.
Obesity is caused by unhealthy diets and physical inactivity; therefore, the solution is simply to promote healthier eating and active lifestyles. However, healthy eating is a complex matter given the increasing consumption of processed food that are high in calories, sugar, trans fats, and salt [1]. Although some jurisdictions have implemented regulations (mainly in the form of taxes) there is still a lot to be done to successfully regulate food manufacturers and retailers.
Obesity is also a factor of vulnerability to COVID-19 [5]. Moreover, COVID-19 could also exacerbate the obesity rates as a result of the lockdowns and self-isolating measures [6]. Together these measures may lead to less physical activity and socioeconomic stresses that can deteriorate psychosocial health and alter eating behaviors. Figure 1 shows the vulnerability feedback loop of obesity under the current COVID-19 context and the historical societal context.
Even though obesity is mainly a health problem, it is also an equity issue. The access to high quality food is a privilege, because it implies the access not only to food, but to education, time, and purchasing power. Vulnerable people may find junk foods appealing for diverse reasons, including: cheapness, easy to acquire (for their wide distribution), addictiveness (because of their high sugar content), and because they are usually accompanied by well-made marketing campaigns. Children — who according to the World Health Organization are overweight in a one-in-five ratio — are a main target for these campaigns. Chile acted against these pervasive marketing strategies by banning them back in 2016 [6 bis]. Other challenges that make it harder for vulnerable populations to access a healthy lifestyle are the lack of time to cook, the lack of access to nutritional education to make informed decisions, and the lack of economic means to buy healthier foods [5]. Moreover, thanks to these vulnerable conditions, the food industry has not only managed to become one of the most profitable industries [7] but it has also contributed to exacerbate people’s vulnerabilities by making them obese. Therefore, governments urgently need to regulate food companies through new standards and regulations, such as food labels.
FOOD LABELLING
There are different types of food labels; from the traditional nutritional information label (with long lists of ingredients and nutritional profiles), to more informative logos (i.e., less wording, more visible), such as traffic lights and black octagons (Figure 2). The latter have been adopted in Latin American and European countries, where the additional requirement is to add the labels at the front of the pack. Depending on the jurisdiction, these front-of-pack (FOP) labels can be voluntary and compulsory. For instance, Chile and Mexico have adopted FOP as a law (read next section). Even though the level of requirement varies among jurisdictions, FOP labels are already showing positive results not only on the consumer’s side but also on the producer’s. With FOP labelling, food companies do not only have to sometimes change the whole design of their packaging, but more importantly, they are also reformulating their products in order to have the least possible warning seals [8], [9].
Although empirical evidence is showing the effectiveness of food labels, there is still debate on different areas. First, it is still no clear which scheme works better; some argue that traffic lights are more efficient than black octagons, but further research needs to be done on the effectiveness of each model. Second, opponents to these measures argue that no matter the label, if the consumer likes a certain product, they will continue to buy it regardless of the health warnings. Third, while opponents argue that FOP labels may be more confusing to consumers, an undebatable positive characteristic about FOP is that without educational campaigns, the new seals allow everyone (no matter their socioeconomic status or education level), to identify the labels as warning signs. Further research needs to be done regarding not only the effectiveness of each food labelling model, but also on the different requirement levels (compulsory and voluntary). FOP labels are one action among many that are needed to improve people’s health. As consumers and essential actors in the food system we must keep asking for the implementation of a diversity of public policies and keep questioning the FOP labels as we learn from them, their effectiveness and weaknesses.
Constitutional measures: The case of Mexico
We know that diets are becoming less diverse due to globalization [10]. For the case of Mexico, the traditional diet (based on whole grains like corn and beans) dramatically changed after the 1994 adoption of the NAFTA agreement [11]. Twenty-six years later, Mexico is now the largest consumer of processed food in Latin America and the country with the second-highest obesity rates worldwide (after the US) [12]. To address this serious national health epidemic the country adopted in October 2020 a new regulation (NOM-051-SCFI/SSA1–2010) that requires a FOP nutrition labeling on all processed food products. The label consists of black octagons (Figure 2) that warn consumers about the health risks posed when processed food products are high in sugars, calories, salt, and saturated or trans-fat.
It is quite surprising that the NOM-051-SCFI/SSA1–2010 is silent on what might be the most robust legal argument upon where this regulation is acted: the constitutional right to food, recognized since 2011. What it is not a surprise is the regulation itself. Since the right to food inclusion, the three branches of the Mexican government have been fulfilling its constitutional mandate of implementing said right by ruling on and enacting right to food law and policy.
