Doctors And Global Public Health Experts Urge For ‘High-in’ Warning Labels On Food & Beverages

Unhealthy diets have been recognised as the largest modifiable risk factor for the increasing burden of Non-Communicable Diseases (NCDs), responsible for 71 per cent deaths worldwide.

Doctors and global public health experts have come together to emphasise on the importance of consumer-friendly warning labels, which will address the rising burden of non-communicable diseases in India. As India prepares to adopt front of package labels (FOPL) for its rapidly growing packaged food and beverage industry, experts participating in the roundtable discussion highlighted how over 5.8 million Indians die every year from NCDs (such as cancer, diabetes and cardiovascular diseases) and how most of these deadly diseases, although hard to treat, can be prevented by modifying diets and transforming the food industry. Participants included Ashim Sanyal (COO, Consumer Voice), Dr Christina Pollard (Associate Professor, Curtin University, Perth, Australia), Dr Madhukar Mittal (Additional Professor, Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), Jodhpur) and Dr Nancy Sahni (Clinical Nutritionist, Post Graduate Institute of Medical Education and Research (PGIMER).

Applauding the Indian government and its apex food regulator FSSAI for prioritising the adoption of an FOPL, Ashim Sanyal (COO, Consumer Voice) said that a consultative process has been initiated. “The civil society and consumer rights organisations have been consulted by the FSSAI. We have made a strong representation for an effective label design and a scientific nutrient profile model – the two elements of a strong and mandatory FOPL system. The next few months are crucial for India and we will continue to work in close collaboration with the government towards this historic paradigm shift in our food system.”

Front-of-package warning labelling is 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. Research has revealed that countries such as Chile which have adopted the warning label system of FOPL have succeeded in reducing consumption of the unhealthiest ultra-processed foods and beverages.  With Brazil, Israel, Chile and more recently Colombia adopting ‘high in’ warning labels on their food packets – considered a best practice approach – there is a global momentum to make packaged foods safer and healthier.

Citing the Australia experience, renowned global expert on food policy, Dr Christina Pollard (Associate Professor, Curtin University, Perth, Australia) shared, “Australia adopted the highly controversial Health Star Rating (HSR) five years ago under significant industry pressure. A voluntary system, HSR has neither incentivised the food industry to re-formulate nor has it had any impact on the health of Australian people or guided them to make healthier choices. HSR hinders more than it assists.  Based on the evidence coming from Australia, I would not recommend that India should experiment with this weak labelling system to improve its food supply and address its NCD challenge."

Dr Pollard further illustrated that the HSR system misrepresents the healthiness of unhealthy products and increases the likelihood of misleading consumers into thinking ultra-processed products are healthy. “A packet of candy or a soft drink with added calcium or vitamins may rate itself higher as per the HSR system, not providing enough information to the consumer about whether the dangerous nutrient, whose consumption need to be reduced, is still present in excess or not. If you are looking at altering the food system, which is dependant to a large extent on food industry reformulating its products, then HSR falls short and only misleads the consumer. Food companies are most likely to change the quantity of harmful ingredients if 'high in' warning labels are made mandatory and they cannot confuse the thresholds for sugar, salt and fat with irrelevant information.”

Simple measures, such as front-of-package labels (FOPL), can allow for a paradigm shift in the food consumption pattern of the country and as a result, avert an impending NCD crisis. Dr Madhukar Mittal (Additional Professor, Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), Jodhpur) stated that the evidence linking consumption of processed and packaged foods high in salt, sugar and fats – otherwise known as nutrients of concern – to diabetes, heart disease and various forms of cancer is irrefutable. “India is fast emerging as the diabetes capital of the world. Obesity is on the rise. The entire food system must act now to safeguard people’s health. Food industry tends to make their food products more palatable by adding excess sugar or salt. As a result, we are consuming unnatural levels of these harmful ingredients – far exceeding the recommended thresholds. An interpretive warning labels that say clearly whether a food or drink has high amounts of salt, sugar or fats, would help consumers make a healthy, quick and informed choice.”

Dr Nancy Sahni (Clinical Nutritionist at Post Graduate Institute of Medical Education and Research (PGIMER) said, “Warning labels are the need of the hour and can work wonders for our country where misinformation on food packets is overwhelming. There is enough evidence to show that of all types of labels including traffic light, warning labels move the dial on public health most certainly. In a country like India which is at a health flash point, strong FOPL is the best ally of doctors and criticising nutritionists.” 

In 2018 the Food Safety Standards Authority India (FSSAI) published draft regulation for FOPL which was subsequently withdrawn for further deliberation. In 2019 December, FSSAI delinked FOPL from general labelling regulations and is currently seeking 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, the label is interpretative, simplistic and readily visible, guided by a strong nutrient profile model. 


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