Five billion people around the world have no protection against industrially produced trans fats (ITFAs), putting them at risk of heart disease and death, the World Health Organization said.

ITFAs are responsible for over 500,000 premature deaths from coronary heart disease every year. Commonly found in baked goods, cooking oils, and packaged foods, ITFAs are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.

“Take any liquid oil and bubble hydrogen through it, and that makes it more solid,” Dr Tom Frieden, CEO of Resolve to Save Lives said at a WHO press conference announcing the launch of the report. “That’s pretty good for baking. Unfortunately, it’s also solid in your coronary arteries.”

The WHO first called for the worldwide elimination of ITFAs in 2018. Best-practice policies have gained significant traction since, protecting 2.8 billion people globally – a six-fold increase – but the WHO target for the total elimination of trans fats by 2023 is “unattainable,” the report said.

Most legislation policing ITFAs has been implemented by high-income nations, with the Americas and Europe taking the lead. The European Union successfully banned all ITFAs from its food supply in 2021, and nearly 80% of people living in high-income countries are protected by what the WHO considers best-practice policies.

Four countries – Bangladesh, India, the Philippines and Ukraine – account for all 51% of people covered by best-practice policies in lower-middle income countries, with India representing 41% of that total. While 62 countries have implemented laws to ban ITFAs, covering 46% of the global population, no one living in low-income countries enjoys any legislative protections.

“Trans fat has no known benefit, and huge health risks that incur huge costs for health systems,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Put simply, trans fat is a toxic chemical that kills, and should have no place in food. It’s time to get rid of it once and for all.”

The tobacco of the food industry

Unlike sugar, sodium, or saturated fats, ITFAs are not naturally occurring in any food group. While sugar and sodium can pose serious health risks, their omnipresence in foods people around the world rely on every day makes a ban both impossible and impractical. A ban on nutrients like sugar and sodium is also unnecessary, as their adverse health effects can be managed through light-touch regulation paired with dietary guidelines and recommendations.

But ITFAs are produced industrially and injected into the food supply, and can be easily replaced by healthier alternatives like vegetable oils. Experts say this makes their total elimination an easy decision for governments.

“It’s very rare for us in the nutrition space to be able to say it’s just so bad,” said Dr Rain Yamamoto, a scientist at the WHO’s department of nutrition and food safety. “There are no health benefits whatsoever.”

While significant progress has been made in the fight against ITFAs in recent years, nine of the 16 countries facing the highest estimated burden of trans fat-induced coronary heart disease deaths do not have best-practice policies in place. These include Australia, Egypt, Pakistan, Iran, and South Korea.

WHO also emphasized the cost of falling behind the regulatory wave for countries not currently facing a high burden from ITFAs. As more economies become off-limits to industrial producers of trans fats, countries unprotected by legislation policing ITFAs face the prospect of companies dumping products into their food supplies. This is particularly concerning given the lack of any legislation in low-income nations regulating ITFAs.

“If it’s not present, then there’s no harm in banning it and preventing other countries from dumping products into your country,” Frieden said. “Think of artificial trans fats as the tobacco of nutrition. It has no valid use.”

Denmark leads the way

Studies suggesting that trans fats could be a cause of the large increase in coronary artery disease were penned as early as 1956, but it would take until the early 1990s for renewed scientific scrutiny to confirm their negative health impacts.

The findings spurred Denmark to begin enacting policies to cut ITFAs out of the country’s food supply in 1991. What began as mandatory labelling and nutritional education policies evolved into a political and social pressure on companies to phase out ITFAs from their products in the decades that followed.

By the time Denmark became the first country in the world to pass a total ban on ITFAs in 2007, consumption had already been cut by some 90% since 1991.

A 2022 study found the policies substantially reduced coronary heart disease mortality, preventing an estimated 1,200 deaths by 2007. The 11% reduction in mortality observed over that period is similar to the contribution from decreases in smoking rates.

National legislative bans on ITFAs following Denmark’s lead by Iceland, Austria, and Switzerland, have also proven to be extremely effective.

“There’s really no alternative to governmental action,” Frieden said, adding that proper enforcement mechanisms are critical to ensuring industry takes action to eliminate trans fats.

Globally, legislation to remove ITFAs from foods is seen as one of the most potent public health measures for reducing non-communicable disease burdens emphasized by WHO in the Sustainable Development Goals to reduce premature deaths from NCDs by 30% by 2030.

In the absence of legislation, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on companies to pull their weight.

“I call on the food industry to help us make up for lost time by replacing industrially produced trans-fatty acids with healthier oils,” Tedros said. “If they so choose, these companies could have an almost unparalleled impact on global health.”