Global and local experts have come together to urge for simple and effective front-of-package labels (FOPL) to address India’s spiralling crisis of non-communicable diseases (NCDs). With more than 135 million Indians obese and a sharp rise in childhood obesity, India is nearing a health flashpoint. Three conditions, namely high blood pressure, high fasting blood sugar levels and obesity, are the main drivers of this disease burden in India.
Nearly 5.8 million people or 1 in 4 Indians are at a risk of dying from an NCD before they reach the age of 70. Disease burden of NCDs increased from 30 per cent ‘disability-adjusted life years’ (DALYs) in 1990 to 55 per cent in 2016, with deaths due to these conditions increasing from 37per cent in 1990 to 61per cent in 2016. Cardiovascular disease (CVD) accounts for at least 27 per cent of NCD deaths. Untreated and uncontrolled hypertension contributes to an estimated 1.6 million deaths annually in India – 57 per cent of these deaths related to stroke and 24per cent related to coronary heart disease. India is also fast becoming a diabetes and cancer hotspot. This crisis is being further aggravated by the COVID-19 pandemic, as persons living with NCDs face a greater risk of becoming severely ill or dying from COVID-19. All of these conditions such as high blood pressure, high fasting blood sugar levels and obesity are closely linked to unhealthy diets, and an excessive intake of sugars, total fats, saturated fats, trans fats and sodium. In turn, the excessive intake of these “nutrients of public health concern”, is largely driven by the widespread availability, affordability and promotion of processed and ultra-processed food products with unhealthy nutritional profiles. Reports indicate that the COVID-19 pandemic generated a unique opportunity for the food and beverage industry to thrive in low- to middle-income countries and expand their market of unhealthy, ultra-processed foods and sugary drinks.
Front-of-package warning labelling represents a key component of a comprehensive strategy to promote healthier lives, as it enables consumers to identify in a quick, clear and effective way, products high in sugar, sodium, saturated fats, trans fats and total fats, the critical nutrients associated with the NCD burden in India.
Dr Chandrakant Pandav, President, Indian Coalition for the Control of Iodine Deficiency Disorders (ICCIDD), warns that there is no time is to be lost. “It is clear as day that our food environment needs to change drastically if we are to reverse the health crisis and safe guard our future generations. Even as we move to fortify our food, it is equally critical to equip people with information regarding harmful nutrients in their food products including ie, high concentration of salt, sugar and fats, is an equally important strategy.”
A strong front-of-package label is one of the most efficient tools of influencing consumer behaviour to alter dietary choices and reduce their vulnerability to NCDs. According to Dr Barry Popkin, the W. R. Kenan Junior distinguished professor of nutrition at the University of North Carolina Gillings School of Global Public Health sharing his experience from leading research on impact of FOPL in multiple countries said, “In our ongoing evaluations we have found that all countries which have adopted warning label system of FOPL that are easy to interpret, have succeeded in reducing consumption of the most unhealthy ultra-processed foods and beverages. As suggested by available evidence, this is one of the most effective approaches to preventing obesity and nutrition-related NCDs like diabetes and hypertension. People need to understand clearly and simply what is in the food that they are buying. Food labels have to interpret the nutrition information for consumers across age, income and literacy levels.”
Underscoring the importance of enabling consumer choice, Mr Ashim Sanyal, COO etc talked about the difficulty of making a choice when it comes to buying food off the shelf. “While at the grocery shop or supermarket consumers faced with a variety of choices, take their decisions in a few seconds. Labels have to influence diet choices within that window of time. FSSAI has taken an important step towards making our food systems healthier by capping the content of trans fats. It is the need of the hour that government set threshold for HFSS foods and to develop a labelling system that shares that information most effectively.”
Vandana Shah, Regional Director, Global Health Advocacy Incubator drew attention to the momentum on FOPL warning policies building across the world. “India can join the growing list of countries that are realising the potential of a strong FOPL to safeguard the lives of their people. Effective FOPL is a key tool in the global fight fight against obesity and diabetes. India, with its fast growing packaged food industry and youth demographics, could lead the way for a regional roadmap, by picking a labelling system that best guides consumers towards the healthiest choice.”
In 2018 the Food Safety Standards Authority India (FSSAI) published draft regulation for FOPL which was subsequently withdrawn for further deliberation. In 2020 December, FSSAI restarted the process of developing FOPL and has been consultations with civil society, industry and nutrition experts for a viable model for India.
FOPL works best when it is made mandatory and applies to all packaged products, and the label is interpretative, simplistic and readily visible, guided by a strong nutrient profile model.