A Good Place To Start To Beat The COVID Obesity Pandemic – Warning Labels on Unhealthy Foods Vital Strategies 01/04/2021 • Svĕt Lustig Vijay Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) The obesity pandemic is in “the same room” as the COVID pandemic in terms of its threats to health – putting people at greater risk of premature death from multiple causes, including SARS-CoV-2, the virus that leads to COVID-19. And ever since stay-at-home measures became routine, people have gained even more weight – up to 1.5 pounds a month according to one recent US study. Yet countries have the tools to address obesity, note Trish Cotter and Dr. Nandita Murukutla at Vital Strategies, a global public health NGO. We spoke to Ms. Cotter and Dr. Murukutla to find out more: Health Policy Watch (HPW): A third of the global population now suffers from overweight, and rates of obesity are growing across the world, including in poor countries. How can we explain these trends? Vital Strategies (VS): Over the last 40 years, obesity rates around the world have ballooned. High-income countries, like the United States, were the first to experience substantial weight gains of their populations, but the 21st century has seen that phenomenon spread to all parts of the globe. Now, the average adult is three times as likely to be overweight as the average adult in the 1970s. There are a number of reasons for this alarming trend, which began well before COVID-19, starting with the environments in which people live, as well as poverty, discrimination, increasing availability of unhealthy foods in schools, dwindling levels of physical activity, and a lack of knowledge of unhealthy diets and products. However, the fundamental reason is the rapid change in our diets and the broader food environment. Ultra-processed products or “junk food”, such as soft drinks, ice creams, or prepared frozen dishes, are one of the key drivers of growing obesity worldwide. They are high in sugar, salt and fat and, unfortunately, widespread in most societies. Yet their harmful effects are poorly understood. One in three people worldwide are overweight HPW: Why are ultra-processed foods so ubiquitous? VS: They are cheap, easily available, and because of additives and preservatives, they have a long shelf-life. They’re made to feel and look attractive, and they’re made to taste good. Importantly, they’re also hyper-marketed by the food industry. Advertising campaigns are very good at making unhealthy products seem part of the fabric of society: unhealthy foods are made to seem crucial to family gatherings and entertainment, so they become part of the social norm that normalizes unhealthy foods. And much of the advertising around unhealthy foods is so enticing that it gets children hooked at a young age. In what ways is advertising of ultra-processed products misleading? Unhealthy products are often marketed cleverly as convenient substitutes for healthy, minimally processed options that include whole grains, fruits and vegetables. They are marketed as convenient breakfast foods, snacks, juices, and sometimes they are also marketed as being more sanitary than fresh fruits and vegetables. But that’s misleading, because current evidence demonstrates that ultra-processed products result in worse diets and ultimately overweight and obesity, which exacerbates the risk of contracting a range of chronic diseases as well as suffering poorer outcomes from infectious diseases like COVID-19. Claims that ultra-processed products are healthy alternatives are untrue. Can you give a concrete example of a strategy that misleads customers into thinking they’re buying healthy products? Labels on the front and back of food packages are often really hard to accurately decode. And many of these labels use clever algorithms to hide unhealthy levels of sugar, salt, and saturated fat. Customers may not always realize that the product they are buying is unhealthy. Late last year, you co-authored a guide to help policymakers introduce clear, yet highly effective warning labels on foods and beverages to nudge customers away from unhealthy foods. How do these warning labels work? Front-of-Package (FOP) nutrient labels, sometimes called warning labels, tell consumers immediately, on the front of products, and simply when a product contains high levels of unhealthy nutrients. That means customers don’t need to spend several minutes trying to work out whether each product is healthy or not. This system is simple, visual, and easy to understand. And it is effective, as seen from studies across the world, in triggering immediate behavior change. The front-of-package labels serve as behavioral nudges, protecting people from making unintended unhealthy purchases. In other words, the warning labels work by reminding consumers that the products they are purchasing are unhealthy, thus nudging them to make healthier choices. But they also have important knock-on effects: they help change social norms around unhealthy eating. Example of warning labels on food products in Chile to nudge customers away from unhealthy foods. Translation from top-left to bottom-right: high in calories; high in sugars; high in sodium; high in saturated fats. Source: Ministry of Health of Chile. You mentioned that warning labels can help change social norms that promote the consumption of unhealthy foods. Can you unpack that? One study found that children pestered their parents to buy healthier products that did not have warning labels, partially because teachers at school would not accept unhealthy snacks. In some cases, teachers would even confiscate unhealthy snacks brought