Healthy Foods, Reformulation Initiatives and Role of

Healthy Foods, Reformulation
Initiatives and Role of Government
Department of Nutrition for health and Development
OECD Paris, 25-26/10/2012
Questions for panel II
• What public and private initiatives for the
production and marketing of healthy foods?
• What innovations and reformulations of foods
are underway to increase the healthy food
• Is there a role for governments in providing
for the production of healthy foods?
OECD Paris, 25-26/10/2012
Healthy foods
OECD Paris, 25-26/10/2012
Ranges of population
nutrient intake goals (WHO/FA0, 2003)
OECD Paris, 25-26/10/2012
Global Strategy on Diet,
Physical Activity and Health (2004)
1. Reducing trans fatty acids and salt
2. Restricting availability of energy dense
foods and high calorie non-alcoholic
3. Increasing availability of healthier foods
including fruits and vegetables
4. Practice of responsible marketing to reduce
impact of unhealthy foods to children
5. Making healthy options available and
6. Providing simple, clear and consistent food
labels that are consumer friendly
7. Reshaping industry to introduce new
products with better nutritional value
8. Making physical activity accessible in all
OECD Paris, 25-26/10/2012
"Best buys" interventions to address NCDs
addressing NCD
risk factors
Tobacco use
Harmful use of alcohol
Unhealthy diet and physical inactivity
Excise tax increases
Smoke-free indoor workplaces and public places
Health information and warnings about tobacco
Bans on advertising and promotion
Excise tax increases on alcoholic beverages
Comprehensive restrictions and bans on alcohol marketing
Restrictions on the availability of retailed alcohol
Salt reduction through mass media campaigns and
reduced salt content in processed foods
Replacement of trans-fats with polyunsaturated fats
Public awareness programme about diet and physical
NCDs in primary
Cardiovascular disease and diabetes
Prevention of liver cancer through hepatitis B immunization
Prevention of cervical cancer through screening (visual
inspection with acetic acid [VIA]) and treatment of precancerous lesions
Multi-drug therapy (including glycaemic control for diabetes
mellitus) for individuals who have had a heart attack or stroke,
and to persons at high risk (> 30%) of a cardiovascular event
within 10 years
Providing aspirin to people having an acute heart attack
OECD Paris, 25-26/10/2012
Proposed Indicators
NCD Global
and targets for 2025
for the global
for NCDs
Mortality between ages 30 and 70 due to
CVD, cancer, diabetes, and chronic respiratory disease
25% reduction
25% reduction
30% reduction
30% reduction
10% reduction
Overweight/obesity (adult, child, adolescent)
Raised total cholesterol
Raised blood glucose/diabetes
Adult per capita consumption of alcohol and heavy
episodic drinking
Policies to virtually eliminate trans fats and to reduce
marketing of unhealthy foods to children
Cervical cancer s creening
Vaccination: HPV, Hepatitis B
Access to basic technologies and medicines
Low fruit and vegetable intake
Access to palliative care
Cancer incidence, by type
Multidrug therapy for CVD risk reduction
Other country-specific indicators of NCD and related issues including social determinants of health
* All indicators should be disaggregated by gender, age, socioeconomic position, and other relevant stratifiers
OECD Paris, 25-26/10/2012
Food reformulation initiatives
OECD Paris, 25-26/10/2012
Salt reduction in the UK
2003 : 3 pronged strategy
– campaign to raise awareness
– targets for food industry to reduce salt
levels in 80 food categories
– front of pack labelling
2008 : 26,000 t/y salt removed
• 24h urinary sodium in a random sample of
adults has decreased 10% (from 9.5 to
8.6 g/d salt)
• ≈ 6000 deaths/yr - strokes, heart attacks
2010: ↓20-40% in processed food products
OECD Paris, 25-26/10/2012
Setting Guiding Benchmark Sodium
Reduction Levels for Processed Foods
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Salt reduction in catering (USA)
Targets to guide company reductions in the salt levels in 25 categories of restaurant
food. The initiative includes voluntary 2012 and 2014 targets for average salt levels in
each food category as well as a maximum salt level for all items served in restaurants.
