Front-of-pack labelling in the UN Decade of Nutrition –Relevance for obesity prevention?

LAUREN LISSNER, UNIVERSITY OF GOTHENBURG (SWEDEN)

Packaged food dominating food supply

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Back of package labels: an information overload

Front of pack food labels

Content

1. Basics of FoP labeling

2. The evidence

3. Systems approach to obesity prevention – what do we need to know?

4. Recent developments – what does future hold?

Basics of Front-of-Pack (FoP) labelling

❖ Policy tool to tackle the global obesity epidemic and non-communicable diseases (WHO, 2014)

❖ By simplifying nutritional information on pack

❖ By stimulating healthy product reformulation

To guide consumer choice◦Positive logos◦Mixed e.g. traffic light◦Negative: warnings

To drive reformulation◦Positive: to challenge industry◦Negative: to penalize industry

Dual Objective of Front-of-pack labels

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COMPLY WITH CRITERIA

TO GET ON BOARD

14%

Less salt

43%

Less saturated fat

30%

Less saturated fat

75%

Less sugar

Ref.: Vyth cs., I J Behav Nutr Phys Act 2010

Incentifve through positive logo – what can happen?

ONGOING INNOVATION

STIMULATED BY TIGHTENING CRITERIA

SODAS

10% less sugar

DAIRY DRINKS

7% less SAFA

MARGARINES

31% less salt

SAUCES

34% less SAFA

INVOLVING SUPPLIERS

TO CREATE ADDITIONAL IMPACT

“ The more, the better;

40% of our supply now complies

with Healthy Choice criteria.”

Albron Foodservice

National FoP labelling schemes in Europe and Israel

Many similarities and differences

The Funnel ModelNutrients 2019, 11(3), 626.

Van der Bend D.,. Nutrients 2019, 11(3), 626.

FoP label product criteria componentsQualifying: beneficial for healthDisqualifying: unfavourable for health

Reference unit of product criteria

Method to measure compliance to product criteria

Range of products covered by product criteriaAll products: at least all pre-packaged foods, excl. infant formula, alcoholic beverages, food supplements

Methodological approach of FoP labelFood category: different criteria for different food categoriesAcross-the-board: one set of criteria

Van der Bend D.. Nutrients 2019, 11(3), 626.

Main purpose of FoP label

Main driver of FoP label

Directivity of FoP labelDirective: summary indicator of ‘healthiness’Semi-directive: summary indicator + factual informationNon-directive: factual information

Tone of voice of FoP label

Mandatory or voluntary use (regulated nationally)

Below, methodology and expression

Keyhole❖ In 1989 introduced by Swedish retailer ICA Gruppen

❖ Adopted by Swedish National Food Agency

❖ Common Nordic positive label for healthier foods: Denmark, Norway, Iceland (Finland has own)

❖ Also used in Lithuania and Macedonia

❖Positive, category specific (different foods have different criteria), dual aim, voluntary

Choices International❖ Founded in 2007 as an industry initiative, now NGO

❖Global platform for collaboration with industry, scientists, NGOs and health authorities

❖ Current members: Czech Republic, Nigeria, Argentina

❖Simiar to keyhole, no longer led by industry, independent scientists set criteria

Nutriscore❖ In 2017 adopted by the health authorities in France

❖ After 4 years of studies on its underlying nutrient profiling system and format (2014-2017)

❖ Recently adopted by Health Ministries of Belgium, Spain, Portugal

❖Score with threshold, across-the board criteria, if company joins they have to label all products, per weight

Portion size…per weight is often preferable. Consumer distrust of portion size manipulation

Multiple Traffic Light

❖ In 2012: joint consultation on front-of-pack labelling on behalf of UK health

❖In 2013 launched as FoP label in the UK

Israeli Warning Label❖ In 2017 approved by the Israeli Parliament’s Labor, Welfare, and Health Committee

❖ First 12-month transition phase will go into force in January 2020

❖ Second permanent phase starts in 2021 with stricter criteria

❖ Negative tone, mandatory, a positive green label is being developed

Content

1. Basics of FoP labeling

2. The evidence

3. Systems approach to obesity prevention – what do we need to know?

4. Recent developments – what does future hold?

What kind of evidence do we have, and what do we need?

❖ Evidence of consumer awareness

❖ Evidence of industry reformulation

❖ Evidence of nutrition benefits

❖ Evidence of potential health benefits

(Impact can be potential or actual)

Consumerawarenesscan be high

(but do peopletrust or act on it?)

