India is facing the devastating impact of an unhealthy diet. One hundred thirty-five million (135 M) people are obese, and deaths due to non-communicable diseases (NCDs) are on the rise. Leaders from All India Institute of Medical Sciences (AIIMS), Post Graduate Institute of Medical Education and Research (PGIMER), Institute of Liver and Biliary Sciences, Indian Association of Preventive and Social Medicine (IAPSM), Indian Public Health Association (IPHA), Indian Academy of Pediatrics and Epidemiological Foundation of India (EFI), along with leading doctors from other top medical institutes have issued a clarion call for mandatory front-of-pack food labels (FOPL).
Packaged junk food, a major component of unhealthy diets, is responsible for more deaths worldwide than any other risk factor and is a leading cause of obesity, type 2 diabetes, cardiovascular disease (CVD), and cancer.
Citing an exponential rise in market availability of ultra-processed foods containing high levels of sugars, sodium and saturated fats as a key contributor to this obesity epidemic and upsurge in NCD prevalence. India’s top medical experts urged that adoption of an effective FOPL is the need of the hour.
At an event organized by AIIMS Rishikesh, experts from the nationwide network of AIIMS, the Indian Academy of Pediatrics, Indian Institute of Liver and Biliary Sciences, PGIMER, IPHA and other medical institutions asserted that would save millions of lives. India should establish scientific cut-off limits for salt, sugar, and saturated fats and mandates a clear and simple warning label on packaged products as has been done in Chile, Mexico, and Brazil.
Dr Ravi Kant, Director, AIIMS Rishikesh, said, “A strong and effective FOPL is a public health priority for India. The medical community of India stands in solidarity with this important policy measure that will protect thousands of Indian lives.”
Nearly 5.8 million people or 1 in 4 Indians are at risk of dying from an NCD before they reach 70. India’s deadly second wave of Covid-19 has demonstrated that NCDs also compound the burden of infectious diseases on health systems, with hospitals ill-equipped to meet the sudden surge of demand for patient care. As a result of packaged and ultra-processed food, poor diet is a leading cause for this gradual epidemiological shift in India’s disease burden.
According to Dr. Suneela Garg, President, Indian Association of Preventive and Social Medicine (IAPSM), “All of these conditions such as diabetes, obesity, heart disease or cancers are closely linked to excessive intake of energy-dense and nutrient-poor foods and beverages.”
World over, countries recognize that consumers have the right to accurate health information regarding these products as part of their right to health. Having incomprehensible or misleading information about a food product puts them at a higher risk of making uninformed choices that lead to obesity and other diet-related conditions.
Front-of-package warning labeling is a key component of a comprehensive strategy to promote healthier lives. It enables consumers to identify in quick, clear and effective ways products that are high in the nutrient of concern associated with the NCD burden in India.
As India observes the national nutrition month and leading up to the UN Food Summit, the spotlight is more than ever on excessive intake of these “nutrients of concern.” Even as the COVID-19 pandemic ravaged countries, the food and beverage industry expanded its unhealthy, ultra-processed foods and sugary drinks market.
Pursuant to Euromonitor estimates, in India, the sale of ultra-processed food increased from 2 kg per capita in 2005 to 6kg in 2019 and is expected to grow to 8kg in 2024. Similarly, beverages have gone up from less than 2 L in 2005 to about 8 L in 2019 and are expected to stretch to 10 L in 2024.
Dr Sanjay Rai, President, Indian Public Health Association (IPHA), emphasized that “While a FOPL is indeed one of the most effective approaches to positively impact public health, it is also important to choose the correct format. Evidence from across the world indicates a warning label system of FOPL – such as the “high in” warning symbols adopted in Chile. These interpretive and direct labels are most effective in supporting healthy food choices. They also are most likely to motivate product reformulation. Given the evidence, we should consider adopting these nutrient-based labels without further delay.”
Besides the design, a FOPL is successful when it is mandatory and guided by a scientific nutrient profile model. The single threshold nutrient profile model – for food and beverages – has been the most effective solution for implementing and monitoring the FOPL policy. Countries such as Chile, Israel, and Mexico with robust FOPL policies have adapted models with a single nutrient threshold.
Stressing on the importance of acting swiftly and not ignoring the science that informs the setting of these thresholds, Dr Umesh Kapil said, “Experts across the world have conducted research and compiled field level studies to develop the NPM frameworks.
The WHO SEARO model was put together in consultation with member countries in the region and is perfectly aligned to the Codex Alimentarius or food code. The industry will continue to use diversionary tactics. We need to adopt what is scientifically established as a healthy limit and waste no more time on negotiations.”
FSSAI’s step towards the impact of Obesity
All the experts present have agreed to send recommendations to the Ministry of Health and hope to work with the Government of India towards a healthier and accountable food system. They said it is encouraging to note that the FSSAI has revived FOPL related consultations.
In 2018 the Food Safety Standards Authority India (FSSAI) published a draft regulation for FOPL, which was subsequently withdrawn for further deliberation. In 2019 December, FSSAI delinked FOPL from general labeling regulations and is currently seeking inputs from consumer rights organizations, industry and nutrition experts for a viable model for India.