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
EU Regulation 1169/2011 on the Provision of Food Information to Consumers, passed in 2011, requires a list of the nutrient content of most pre-packaged food to be provided on the back of the pack from 13 December 2016. This Regulation is also applicable in Iceland, Norway and Liechtenstein as members of the European Economic Area. In Switzerland, nutrient content labelling is only mandatory for products bearing nutrient or health claims or sold to the EU (but most manufacturers already label nutrient content on their food products voluntarily).
EU Regulation 1169/2011 on the Provision of Food Information to Consumers, passed in 2011, permits EU Member States to develop voluntary guidelines for front of pack nutrition information, to be used in addition to the mandatory nutrition information on the back of pack. Information on energy value, fat, saturated fat, sugar and salt content is permitted. Different styles of presentation (eg % Guideline Daily Allowances or traffic lights) are permitted. This Regulation is also applicable in Iceland, Norway and Liechtenstein as members of the European Economic Area and Switzerland based on its bilateral agreements with the EU.
Regulation 1924/2006 establishes EU-wide rules on the use of specified nutrient content and comparative claims (ie levels of fat for a low-fat claim). As of January 2010, only nutrition claims as listed in the Regulation’s annex are permitted. In theory, these nutrition claims may only be used on food defined as "healthy" by a nutrient profile. This nutrient profiling restriction was due to be implemented in 2010 but no model has yet been established. Therefore, permitted nutrition claims can be used as long as the conditions for use of the claim as set out in the annex are met. Once nutrient profiles are established, nutrition claims may only be used on food products deemed "healthy", though two notable exceptions will apply: nutrition claims referring to the reduction of fat, saturated fats, trans fats, sugars and salt/sodium will be allowed without reference to a profile for the specific nutrient, provided the claims comply with the conditions of the Regulation; and a nutrition claim may be used even if a single nutrient exceeds the nutrient profile as long as a statement in relation to this nutrient appears on the label in close proximity to, on the same side and with the same prominence, as the claim (the statement must read: 'High [name of nutrient] content'). This Regulation is also applicable in Iceland, Norway and Liechtenstein as members of the European Economic Area; Switzerland amended its foodstuff law based on its bilateral agreements with the EU to include permitted EU nutrient claims.
Regulation 1924/2006 (applicable as of July 2007) establishes EU-wide rules on the use of health claims (claims on nutrient function, disease risk reduction and children’s health). Companies may only use health claims that are substantiated and authorised by the European Commission and Member States (various regulations authorising health claims to date). The European Food Safety Authority is responsible for verifying the scientific substantiation of claims; it has done so for claims currently in use and continues to do so for claims that are proposed and applied for by companies that want to use health claims in the EU. In theory, health claims may only be used on food defined as "healthy" by a nutrient profile. This nutrient profiling restriction was due to be implemented in 2010 but no model has yet been established. Therefore, permitted health claims can be used as long as the conditions for use of the claim as set out in the respective regulations are met. Once nutrient profiles are established, health claims may only be used on food products deemed "healthy". This Regulation is also applicable in Iceland, Norway and Liechtenstein as members of the European Economic Area. Switzerland amended its foodstuff law based on its bilateral agreements with the EU to include permitted EU health claims.
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.
The EU School Fruit Scheme, launched in the 2009-2010 school year, merged with the EU School Milk Scheme on 1 August 2017 into one legal framework based on the Regulation on the new School Fruit, Vegetables and Milk Scheme (Regulation EU No 2016/791). The scheme is funded through the EU’s common agricultural policy and supports the distribution of fruit, vegetables and milk and milk products to schools across the EU as part of a wider programme of education about European agriculture and the benefits of healthy eating. It provides financing to Member States based on the number of school children and level of development of the country. The implementation of the programmes is at the discretion of national or regional governments, but to receive funding, they must distribute fruit, vegetables and milk products in schools and implement educational measures, such as farm and market visits, educational material distributed to teachers and interactive games on education and nutrition, and regularly monitor and evaluate implementation. Foods containing added sugars, salt, fat, sweeteners or artificial flavor enhances are exempt from the scheme: as an exception, limited quantities of added sugar, salt and fat are allowed if they are approved by the Member States' health/nutrition authorities. The Member States determine the frequency and duration of the distribution of the food.
European Commission, Directorate-General for Agriculture and Rural Development. Evaluation of the European School Fruit Scheme Final Report. Brussels, 2012
European Court of Auditors. Are the school milk and school fruit schemes effective? Special Report No. 10. Luxemburg, 2011
Since 2012, food and beverages subject to the public health product tax (see “U – Use economic tools to address food affordability and purchase incentives” for details on the tax) may not be sold on school premises or at events organised for school children, including out-of-school events based on the Ministerial Decree 20/2012 (VIII. 31.) on the Operation of Public Education Institutions and the Use of Names of Public Education Institutions. Section 130(2) of the Decree requires the head of the educational institution to consult the school health service prior to entering into agreements with vending machine operators or food vending businesses. The school health service verifies whether the products to be sold meet the nutritional guidelines set by the National Institute of Pharmacy and Nutrition. Products that do not comply with the guidelines’ “healthy eating” requirements or that have a negative impact on the students’ attention or behaviour, such as those containing artificial colours found in sugary snacks and drinks, are prohibited.