While the right to food encompasses social, environmental and health dimensions, specifically on the latter, the Mexican legislature crafted legislation — the Children and youth rights law (2014) and the Provision of services for the care and integral development of children law (2011) — that established that the federal and provincial authorities have an obligation to guarantee an adequate nutrition to minors.
Also on the health component of the right to food, in 2017 the Mexican Supreme Court deemed constitutional a regulation that imposed a tax on non-basic foods with a high caloric density arguing that said regulation’s objective is to fulfill the States obligation to guarantee the constitutional right to food.
Recently the executive implemented the Comprehensive Food and Community Development Social Assistance Strategy 2020, an umbrella policy that seeks to develop the right to food by establishing, among others, health and nutritional criteria for the operation of food assistance programs at the federal level.
Moreover, at the state level, Oaxaca has banned the sale, distribution and advertising of junk food and sugary drinks to children. The imposition of this new set of regulations, specifically regarding the NOM-051-SCFI/SSA1–2010, has received many critiques and opposition coming mainly from large food companies, but also from merchants who argue that these measures could have a negative impact on the economy. Nonetheless, these arguments can be easily countered with the positive results seen in Chile. The South American country implemented back in 2016 a set of regulations at the national level that included the FOP label, the ban of advertising for kids, and a tax on high sugar beverages. Four years after the implementation of this set of regulations, the purchase of this type of beverages has decreased by 24% [13].
RECOMMENDATIONS
· Governments, and in particular the public health sector, need to regulate food companies. Food labels are an innovative and useful tool that can constitute an elemental part of a larger set of regulations (e.g. imposing taxes, banning marketing campaigns, and restricting the sale of these products to children).
· Governments must prioritize the health of their citizens instead of the interests of large food companies.
· Governments need to acknowledge the importance of developing this type of policies under the context of the COVID-19 pandemic that may exacerbate obesity pre-conditions.
· To mitigate the possible negative impacts (e.g. on the economy) and leverage good practices, Governments need a comprehensive approach that is expressed through transversal policies and regulations across different sectors (health, economy, education and agriculture), for which the overall goal should be guaranteeing the right to healthy, fair and sustainable food for all.
REFERENCES
[1] M. Fischetti, “Fatter Still,” Sci. Am., vol. 315, no. 2, pp. 80–80, Jul. 2016, doi: 10.1038/scientificamerican0816–80.
[2] M. Balcazar, “Beyond Overabundance: A Smarter Strategy For True Food Security — Berkeley Public Policy Journal,” Berkeley Public Policy Journal, Feb. 22, 2019. https://bppj.berkeley.edu/2019/02/22/beyond-overabundance-a-smarter-strategy-for-true-food-security/ (accessed Feb. 18, 2021).
[3] World Health Organization, “POLICY BRIEF: PRODUCING AND PROMOTING MORE FOOD PRODUCTS CONSISTENT WITH A HEALTHY DIET,” 2014.
[4] World Health Organization, “Obesity,” 2020. https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesity (accessed Nov. 01, 2020).
[5] World Obesity, “Obesity and COVID-19: Policy statement,” World Obesity Federation, Aug. 2020. https://www.worldobesity.org/news/obesity-and-covid-19-policy-statement (accessed Oct. 31, 2020).
[6] C. Clemmensen, M. B. Petersen, and T. I. A. Sørensen, “Will the COVID-19 pandemic worsen the obesity epidemic?,” Nat. Rev. Endocrinol., vol. 16, no. 9, pp. 469–470, Sep. 2020, doi: 10.1038/s41574–020–0387-z.
[7] R. Moodie et al., “Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries,” The Lancet, vol. 381, no. 9867, pp. 670–679, Feb. 2013, doi: 10.1016/S0140–6736(12)62089–3.
[8] F. Goiana-da-Silva et al., “Front-of-pack labelling policies and the need for guidance,” Lancet Public Health, vol. 4, no. 1, p. e15, Jan. 2019, doi: 10.1016/S2468–2667(18)30256–1.
[9] A. Jacobs, “Sellos para combatir la obesidad: cómo identifican en Chile la comida chatarra,” The New York Times, Feb. 07, 2018.
[10] J. Fedacko et al., “Globalization of Diets and Risk of Noncommunicable Diseases,” in The Role of Functional Food Security in Global Health, Elsevier, 2019, pp. 87–107.
[11] A. Esposito, “Mexico’s new warning labels on junk food meet supersized opposition from U.S., EU,” Reuters, Aug. 12, 2020.
[12] OECD, “Obesity Update 2017,” 2017.
[13] L. S. Taillie, M. Reyes, M. A. Colchero, B. Popkin, and C. Corvalán, “An evaluation of Chile’s Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study,” PLOS Med., vol. 17, no. 2, p. e1003015, Feb. 2020, doi: 10.1371/journal.pmed.1003015.