Other evidence on impact

❖Numerous studies on consumer understanding, trust, interpretation, appreciation❖Multiple FoP labelling formats are challenging for consumers (Draper et al., 2013)

❖ Less data on actual behavior, consumption, or health impact❖ Health-conscious consumers buy FoP labels (Vyth et al., 2010)

❖ Country; urbanity; household with children; type of product (Smed et al., 2017)

….the story from Finland

Finland: Gradual setting of tighter limits for ”highly salted”

warning labels for bread encouraged industry to reformulate if

they don’t want the label

Current- Dec2016

Previous- June2009

Before1993

Bread >1.1 >1.2 …. >1.7

Crisp bread >1.4 >1.6 ….

Breakfast cereals >1.4 >1.6 …. >2.5

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Salt intake among 25-64 y. men and women in Finland, 1992-2012

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Source THL: FinDiet study

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Revormulation did not onlyl cover salt in bread but

other critical nutrients

Heart Symbol has very high awareness

High customer satisfaction

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1600

Number of products

Modeling studies: calculated potential impact on nutrient intake

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Source A. Roodenburg

PLoS One 2013

Also calculated potential impact on micronutrient intake in young adults (NL)

We need more knowledge about ACTUAL impact on nutrition and health

Source A. Roodenburg

PLoS One 2013

Content

1. Basics of FoP labeling

2. The evidence

3. Systems approach to obesity prevention – what do we need to know?

4. Recent developments – what does future hold?

Relevance to EASO and obesity research?

Not so simple..social and systems perspectives

FoP labeling and closing the obesity gap

Can systems science help us understanddeterminants of inequities in healthful diets?

Friel S, Pescud M, Malbon E, Lee A, Carter R, et al. (2017)

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.01888

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EmploymentFood security(affordability)

Housing, built environmentAccessibility:Convenience foodsPackaged foods

TransportCommuting timeTime for food preparation

Food supply and EnvironmentRegulation of food labelingIndustry adherence- reformulationPromotion of (un)healthy foodsNutritional quality of foods in retail(pricing, taxation?)

Health LiteracyComprehension of nutritional infoAbility to sort out conflicting messages

Social protectionAccess to: welfare, income, education

Equitable /Inequitabledistribution of healthy eating

Food preferencesDesirability of healthy foodsExposure to unhealthy eatingCultural importance of diet(preferences formed by exposure)

Various subsystems impact upon nutritional inequalities and touch upon each other

Cell Metabolism, 2019

Packaged and/or Processed foods

On processed diet subjects ate 500 kcal more/day, ate faster, gained weight in proportion to energy difference, didn’t like significantly more, compared to unprocessed diet

Do packaged foods have to be highly processed and obesogenic? Can FoP improve the situation?

Content

1. Basics of FoP labeling

2. The evidence

3. Systems approach to obesity prevention – what do we need to know?

4. Recent developments – what does future hold?

SDG 2.2: End malnutrition

SDG 3.4: decrease premature deaths from NCDs

SDG 17: strategic partnerships with industry

Relation to UN Sustainable Development Goals

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Recent attention by various bodies reviewing evidence and making recommendations on FoP

e.g. 2019 Codex Alimentarius: some general principles for FoP labelling (draft)

• One system per country/region• Easy to understand for variety of consumers• Not in place of nutrient declaration• Should be led by government, incollaboration with all intrested parties• Should align with evidence based guidelines

•

FoP labels - some consensus but still many different opinions

❖No longer a matter of whether or not to implement FOP labels, but how to share knowledge of labelling systems to decide but which system to use❖ Results from Finland suggest that both sticks and carrots may be needed to encourage

industry to reformulate (Israel next)❖Stay out of the trap of focusing on which logo is best. Whatever logo is used, the stakeholder

is decisive for success❖Time lag from launching and awareness may be long – needs time and resources❖Simulation models are intuitive but not real life. We need evidence on real health impact.❖Proliferation of climate symbols, taking away attention from individual nutrition❖If systems are to be effective government have to support them, not just start up (keyhole)❖Link to other policy issues is critical (marketing, taxes, agricultural policy etc)❖It is inevitable that countries will develop new logos – but hopefully not too many different

ones.

Acknowledgements:

Daphne van der Bend University of Newcastle (Australia)Marjaana Lahti-Koski, Heart Association (Finland)Rutger Scilpzand, Secretariat, Choices Foundation (Netherlands)

Thank you!