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
In 2014, the governments of Australia and New Zealand started to implement a Health Star Rating (HSR) system as a voluntary scheme for industry adoption. It is a joint Australian, state and territory governments and New Zealand government initiative developed in collaboration with industry, public health and consumer groups. The HSR system takes into account four aspects of a food associated with increasing risk for chronic diseases; energy, saturated fat, sodium and total sugars content along with certain “positive” aspects of a food such as its content of fruit, vegetables, nuts and legumes, and in some instances, dietary fibre and protein. Star ratings range from ½ star (least healthy) to 5 stars (most healthy). Implementation is overseen by the Australia and New Zealand Ministerial Forum on Food Regulation, the Front-of-Pack Labelling Steering Committee, the Trans-Tasman Health Star Rating Advisory Committee, the New Zealand Health Star Rating Advisory Group and a Technical Advisory Group. The Technical Advisory Group is currently evaluating progress as well as conducting a formal review of the HSR system, including an assessment of the underlying algorithm. Recommendations for the HSR system’s improvement will be presented in 2019.
Added December 2019: Jones A, Thow AM, Mhurchu CN, Sacks G, Neal B (2019) The performance and potential of the Australasian Health Star Rating system: a four-year review using the RE-AIM framework. Australian and New Zealand Journal of Public Health 43(4): 355-365.
Added December 2019: MP Consulting (2019) Health Star Rating System Five Year Review Report – May 2019.
Jones A, Shahid M, Neal, B (2018) Uptake of Australia’s Health Star Rating System. Nutrients 10(8): 997.
Mhurchu CN, Eyles H, Choi YH (2017) Effects of a voluntary front-of-pack nutrition labelling system on packaged food reformulation: The Health Star Rating system in New Zealand. Nutrients 9(8):918
Health Star Rating Advisory Committee (2017) Two year progress review report on the implementation of the Health Star Rating system – June 2014 – June 2016.
Nutrition, Health and Related Claims Standard 1.2.7 (2013) introduces rules on the use of nutrition content claims (ie levels of fat for a low-fat claim) in Australia and New Zealand. Although nutrition content claims need to meet certain criteria set out in the Standard, 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.
Local public health service units oversee the WorkWell programme, launched in New Zealand in 2011. WorkWell helps businesses improve their employees’ health by supporting the improvement of the working environment and organisational systems. It includes a focus on healthy eating by providing companies with the WorkWell for Healthy Eating Toolkit. The Toolkit contains a step-by-step approach, including how to write a healthy eating policy for the company and ideas to change the food environment at the workplace (eg providing drinking water and low-fat milk, changing the caterer to a healthier option). Other tools provided are Guidelines for workplace vending machines, Guidelines for snack boxes, Food ideas for work meetings and Drinking water guidelines.
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.
Since 2007, the New Zealand Heart Foundation has received funding from the government to implement a national food reformulation programme. The programme – HeartSAFE (Sodium Advisory and Food Evaluation) – focuses on salt reduction in packaged food. Best Practice Guidelines have been established as orientation for food manufacturers, outlining maximum levels of sodium in mg per 100g for bread, breakfast cereals, soups, processed meat, savoury pies, savoury snacks, cheese, cooking sauces and edible oil spreads including proposed timelines until 2017 for reformulation. For savoury pies, maximum levels of saturated fat in g per 100g are also included. The programme's objective is to achieve at least 80% of the market share (by sales volume) to meet the targets, which ensure high-volume food is prioritised. Currently in the majority of categories (eg bread, breakfast cereals, processed meats) this objective has been met and, as a result, over 210 tonnes of salt has been removed from these categories. Work is currently being done on establishing best practice guidelines for further categories.
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.
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).
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