Kwesi Marshall | What’s in our food? - Addressing obesity prevention through front-of-package labelling

Your doctor has advised you to reduce your sugar consumption. You are told to cut down on your saturated fat intake, too. Not to mention completely avoiding something called trans fats. Unsure of what you should do, you phone a nutritionist friend, who provides some advice for reading the labels on packaged foods.

Nevertheless, your most recent trip to the local supermarket could politely be described as frustrating. Why?

First, you picked up a packet of your family’s usual choice of breakfast cereal. As advised, you searched for its nutritional content. You found it, tucked away on the side of the package, yet when you try to read it, you are faced with a bunch of technical terms next to a slew of meaningless numbers – in the tiniest of prints. Undeterred, you then !picked up a different brand of breakfast cereal, but that package had much of its information printed in some foreign language. Frankly, you’re still not even sure which one! So then you looked at yet another brand. But that was even less helpful. It didn’t contain any nutrient-related information at all! Reluctantly, you decide to stick with your usual brand. And regrettably, the rest of that day’s search for meaningful nutrition information goes no better.

And you only wanted to find out what was in your food!

But now, imagine this.

Now, as you walk through the familiar aisles of that very same supermarket, you are greeted with a very unfamiliar experience. Glancing along row upon row of foods and beverages, you can see clearly noticeable changes.

Look. There is a packet of pasta. On its front, there is nutritional information printed in a large, friendly, readily seen font. And there’s more. Distinctive coloured symbols accompany the written information, making it so much easier to understand. For good measure, detailed nutritional and health facts can also be found on the backs and sides of the packages. And so it goes for the rest of your shopping experience.

The result? You spend a lot less time trying to make sense of the labels. In the process, you find it much easier distinguishing and selecting healthier food choices. In the bargain (and to your great surprise), you also pick up quite a bit of useful dietary knowledge.

What just happened?

Welcome to a world with front-of-package food labelling.

Well, at least some parts of the world, because at the time of writing, this isn’t our current reality in Jamaica. At least not now … at least not yet.

But can we really look forward to this change? Perhaps sometime in the near future? We at the National Food Industry Task Force, a food and nutrition advisory and advocacy body that reports to the Ministry of Health and Wellness (MOHW), believe that front-of-package labelling is not only well justified, but urgently required. To show you why, let us look at our current situation.

NCD Epidemic

Currently, the entire world is struggling with the COVID-19 pandemic. Justifiably, public-health concerns and priorities here in Jamaica and elsewhere have been focused on actions to curb the spread of this potentially deadly infectious disease. After all, one cannot just wish the coronavirus away. Likewise, however, one cannot just wish away our other major health problems. Jamaica remains confronted by a range of serious challenges posed by chronic non-communicable diseases (NCDs) such as obesity, diabetes, and cardiovascular disease. These and other long-standing but still critically important and growing public-health problems comprise what is often referred to as an NCD epidemic. This NCD epidemic also demands our urgent attention.

Obesity and other NCDs are linked to the foods we eat. For instance, the proliferation of convenience and fast foods, high in saturated fats, trans fats, salt, and added sugars, is reflected by high levels and rising rates of overweight and obesity among the Jamaican population. One in two Jamaicans (54 per cent) is overweight or obese, including two- thirds of Jamaican women 15 years or older. Moreover, between 2010 and 2017, obesity among Jamaican children aged 13 - 15 increased by 68 per cent. Similar patterns and trends are seen for other NCDs.

The NCD epidemic brings severe healthcare strains and enormous financial costs. Nearly four out of every five deaths in Jamaica are attributed to NCDs. In addition, recent figures show that the Government of Jamaica spends in excess of US$170 million annually on NCD prevention and treatment.

To make matters worse, accumulating evidence is revealing that people who present with COVID-19 plus one or more underlying NCDs are not only at a higher risk of developing severe virus-related symptoms, but also at a higher risk of dying as well. This means that our entire health system is threatened by concurrent communicable and non-communicable disease burdens, entailing grim societal-wide health and economic consequences. These burdens make the utilisation of feasible, effective, and nutritionally based health promotion strategies all the more pressing.

Food Labelling

Food labelling represents one such population-level strategy. For example, the reader might well be familiar with the Nutrition Facts panel. This panel is typically found on the back or sides of pre-packaged items, where it provides quantitative information on selected nutrients. However, research shows that information conveyed via such labels is insufficient for helping consumers to distinguish healthy from not-so-healthy food choices. In addition, the Nutrition Facts panel is neither mandatory nor standardised in Jamaica or, indeed, the rest of the Caribbean. Hence, many products carry no Nutrition Facts panels at all. Moreover, even when present, they often point to significant shortcomings in the existing regulatory framework: labels can contain unverifiable nutritional claims or reveal significant item-by-item variations in nutritional content. Knowing this, few would dispute that food labels in the Jamaican market place require a significant upgrade.

Front-of-Package Food labelling (FOPL)

Enter front-of-package food labelling (FOPL). Consumers require clear, concise communication of nutritional information. FOPL systems can communicate such information. They do so primarily via their standout feature: located on the front of packaged foods and beverages, FOPL presents relevant and important nutritional facts that promote the adoption of healthier diets. Based on a body of convincing evidence, leading global and regional health organisations such as the World Health Organization (WHO), the World Cancer Research Fund (WCRF), the Pan American Health Organization (PAHO), and the Healthy Caribbean Coalition (HCC) have urged governments to leverage FOPL as a key policy tool.

The National Food Industry Task Force here issues its own call for the introduction of mandatory FOPL into the Jamaican food environment. Crucially, the task force views FOPL as one component of a comprehensive multipronged framework, encompassing complementary measures such as food and beverage reformulation. Deployed in such a manner, FOPL can accomplish the following:

• Elevate health awareness among consumers at all literacy and numeracy levels

• Enhance consumer understanding and interpretation of nutritional information

• Motivate healthier point-of-purchase decisions by consumers

• Reduce exposure of children and adolescents to targeted marketing

• Encourage product reformulation by our partners in the food and beverage industry, thereby expanding the availability of healthier alternatives

• Support other national, regional, and global health-promotion initiatives

Recent real-world evidence speaks to the utility of implementing policy measures that incorporate FOPL. For instance, the Government of Chile’s Law of Food Labelling and Advertising, introduced in 2016, jointly mandates the use of FOPL warning labels, restricts child-directed marketing, and bans the sale in schools of all foods and beverages containing added sugars, sodium, or saturated fats exceeding so-called “high-in” thresholds. Of note, a 2020 study published in the peer-reviewed journal PLOS Medicine reports significantly reduced sugary drink purchases in Chile following implementation of these measures. Buttressed by similar successes, more than 40 governments, to date, have either led the implementation or supported the development of FOPL.

Why hasn’t then FOPL already been implemented in Jamaica? In part, this reflects the fact that revisions to existing labelling standards also involve region-spanning consultations within CARICOM. It also reflects concerns expressed by the food and beverage industry, which has brought up potential issues in areas such as international trade and the law. These concerns have been duly noted and can be adequately addressed. However, they should not deflect us from our primary areas of focus. To combat obesity and to promote the public health more generally, the time for expeditious action is upon us.

We reiterate our call for the urgent introduction of a robust FOPL system into the Jamaican marketplace. After all, Jamaican consumers deserve better-informed answers to the question: What’s in our food?

- Kwesi Marshall, PhD, is chairman of the National Food Industry Task Force, a food and nutrition advisory and advocacy body that reports to Jamaica’s Ministry of Health and Wellness. Email feedback to jctc@heartfoundationja.org