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
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
Added May 2019: In August 2018 the Uruguay Executive Branch approved the Decree 272/018 requiring mandatory use of front-of-package labels on food products containing excess amounts of certain compounds as specified in the Decree. The Decree states that a food product must display a front-of-pack label by February 2020 if it exceeds at least one of the established criteria: sodium - 8 mg/1kcal or 500mg/100g; sugars- 20% of the total caloric value; fat- 35% of the total caloric value; saturated fat- 12% of the total caloric value. After February 2020 this will increase to 1 mg/1kcal or 360mg/100g; sugars- 10% of the total caloric value; fat- 30% of the total caloric value; saturated fat- 10% of the total caloric value. The front-of-pack label shall consist of symbols with octagonal design and black background and white border, which state "EXCESS" followed by the corresponding nutrient: FAT, SATURATED FATS, SUGARS or SODIUM. It must include a symbol for each nutrient that is in excess.
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 September 2013, the government of Uruguay adopted Law No. 19.140 on healthy eating in schools. It mandated the Ministry of Health to develop standards for food available in canteens and kiosks in schools, prohibited advertising for these same food items, and restricted the availability of salt shakers. The school food standards were elaborated in March 2014 in two further documents: Regulatory Decree 60/014 and the National Plan of Health Promoting Schools. The standards aimed to promote food with “natural nutritional value” with a “minimum degree of processing" and to limit the intake of free sugars, saturated fat, trans fat and sodium. Limits are set per 100g of food, 100ml of drink and also per 50g portion. Prohibited food includes sugary beverages and energy drinks, confectionery, salty snacks, cakes and chocolate. The school food standards and restrictions on advertising began to be implemented in public schools in 2015 and are being monitored for compliance.
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 September 2013, the government of Uruguay adopted Law No 19.140 Alimentación saludable en los centros de enseñanza (Healthy food in schools). The Law prohibits the advertising and marketing of food and drinks that don’t meet the nutrition standards, referenced in Article 3 of the Law, and outlined in school nutrition recommendations published by the Ministry of Health in 2014 (see “O – Offer healthy food and set standards in public institutions and other specific settings”). Advertising in all forms is prohibited, including posters, billboards, use of logos/brands on school supplies, sponsorship, distribution of prizes, free samples on school premises and the display and visibility of food. The law began to be implemented in 2015.
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.
Salt reduction is part of Uruguay’s national non-communicable disease prevention and national nutrition programmes led by the Ministry of Health. The strategy includes a voluntary agreement with the bakery industry to reduce sodium in bread products. Engagement with the bread industry to reduce salt began in September 2013.
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.
Updated May 2019: 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.