We developed the NOURISHING framework to highlight where governments need to take action to promote healthy diets and reduce overweight and obesity.
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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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*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
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).
Huang L et al. (2015) A systematic review of the prevalence of nutrition labels and completeness of nutrient declarations on pre-packaged food in China. Journal of Public Health 37(4), 649-658
A 2012 Central American Technical Regulation (67.01.60:10) establishes rules on the use of specified nutrient content claims (ie levels of fat for a low-fat claim). Claims are not permitted on products that may promote or sanction excessive consumption of these nutrients or undermine good dietary practice. Although nutrition content claims need to meet certain criteria set out in the Regulation, there are no generalised nutritional criteria that restrict their use on "unhealthy" food.
A 2012 Central American Technical Regulation (67.01.60:10) permits and regulates the use of nutrient function and disease risk reduction claims. Claims must be substantiated through information demonstrating the nutritional composition of the food, and the relationship between the claimed function of the food product and the beneficial effect on diet and health. The Ministry of Health has responsibility to approve the use of claims on food containing high levels of nutrients that can increase risk of illness or health problems. Claims are not permitted on products that may promote or sanction excessive consumption of these nutrients or undermine good dietary practice. There are no generalised nutritional criteria that restrict their use on "unhealthy" food.
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.
Executive Decree No. 36910-MEP-S (2012) of the Costa Rican Ministries of Health and Education sets restrictions on products sold to students in elementary and high schools, including food with high levels of fats, sugars and salt such as chips, cookies, candy and carbonated sodas. Schools are only permitted to sell food and beverages that meet specific nutritional criteria. The restrictions were upheld by the Constitutional Court in 2012 following a challenge by the Costa Rican Food Industry Association.
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 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 of how they are also influenced by promotional activities.
Article 10 of Executive Decree No 36910-MEP-S (2012), updated in 2013 (Executive Decree No 37869), of the Costa Rican Ministries of Health and Education restricts both direct and indirect advertising of food products with high levels of fats, sugars and salt in elementary and high schools (see “O – Offer health food and set standards in public institutions and other specific settings” for details of school food regulations). Partial implementation is reported and not in all schools. A strategy to enforce the decree is currently being developed and will be implemented in 2018.
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.
The National Plan to Reduce Public Consumption of Salt 2011–2021 was established in Costa Rica in 2011. The aim of the Plan was to reduce population-wide salt consumption to 5g per person per day. Implementation of the Plan began in 2012, and included voluntary agreements with the food industry to reduce salt content in processed food.
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.
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 limited 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, Paraguay), pineapples (Fiji), pyramids (India, US), plates (Australia, Colombia, UK), pagodas (China), spinning top (Venezuela), traditional African house (Benin) and circles (Argentina). Some countries have started to include sustainability criteria in their dietary guidelines (eg Germany in 2013, Finland and Brazil in 2014, Sweden and Qatar in 2015, the Netherlands and UK 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. Canada’s new food guide, launched in 2019, provides guidance on what to eat, as well as how to eat. This includes recommendations on healthy eating habits that encourage people to cook more often, to be mindful of their eating habits, to use food labels, to cook at home and to eat meals with others. The new food guide is an online suite of resources that provides information targeted to different audiences, including the general public, health professionals and policy makers.
Details on the content of national dietary guidelines can be found on the FAO database on Food-based dietary guidelines.