When a restaurant signs on to the initiative, it pledges that its overall sales in a given
category – cheeseburgers, for example – will meet the relevant target for salt content,
even if some individual products don't.
OECD Paris, 25-26/10/2012
TFA reduction in New York City
2007 regulation : restricts from using, serving, storing, serving foods that contains
PHVO and has a total 0.5 g or more TFA per serving
Angell et al. Ann Intern Med 2012;157:81-86
OECD Paris, 25-26/10/2012
Australia – food category action plan
• To achieve the overall objective of reducing sodium and saturated
fat in processed meats, participants have agreed to:
– reduce the sodium content of nominated bacon2 and ham/cured meat
products to 1090mg per 100g.
– reduce the sodium content of nominated emulsified luncheon meats3
to 830mg per 100g.
– reduce by 10 per cent the saturated fat content of nominated
cooked/smoked sausages4 and emulsified luncheon meats that have in
excess of 6.5g of saturated fat per 100g.
• The timeframe for action will be 1 January 2010 to 31 December
2013. The products targeted and the amount of sodium and
saturated fat to be removed from products each year will be
determined by the individual companies involved.
OECD Paris, 25-26/10/2012
Potential impact of “my choice”
program on key nutrient intake
Dutch Menu
My Choice Menu
2000-2500 kcal
2421 kcal
2058 kcal
Saturated fat
<10 E%
10.9 E%
7.1 E%
Trans fat
<1 E%
0.4 E%
0.1 E%
Free sugars
<10 E%
19.1 E%
7.8 E%
>25 g
27 g
38 g
<2400 mg
3579 mg
2773 mg
Jansen L. VOEDING NU 2007; 4:21-23
OECD Paris, 25-26/10/2012
Role of governments
OECD Paris, 25-26/10/2012
Current food policy environment
Hawkes, BMJ 2012; 344:e2801
OECD Paris, 25-26/10/2012
Consumer purchases with traffic light food
labelling of nutrients as proposed by UK's
Food Standards Agency
Wheel of Health
JS Ham and Pineapple
Pizzeria 356g
all 5 GREEN on WoH
'Be Good to Yourself'
Chocolate sponge
4 Green, 1 amber
JS Ham & Pineapple Thin &
Crispy Pizza 335g
1 red, 2 amber, 2 green
Sainsbury's Supermarket
presentation to The National
Heart Forum, UK., 2006.
'Taste the Difference' Melting
Middle Chocolate puddings
4 red, 1 amber
Evidence of the impact of advertising regulations
Quebec (1980)
•Between 7.1% and 9.3% drop in the probability of purchasing fast food
•Annual drop of between 11 million and 22 million fast-food meals
Baylis & Dhar (2007)
UK (2008)
• Children aged 4–9 saw 52% less advertisement on unhealthy food
• Children aged 10–15 saw 22% less advertisement on unhealthy food
Ofcom (2010)
France (2004)
• 21% of individuals above age 15 changed their eating habits
• 17% of individuals above age 15 changed their food-purchasing habits
Ministère de la santé de la jeunesse et des sports (2008)
OECD Paris, 25-26/10/2012
Population approached to improve diet
recommended by the American Heart Association
• Sustained, focused media and educational campaigns,
using multiple modes, for increasing consumption of
specific healthful foods or reducing consumption of
specific less healthful foods or beverages as part of
multicomponent strategies (I B)
• Multicomponent school interventions (I A)
• Subsidy strategies to lower prices of more healthful
foods and beverages (I A)
• Restriction of TV advertisement (I B)
• Regulatory policies to reduce specific nutrients in foods
(I B)
Mozaffarian et al. Circulation 2012;126:1514-1563
OECD Paris, 25-26/10/2012