Front of the package labelling key to tackling lifestyle diseases

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Rising need of food package labelling: Display of warning labels with pictures on cigarette packs is a globally accepted practice to discourage smokers. The same practice can be followed in the case of other consumer items that are harmful to health. There is strong demand for hazard labels on packages of food that are harmful to humans. It has been 10 years since Codex, the International Food Safety Agency, issued a directive on food labelling. Most countries have implemented labelling for food sold in packets. There are two types of labelling. The first provides nutritional information of the food such as calories, protein, fat, vitamins, and preservatives.

This information is usually detailed on the back of the package. It is suggested that the front of the package should include colours and pictures which are easy for consumers to understand. This can help diabetic patients to choose food by avoiding sugar; blood pressure patients from excessive salt, and heart patients from fat.

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The burden of lifestyle diseases such as obesity, diabetes, hypertension and heart disease is increasing rapidly all over the world. The ‘MacDonaldisation’ happened due to globalisation, leading to high-fat fast food consumption. This is called the epidemic of over nutrition. In India more than 60% of people die from non-communicable diseases (NCD). The main reason for this is the consumption of food that is high in fat, sugar, and salt. The consumption of processed food such as noodles, popcorns, potato chips, and cola is directly linked to the incidence of non-communicable diseases.

The science behind front food package labelling

The World Health Organisation wants food labelling to discourage the consumer from buying products that have harmful ingredients. To achieve this, front of labels should include information of levels of fat, sugar, and salt. It is important to alert consumers if the packaged food contains more than or equal to 10% of the daily required calories for a person. This type of labelling will help consumers make informed choices while food manufacturers will be encouraged to produce products that are good for health. This will end up being a cost-effective disease control method at the social level.

These labels should be in pictures, colours, or letters separately or in combination. The warning labels can use traffic signals — green for low risk, amber for medium and red for high risk products. One should try to cut down consumption above daily allowance percentage. Health star rating and scoring can be used for ranking a packaged food item based on salt, sugar, and fat content. Traffic lights have been implemented in Britain, percentages/amounts per person in the European Union and warning labels in Chile. After a year of implementing this method, it was found that Coca Cola sales decreased by 24% in Chile.

India decided to implement safety labels on packaged food items as a health protection measure in 2014. This was further delayed because of the interference of processed food manufacturers. After several years of efforts, the national level Food Safety Standard Authority of India (FSSAI) has prepared Food Safety Standard Labelling Display Regulation 2022 Order on September 13. The three-month period given to the public for filing complaints/suggestions expired in November itself.

Public health and nutrition experts in the country have protested this order pointing out many shortcomings and demanding its reversal. Many experts point out that many of the current proposals are not suitable for protecting people’s health, but rather the goal is to achieve the financial security of the food manufacturing companies. This is revealed by a simple analysis of the Food Security Act which is in the shadow of doubt.

According to the National Food Safety Authority Order 2022, Star Rating will be implemented in India soon. As per this, the ratings ranges between 1/2 star to 5 stars: 1/2 star is not healthy and 5 stars indicating very healthy.

A study conducted in 14 districts by a team of doctors from AIIMS Madurai got published in Frontiers in health July edition. It showed that warning labels and traffic lights were the most helpful FOP labels in identifying food items, while star signs were the least helpful. Similarly, traffic light signs are the fastest to understand, and health warning labels with images of fat, sugar and salt help children and adults to avoid harmful packets. The last position was given to star rating. Here the label is implemented against this opinion. Many experts are of the opinion that this should be corrected because of the reasons mentioned below.

A country like India which has multilingual population should opt a labelling which helps the illiterate, children and adults to avoid harmful food/beverage packets by incorporating hazard warnings with images indicating fat, sugar and salt content along with red, yellow and green traffic light symbols.

  • According to the star rating, the score goes from the bottom to the top. But the principle of psychometrics is that the selection of individuals should be reversed from top to bottom to select the best from the worst.
  • According to scientific recommendations, scores for negative ingredients like fats, sugars and salt should be included so that people can avoid harmful food. Only then the consumption of harmful food items can be reduced. To neutralise the above negative factors, the positive factors in the diet such as vegetables, fruits, fibre-rich foods, small grains, peas and beans etc will get added to harmful food and will be assigned positive scores and given star status for unhealthy food items. From the study conducted by the Institute of Medicine in America, the world-accepted lesson of never adding positive ingredients to unhealthy food is completely omitted in our country. Thus, adding fruits and nuts with a high positive score to a food product containing dangerous amounts of fat, salt and sugar can increase the star rate and make a profit in the market. In this way one can increase the star rating of high calorie colas by adding fruit juices. Many biscuit and junk food manufacturers have already turned to this way. This will glorify junk foods and get licenses and shine in the food market with the stars.
  • The World Health Organisation recommends studies among the people before implementing food safety labelling guidelines. But the current recommendation is to not make it compulsory for traders in India but to implement it on their own willingness or choice. A gap of 4 years has been given to implement — that too without any haste. While reading the information given in the gazette, it seems that these instructions forget the health goals.
  • Accordingly, the Food Safety Authority of India held the first round of discussions with the food manufacturing companies. It is also alleged that this is being implemented all over India on the back of a biased study which did not confirm to scientific norms. This has been rejected by researchers in India and abroad.
  • The Food Safety Authority has yielded to the demands of manufacturing companies rather than prioritizing the health of the people. Australia and New Zealand, which implemented star rating, are considering measures to correct this.

The unwillingness of the professional bodies of doctors, nutritionists and legal experts in India which are supposed to point out the pitfalls and suggest the right ways are being kept silent. The far-reaching impact of this law needs to be discussed.

(Dr Jayakrishnan T is Professor and head, Community Medicine; and Dr Ahana Salam Resident, Community Medicine, at KMCT Medical College. Kozhikode.)

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