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
In South Korea, a nutrient list must be provided on select categories of pre-packaged food, including cookies/candies/popsicles, breads and dumplings, cocoa products, jams, oils, noodles and pasta, drinks and beverages, and food of special use. The Foods Labelling Standards were first enacted in 1996, and the Labelling Standard for Health Functional Food in 2004; both Standards have been revised several times since then. Based on the 1st Master Plan on Reducing Sugar Intake 2016–20 and the 2016 White Paper by the Ministry of Food and Drug Safety, further categories will be required to bear nutrient lists with a three-stage implementation between 2017 and 2022 (including cereals, ready-to-eat products and ready-to-cook products in 2017; dressings and sauces in 2018–19; Korean-style boiled grain-/meat-/fish-based food and processed food based on fruit or vegetable purees/pastes in 2020–22).
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.
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
The South Korean Special Act on Safety Control of Children's Dietary Life recommends colour-coded labelling for use on the front of pre-packaged children's "favourite food" including cookies/candies/popsicles, breads, chocolates, dairy products, sausage (fish or meat based), some beverages, instant noodles and fast food (seaweed rolls, hamburgers, sandwiches). Guidance for the front-of-pack colour-coded labelling was issued by Public Notice (2011), and outlines three permitted designs using green, amber and red to identify whether products contain low, medium or high levels of total sugars, fat, saturated fat, and sodium.
Since 2010, the South Korean Special Act on Safety Control of Children’s Dietary Life has required all chain restaurants with 100 or more establishments to display nutrient information on menus including energy, total sugars, protein, saturated fat and sodium on menus.
The rules on the use of nutrient claims were established in July 2000 under Section 4 of the South Korean Food Sanitation Act (food labelling). The law regulates which claims are permitted, defines the conditions that must be met for the claim, and governs the language that may be used.
The rules for the use of health claims are set out in the South Korean Health Functional Food Code, based on Article 17 of Section 3 (Standards, Specifications, Labelling and Advertisements) of the Health Functional Food Act 2004 (which has been amended several times). The Act allows for claims to be expressed in both words and diagrams. The Code lists the wording for allowed claims, sets out standards for manufacturing to be observed for each nutrient, and how much the actual nutrient content of the product may deviate from the labelled content (in percentage, ie beta-carotene must be within 80–150% of the labelled amount). The Code includes the recommended daily intake amount, generally expressed as a range between the minimum to maximum amount. If intake of a nutrient may cause negative health effects, a warning label has to be applied.
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 South Korea, the sale of sugary drinks within school premises, along with other energy-dense and nutrient poor foods is prohibited. Originally enacted as an action of a Special Presidential Committee in 2007, it is now enforced by the Special Act on the Safety Management of Children’s Dietary Life.
In 2010, the South Korean Special Act on the Safety Management of Children’s Dietary Life incorporated provisions to improve the nutritional quality of school meals and sets nutrition and food-based standards for other food on sale in schools. Additionally, this Act establishes Green Food Zones, banning the sale of energy dense and nutrient poor foods including fast food and soda within school premises and stores within 200 metres of schools. In 2017, Green Food Zones existed at over 10,515 schools (over 90% of schools). The provisions were implemented in 2009–10.
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 South Korea, TV advertising to children under 18 years of age is prohibited for specific categories of food before, during and after programmes shown between 5pm–7pm and during other children’s programmes (Article 10 of the Special Act on the Safety Management of Children’s Dietary Life, as amended 2010). The restriction also applies to advertising on TV, radio and internet that includes “gratuitous” incentives to purchase (eg free toys).
Lee Y et al. (2017) Effect of TV food advertising restriction on food environment for children in South Korea. Health Promotion International 32(1), 25-34
Kim S et al. (2013) Restriction of television food advertising in South Korea: impact on advertising of food companies. Health Promotion International 28(1), 17-25
In South Korea, internet advertising that includes “gratuitous” incentives to purchase (eg free toys) is prohibited (Article 10 of the Special Act on the Safety Management of Children’s Dietary Life, as amended 2010).
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 Korea Center for Less Salt Campaign is a joint initiative of the Ministry of Food and Drug Safety (MFDS, formerly KFDA), academia and NGOs in Korea. It was launched in March 2012 and has been working to increase the awareness of the general population and encourage the food and catering industry to participate in sodium content reduction in food. MFDS set the goal to decrease the sodium intake of the population by 20% by 2017 (base 2010), and has developed sodium reduction guidelines for certain food products including Kimchi, soy sauce, soybean paste, noodles and salted fish to be used by food manufacturers. In 2013, 13 food manufacturers voluntarily produced or reformulated 87 processed food products with lower sodium content, and some large supermarkets also provide separate sections for the sale of lower sodium products.
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 (Australia, India, US), plates (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. Details on the content of national dietary guidelines can be found on the FAO database on Food-based dietary guidelines.
The reason for nutrition education is to improve knowledge and the ability to put that knowledge into practice. Studies have demonstrated that nutrition knowledge and healthy dietary behaviour are positively correlated. Higher levels of general education have been found to increase the ability of individuals to obtain and understand the health-related information needed to develop health-promoting behaviours.
The evidence shows that interventions to provide education can be effective, but this depends on the pre-existing attitude, knowledge and habit strength of the targeted group. Education should thus be accompanied by changes in the food environments to effect longer-lasting change.
In 2011, South Korea made amendments to the 2006 School Meals Act to include nutrition education in school curricula. Nutrition education is provided by nutrition teachers who are dietitians with a government issued license who have passed a special examination.