N
Nutrition label standards and regulations on the use of claims and implied claims on food
The evidence suggests people who want to eat well use nutrient lists to choose healthier options. Interpretative labels help them when they find the labels hard to understand. Nutrition labels also create incentives for food manufacturers to reformulate their products, so helping populations more broadly by increasing the availability of food of higher nutritional value.
Clear standards are also needed on the use of nutrient and health claims. Evidence shows these claims alter the perception people have of these products – making it essential that they do not mislead.
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Examples of policy actions
Mandatory nutrient lists on packaged food*
*Most other countries follow Guideline CAC/GL 2-1985 from the Codex Alimentarius Commission in requiring nutrition labels only when a nutrition or health claim is made and/or on food with special dietary uses
What the action involves and where implemented
Producers and retailers are required by law to provide a list of the nutrient content of pre-packaged food products (with limited exceptions), even in the absence of a nutrition or health claim. The rules define which nutrients must be listed and on what basis (eg per 100g/per serving).
Trans fats included in mandatory nutrient labels
What the action involves and where implemented
Nutrient lists on pre-packaged food must, by law, include the trans fat content of the food. The rules generally define how the trans fat content must be listed, and on what basis (eg per 100g/100ml or per serving). If the trans fat content falls below a certain threshold, it may be listed as 0g (eg less than 0.5g per serving, or less than 0.3g per 100g of food product). Chile requires mandatory trans fat labelling only once the total fat content per serving exceeds 3g.
Evaluations
Doell D et al. (2012) Updated estimate of trans fat intake by the US population. Food Additives and Contaminants 29(6), 861-874
Van Camp et al. (2012) Changes in fat contents of US snack foods in response to mandatory trans fat labelling. Public Health Nutrition 15(6), 1130-1137
Lee JH et al. (2010) Trans Fatty Acids Content and Fatty Acid Profiles in Selected Food Products from Korea between 2005 and 2008. Journal of Food Science 75(7), C647-C652
Ricciuto L et al. (2008) A comparison of the fat composition and prices of margarines between 2002 and 2006, when new Canadian labelling regulations came into effect. Public Health Nutrition 12(8), 1270-1275
Friesen R, Innis SM (2006) Trans Fatty Acids in Human Milk in Canada Declined with the Introduction of Trans Fat Food Labeling. The Journal of Nutrition 136(10), 2558-2561
Clearly visible "interpretative" labels and warning labels
What the action involves and where implemented
In 2012, the Chilean government approved a Law of Nutritional Composition of Food and Advertising (Ley 20.606). In June 2015, the Chilean authority approved the regulatory norms required for the law’s implementation (Diario Oficial No 41.193) which came into effect on 27 June 2016. The regulatory norms define limits for calories (275 calories/100g or 70 calories/100ml), saturated fat (4g/100g or 3g/100ml), sugar (10g/100g or 5g/100ml) and sodium (400mg/100g or 100mg/100ml) content considered “high” in food and beverages. All food that exceeds these limits will have a front-of-package black and white warning message inside a stop sign that reads “HIGH IN” followed by CALORIES, SATURATED FAT, CALORIES or SUGAR OR SODIUM, as well as “Ministry of Health”. A warning message will be added to products per category that exceeds the limit (eg a product high in fat and sugar will have two stop signs). The regulatory norms provide specifications for the size, font and placement of the warning message on products. The limits for calories, saturated fat, sugar and sodium will be implemented using an incremental approach, reaching the defined limits by 1 July 2018 (see "O – Offer healthy food and set standards in public institutions and other specific settings" and “R – Restrict food advertising and other forms of commercial promotion” for details of the law's school food and advertising restrictions).
O
Offer healthy food and set standards in public institutions and other specific settings
We know from the evidence that making fruit and vegetables available in schools increases consumption. There is also evidence that food standards to restrict availability have the effect of reducing consumption of the restricted food.
For these actions to be effective for all children, they need to be sustained over time and accompanied by complementary behaviour change communication techniques, such as "modelling", school gardens, and communication to all stakeholders involved in the provision and consumption of school food. Worksites and healthcare also present strong potential for improved eating among adults.
