We developed the NOURISHING framework to highlight where governments need to take action to promote healthy diets and reduce overweight and obesity.
The framework is accompanied by a regularly updated database (last updated 8 May 2019), providing an extensive overview of implemented government policy actions from around the world.
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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 regulation of the Ministry of Public Health of Ecuador published in November 2013 (No. 4522, El Reglamento de Etiquetado de Alimentos Procesados) requires packaged food to carry a “traffic light” label in which the levels of fats, sugar and salt are indicated by red (high), orange (medium) or green (low). Full compliance with the regulation was required by 29 August 2014.
Freire WB, Waters WF, Rivas-Mariño G, Nguyen T, & Rivas P (2017) A qualitative study of consumer perceptions and use of traffic light food labelling in Ecuador. Public health nutrition, 20(5), 805-813
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.
In October 2014, the Ministries of Public Health and Education in Ecuador implemented a regulation for school bars within the national education system (Reglamento de bares escalares del system nacional de educacion - Ministerial Agreement 5, Official Record 232). The regulation establishes mandatory nutrition requirements for food and drinks prepared and sold in school bars and cafeterias. Food and drinks must be natural, fresh, nutritious and healthy and it is prohibited to sell or advertise 1) processed foods and drinks with high concentrations of fats, sugars and salt (specified within regulation) 2) food and drinks containing caffeine and/or non-caloric sweeteners 3) energy drinks 4) processed drinks with less than 50% natural food.
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.
Please note, $ refers to USD.
In April 2016, the government of Ecuador passed the Organic Law to Balance Public Finances (Official Record 744 Ley Organica para el equilibro de las finanzas publicas). In effect since May 2016, a 10% ad valorem tax is applied to soft drinks with less than 25g of sugar per litre and to all energy drinks. Drinks with more than 25g of sugar per litre are taxed at a special rate of $0.0018 per gram of sugar. Drinks exempt from the tax include dairy products and their derivatives, mineral water and juices that have 50% of natural content.
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.
In October 2014, the Ministries of Public Health and Education in Ecuador implemented a regulation for school bars within the national education system (Reglamento de bares escalares del system nacional de educacion - Ministerial Agreement 5, Official Record 232). The regulation prohibits schools from advertising: 1) processed foods and drinks with high concentrations of fats, sugars and salt (specified within regulation) 2) food and drinks containing caffeine and/or non-caloric sweeteners 3) energy drinks 4) processed drinks with less than 50% natural food. School bars are visited twice a year by the local school bar committee to ensure compliance with the regulation.
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.
Ecuador has a national salt reduction programme, which includes voluntary agreements with bread and sausage producers to reduce salt in their products.
In 2013, the Ministry of Public Health (MSP) introduced Ministerial Agreement No. 4439 to limit trans fat. The objective of the agreement, which is based on scientific evidence, is to limit the amount of trans fats that edible oils, margarines and confectionery products can have. Both for those that are sold directly to the consumer and for those used as raw material and inputs in the food industry (eg bakeries, restaurants or food services (catering)). The limit established for these products is 2g of trans fat per 100g of fat.
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.