Leading doctors and global public health experts have stressed the need for consumer-friendly warning labels to address the rising burden of non-communicable diseases (NCD) in India.
Participating in a roundtable discussion, the experts highlighted how over 5.8 million Indians die every year from NCDs (such as cancer, diabetes and cardiovascular diseases). They said that most of these deadly diseases, though hard to treat, can be prevented by modifying diets and transforming the food industry. 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, they felt.
Highlighting the importance of front-of-package warning labelling, the experts said it is a key component of a comprehensive strategy to promote healthier lives. Front-of-package warning labelling 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, they said. 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.
Experts said there is a global momentum to make packaged foods safer and healthier. Brazil, Israel, Chile and more recently Colombia have adopted ‘high in’ warning labels on their food packets, which is considered a best practice approach, they said. Applauding the Indian government and its apex food regulator FSSAI for prioritising the adoption of an FOPL, Ashim Sanyal of 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,” he said.
Dr Madhukar Mittal of 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,” he said. Dr Christina Pollard, associate professor, Curtin University said, “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.” 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 dependent to a large extent on food industry reformulating its products, then HSR falls short and only misleads the consumer,” Dr Pollard said.
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. 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.