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Examples of policy actions
Mandatory standards for food available in schools, including restrictions on unhealthy food
What the action involves and where implemented
In 2012, the Chilean government approved a Law of Nutritional Composition of Food and Advertising (Ley 20.606). In June 2015, the Chilean authority approved the regulatory norms required for the law’s implementation (Diario Oficial No 41.193), which came into effect on 27 June 2016. The regulatory norms define limits for calories, saturated fat, sugar and sodium content considered “high” in food and beverages. The law prohibits the sale of these "high in" food items and beverages in schools (see “N – Nutrition label standards and regulations on the use of claims and implied claims on food” and “R – Restrict food advertising and other forms of commercial promotion” for the regulatory norms on labelling regulations and marketing restrictions to children).
U
Use economic tools to address food affordability and purchase incentives
Empirical estimates show that food prices influence, to a varying degree, how much food people buy. Targeted subsidies have been shown to help overcome affordability barriers to healthy food for people on low incomes. Incentives, like financial rewards or price discounts, have also been shown to encourage people to switch to healthier options.
Emerging evidence from implemented taxes, as well as modelling studies, indicate the potential for effectiveness to reduce consumption. Given food choices are influenced by a whole host of factors, especially in modern, complex food markets, taxes must be designed very carefully to maximise effectiveness.
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Examples of policy actions
Health-related food taxes
What the action involves and where implemented
Since 1 January 2015, Chile has applied an 18% ad valorem tax on sugary drinks that contain more than 6.25g of sugar per 100ml, raised from a 13% ad valorem tax on sugary drinks introduced on 1 October 2014. Sugary drinks include all non-alcoholic drinks with added sweeteners including energy drinks and waters. Sugary drinks with less than 6.25g of sugar per 100ml are taxed at 10%.
R
Restrict food advertising and other forms of commercial promotion
There is clear evidence that the advertisements children see influence their food preferences and habits. There is also a lot of evidence that children and adolescents around the world are exposed to a whole host of other promotional techniques, whether on a billboard or through a phone or computer.
Emerging evidence shows that restrictions work to reduce children’s exposure of children to marketing, but this depends on the criteria used in the restrictions. Given the role played by parents and caregivers in what children eat, consideration is needed to how they are also influenced by promotional activities.
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Examples of policy actions
Mandatory regulation of broadcast food advertising to children
What the action involves and where implemented
In 2012, the Chilean government approved a Law of Nutritional Composition of Food and Advertising (Ley 20.606). In June 2015, the Chilean authority approved the regulatory norms required for the law’s implementation (Diario Oficial No 41.193). They came into effect on 27 June 2016. The regulatory norms define limits for calories, saturated fat, sugar and sodium content considered "high" in food and beverages. The law restricts advertising directed to children under the age of 14 of food in the "high in" category. The regulatory norms define advertising targeted to children as TV programmes or websites directed to children or with an audience of greater than 20% children, or in commercial breaks before, during or after these shows, and according to the design of the advertisement. Promotional strategies and incentives, such as cartoons, animations and toys that could attract the attention of children are included in the ban, as is advertising of food in schools (see below). (See "N – Nutrition label standards and regulations on the use of claims and implied claims on food” and "O – Offer healthy food and set standards in public institutions and other specific settings" for details of the law's labelling and school food regulations.)
Mandatory regulation of food advertising on non-broadcast communications channels
What the action involves and where implemented
In 2012, the Chilean government approved a Law of Nutritional Composition of Food and Advertising (Ley 20.606). In June 2015, the Chilean authority approved the regulatory norms required for the law’s implementation (Diario Oficial No 41.193), which came into effect on 27 June 2016. The law restricts advertising directed to children under the age of 14 of food in the "high in" category. The regulatory norms define advertising targeted to children as TV programmes (see above) or websites directed to children or with an audience of greater than 20% children, and according to the design of the advertisement. It also restricts advertising to children on the radio and in magazines. Promotional strategies and incentives, such as cartoons, animations, interactive games, apps and toys that could attract the attention of children are included in the ban, as is advertising of food in schools (see below). (See "N – Nutrition label standards and regulations on the use of claims and implied claims on food" and "O – Offer healthy food and set standards in public institutions and other specific settings" for details of the law's labelling and school food regulations).