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 July 2011, Hungary passed Act CIII on the Public Health Product Tax. Effective since September 2011, the "public health tax" is applied on the salt, sugar and caffeine content of various categories of ready-to-eat food, including soft drinks (both sugar- and artificially-sweetened), energy drinks and pre-packaged sugar-sweetened products. The tax is applied at varying rates. Soft drinks, for example, are taxed 7 forints (around $0.024) per litre, concentrated syrups used to sweeten drinks are taxed 200 forints (around $0.70) per litre and pre-packaged sugar-sweetened products are taxed 130 forints (around $0.45) per kg. The tax also applies to products high in salt, including salty snacks with more than 1g salt per 100g, condiments with more than 5g salt per 100g and flavourings with more than 15g salt per 100g.
Bíró A (2015) Did the junk food tax make the Hungarians eat healthier? Food Policy 54, 107-115
National Institute for Food and Nutrition Science Directorate General. Assessment of the impact of a public health product tax, Final report. World Health Organization, Regional Office for Europe, November 2015
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.
Based on Section 8 of Act XLVIII on Basic Requirements and Certain Restrictions of Commercial Advertising Activities (2008), Hungary prohibits all advertising directed at children under the age of 18 in child welfare and child protection institutions, kindergartens, elementary schools and their dormitories. Advertisements promoting a “healthy lifestyle” are exempt from the ban. The term “healthy lifestyle” is not defined by Section 8, and school boards determine on a case-by-case basis if an advertisement complies with this exception, in addition to adhering to national regulatory mechanisms and EU regulations on health claims. Health promotion and prevention activities in schools may only involve external organisations and consultants who are recommended by the National Institute for Health Development according to Section 128(7) of the Ministerial Decree 20/2012 (VIII. 31.) on the Operation of Public Education Institutions and the Use of Names of Public Education Institutions.
The EU Pledge was launched in 2007 as a commitment by the food industry, supported by the World Federation of Advertisers (WFA), to the European Union Platform for Action on Diet, Physical Activity and Health. Companies commit to not advertising food on mass media where children under the age of 12 make up 35% of the audience unless their products comply with category-based thresholds on sodium, saturated fat and total sugar. Soft drinks and sugar-based products (chocolate, confectionary, jam/marmalade, sugar/honey/syrup) may not be marketed to children under the age of 12. Members can comply with their own criteria if they are demonstrably stricter than the ones developed by the EU Pledge. Members also commit to not advertise in primary schools except when there is agreement with the school for educational purposes. The European Commission mediates the communication between the EU Platform and the WFA. Belgium, Hungary, Portugal and Turkey have national pledges modelled after the EU Pledge. (See Yale Rudd Center for Food and Obesity's database on Pledges on Food Marketing to Children Worldwide).
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.
As part of the Hungarian Stop Salt – National Salt Reduction Programme the Hungarian Baker Association signed an agreement to reduce the salt content of bread by 10.7% by 2014, and by another 5.3% by 2017.
In 2012, Hungary introduced maximum salt levels in bread: <1.67g salt/100g bread from 1 January 2015 and <1.57g salt/100g bread from 1 January 2018.
A 2013 decree sets limits on the trans fat content allowed in food products in Hungary. It covers the trans fat content of oils, fats and fat emulsions intended for consumers, either on their own or as ingredients of a food product. The general provisions establish a limit of 2g trans fat per 100g of total fat content. In the case of processed multi-ingredient food, the limit depends on the percentage total fat content: food containing less than 20% total fat have a trans fat limit of 4g per 100g of fat; for food containing less than 3% total fat the trans fat limit is 10g per 100g.
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.
*Civil society organisations have also developed public awareness campaigns on unhealthy food. For example, Cancer Council Victoria in Australia has a social marketing team that runs campaigns related to cancer prevention, including on diet and obesity. In January 2013, it launched the Rethink Your Sugary Drink campaign on YouTube and social media focused on the amount of sugar in soft drinks. In Mexico, the civil society network Alianza por la Salud Alimentaria ran a public campaign against soft drinks in May–August 2013. A series of adverts were posted on buses, billboards and in the subway showing 12 heaped spoonfuls of sugar next to a bottle of soda. The adverts asked "Would you eat 12 spoonfuls of sugar? Why do you drink soda?”
The Hungarian Aqua Promoting Programme in the Young (HAPPY), run by the National Institute for Food and Nutrition Science, aims to reduce the excessive consumption of sugary drinks and to popularise water consumption among primary school students. Running nationwide since 2010, the programme promotes water consumption by educating students on adequate fluid consumption and makes free water available on school premises. More than 43,500 students from 144 schools participated in HAPPY in 2014.