by children. This suggests that something as simple as a warning label can challenge the idea that ultra-processed products are desirable, and start to change the social norm. It’s also important to reiterate that warning labels are a highly cost-efficient approach because you’re able to target consumers rapidly, constantly, and at the point of decision making to make a purchase or not, with little to no cost to the government. And the costs of not addressing obesity during the pandemic could amount to $US 7 trillion by 2025, according to the latest review by the World Obesity Federation. Furthermore, out of a total of 2.5 million deaths from COVID reported as of February, 2021, 2.2 million were in countries where over half of the population is overweight. Countries with high proportions of overweight people had coronavirus death toll that were ten times higher than those with low proportions of overwheight people So far, six countries including Chile have legally mandated warning labels, although many have put in place “voluntary” systems. How well do the voluntary systems work ? The voluntary systems, which do not legally mandate warning labels on every single food product, are not effective. As warning labels may reduce sales of unhealthy foods, the food industry is unlikely to take them up. That’s why mandatory regulations on warning labels are crucial if we want to make a real dent into obesity and overweight. We’ve seen these warning labels work very well in Chile where they contributed to a decrease in the consumption of sugar-sweetened beverages by almost 25%. This was achieved through a comprehensive approach to addressing obesity, which also included: restrictions on child-directed marketing of unhealthy foods and beverages on the radio, television, cinema, and internet; a ban of unhealthy foods and beverages in schools and daycare; and a tax on sugary drinks. What kinds of labels work best? There are two broad categories of labels. The first category, the so-called “reductive” labels, outline how much of each nutrient is contained in foods, but they don’t help the consumer decide whether the product is healthy or not. These labels are less effective. The second category of labels, the so-called “interpretive” labels, are much more effective. They draw attention to the nutrients of concern or summarize the overall healthfulness of the product. Thus, they can help consumers distinguish between healthy and unhealthy products immediately through clear visual cues. The so-called “interpretive” labels can help consumers quickly identify nutrients of concern in food products to make healthier decisions What are the challenges to getting countries to act? Although a number of high-level commitments have been made to fight obesity, including the inclusion of a target in the SDGs , The UN High-Level Meetings on NCDs as well as the UN Decade of Action on Nutrition, a lot more can and needs to be done. But that said, there is very strong industry pushback, and that’s also not surprising. We have seen decades of this with regard to other issues like tobacco control. Industry pressure cannot be underestimated and industry interference is often what holds governments back. However, governments should not feel powerless to take on food policy. The tools are out there to help them do this effectively and cheaply. Are there any other policies that can be used alongside mandatory warning labels to cut obesity and overweight? Sugary drinks taxes are among the most effective and cost-efficient ways to reduce access to unhealthy foods. Marketing restrictions and the removal of misleading advertising, especially in schools and environments in which children reside, is crucial. Bans on unhealthy products in schools can also help. We also need to ensure that healthy food becomes the default option by making sure that it’s easily available and cheap enough to buy – and at the same time ensure that unhealthy foods like ultra-processed foods are less available. And as mentioned earlier, it’s important to change those social norms around unhealthy foods so that they’re not associated with what marketers want you to associate them with – families, warmth, love, sports – and all of the things that bring people together. Where do we go from here? And let’s be honest that food labels are not a panacea – what about access to healthier diets generally, which are often more expensive than unhealthy diets. And what about environments where people can be physically active? With more than one-third of the world’s population overweight or obese, and the COVID-19 pandemic revealing deep structural inequities in food environments, the push to combat obesity has become more urgent than ever. Many individuals are powerless in the face of food shortages and the over-availability of cheap ultra-processed foods. The onus is on governments to act, and to act now. There were a number of factors, from environmental, structural to social, that brought us where we are today, and we will likewise need a concerted and cohesive set of actions to reverse these trends. FoP warning labels are a strong place to start. Read more here on Vital Strategies’ new guide to help policymakers design and implement warning labels on foods and beverages. Trish Cotter, MPH, Global Lead, Food Policy Program and Senior Advisor, Vital Strategies Dr. Nandita Murukutla, Vice President for Global Policy and Research, Vital Strategies Image Credits: University of Michigan, World Obesity Federation, Vital Strategies, Food Standard Agency, Vital Strateggies, Vital Strategies. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.