Mandatory regulation of food marketing in schools
What the action involves and where implemented
In 2012, the Chilean government approved a Law of Nutritional Composition of Food and Advertising (Ley 20.606). In June 2015, the Chilean authority approved the regulatory norms required for the law’s implementation (Diario Oficial No 41.193), which came into effect on 27 June 2016. The law restricts advertising directed to children under the age of 14 of food in the “high in” category, including TV programmes, internet, radio and magazines (see above). In addition, the regulatory norms ban the promotion, marketing or advertising of these products in pre-school, primary and secondary schools. (See "N – Nutrition label standards and regulations on the use of claims and implied claims on food" and "O – Offer healthy food and set standards in public institutions and other specific settings" for details of the law's labelling and school food regulations).
I
Improve nutritional quality of the whole food supply
We are all influenced by the food that is available and affordable when we grow up, and the habits of the people around us. That’s why people in different countries and communities consume differently. We know that when the food supply changes, so does what people eat. This is why we need to improve the quality of the food supply. Evidence from salt reduction indicates that people’s tastes can change.
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Examples of policy actions
Voluntary reformulation of food products
What the action involves and where implemented
In 2011, the Chilean government agreed a voluntary target with bakers to reduce the salt content of bread to 600mg/100g. The assessment of the progress towards the voluntary targets was made public in 2012, with average salt content dropping from 800mg to 480mg/100g.
I
Inform people about food & nutrition through public awareness
Awareness is one precursor to eating well. The evidence suggests that public campaigns can boost awareness. To influence consumption, they need to be sustained and use multiple channels.
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Examples of policy actions
Development and communication of food-based dietary guidelines
What the action involves and where implemented
Food-based dietary guidelines are an information and communication tool involving the translation of recommended nutrient intakes or population targets into recommendations of the balance of food that populations should be consuming for a healthy diet. They typically promote increased intake of fruit and vegetables and limiting intake of salt/sodium and sugar. They may also include guidance on physical activity and healthy weight, and provide guidelines for different population groups. Countries use various formats of presenting the guidelines including cooking pots (Guatemala), pineapples (Fiji), pyramids (Australia, India, United States), plates (UK), pagodas (China) and circles (Argentina). Some countries have started to include sustainability criteria in their dietary guidelines (eg Finland and Brazil in 2014, Sweden and Qatar in 2015, the Netherlands in 2016). Brazil’s revised dietary guidelines, launched in 2014, present food- and meal-based recommendations that take into account cultural dimensions and promote the consumption of minimally processed food as well as health, wellbeing and sustainable food systems, and recommend avoiding ultra-processed food. Details on the content of national dietary guidelines can be found on the FAO database on Food-based dietary guidelines.
Public awareness campaigns specific to fruit and vegetables
What the action involves and where implemented
Governments in these countries manage, or are involved in, fruit and vegetable campaigns that promote the consumption of a certain number of fruit and vegetable portions a day, often "5 a day" (eg Argentina, Chile, Germany, Mexico, New Zealand, South Africa, Spain, Tonga) but also "6 a day" (Denmark), "Go for 2&5" (Western Australia), “Fruits & Veggies – More Matters” (United States) or 5–10 (France).
Evaluations
Capacci S, Mazzocchi M (2011) Five-a-day, a price to pay: An evaluation of the UK program impact accounting for market forces. Journal of Health Economics 30(1), 87-98
Carter OBJ et al. (2011) ‘We’re not told why – we’re just told’: qualitative reflections about the Western Australian Go for 2&5® fruit and vegetable campaign. Public Health Nutrition 14(6), 982-988
Pollard CM et al. (2008) Increasing fruit and vegetable consumption: success of the Western Australian Go for 2&5® campaign. Public Health Nutrition 11(3), 314-320
N
Nutrition advice and counselling in health care settings
People with elevated risk factors for cancer and other non-communicable diseases – such as heavy bodyweight, high cholesterol or glucose intolerance – can benefit from advice provided by their health care provider. Such advice can also be given to people at low risk for prevention into the future.
There is potentially a wide range of mechanisms for integrating nutrition advice into primary care, including counselling, self-help materials and computer-tailored messages. Randomised controlled trials suggest they can be effective if carefully designed and well targeted. The most positive outcomes appear to be for people already at risk.
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Examples of policy actions
Nutrition counselling in primary care
What the action involves and where implemented
The Chilean national food-based dietary guidelines (established in 2005, and revised in 2013) are promoted in the healthcare sector. The Institute of Nutrition and Food Technology has produced, in conjunction with the health promotion department of the Ministry of Health, guidance for the provision of advice in healthcare settings, including on healthy diets.
