Front-of-pack (FOP) nutrition labeling has been recommended by the World Health Organization (WHO) as one of a suite of measures needed to improve population diets. The voluntary Nutri-Score FOP ...labeling system, which was first implemented in France, was approved for implementation in Belgium by the Minister of Public Health in August 2018 and has been officially adopted in Belgium since April 1st 2019. We assessed the uptake of Nutri-Score by food retailers and manufacturers during the first year of implementation in Belgium.
In November-December 2019, pictures for 1781 products displaying Nutri-Score on the FOP were collected from the five biggest retailers, representing about 10% of products on the market in Belgium. About 90% of products displaying Nutri-Score on the FOP in 2019 were own-brand products from two major food retailers, while the few remainder were branded products. About 56% of products displayed Nutri-Score A or B while 26% of products displayed Nutri-Score D or E.
During the first year of implementation, > 1700 food products displayed Nutri-Score on the FOP in Belgium. While the majority of those products were healthier foods (Nutri-Score A&B), about one quarter of less healthy products (Nutri-Score D&E) already displayed Nutri-Score as well. In the meantime, all five biggest retailers, including discounters, have committed to display Nutri-Score on the FOP from 2020 onwards, which may increase pressure on other food manufacturers to improve uptake of Nutri-Score for branded products.
Delhaize, a major Belgian retailer, started implementing electronic shelf labels (ESL) with Nutri-Score since May 2019. Nutri-Score rates the healthfulness of packaged foods with five colours/letters ...from red/E (least healthy) to green/A (most healthy). This study evaluated the impact of ESL on consumer purchases, overall, and by food category.
For 43 intervention stores (implementing ESL in the period 27 May 2019-19 June 2019), a control store, from the same province and retailer-assigned cluster was matched. There were 14 unique control stores. By store, weekly non-food and food sales for 2018 and 2019 were received by Nutri-Score (A/B/C/D/E) and food category according to a retailer-assigned classification system. The primary outcomes were the proportion of food sales for Nutri-Score A,B,C,D,E. Difference-in-differences regression analysis was conducted to estimate the effect of the ESL intervention on proportion of overall food and food category sales for Nutri-Score A,B,C,D,E, using linear mixed models to account for clustering at store-level. We controlled for store characteristics (region, cluster, non-food sales) and week of the year. Analyses were weighted to re-balance discrepancy between the number of intervention and control stores. To account for multiple testing, a Bonferroni adjustment was applied.
Comparing pre- and post-intervention periods, difference-in-differences for the proportion of Nutri-Score B and C product sales were more favourable in intervention than control stores (0.11 ± 0.04%, p = 0.007 and - 0.06 ± 0.03%, p = 0.026 respectively), while difference-in-differences for the proportion of Nutri-Score D product sales were less favourable in intervention than control stores (0.12 ± 0.04%, p = 0.002). For 17/58 food categories (representing 29% of total food sales) a positive impact increase in healthier (Nutri-Score A, B) and/or decrease in less healthy (Nutri-Score D, E) food sales, and for 16/58 categories (representing 24% of total food sales) a negative impact was found. Positive impacts were found for vegetable, fruit and dairy products and confectionery. Negative impacts were found for bread and bakery products.
The impact of ESL on consumer purchases was mixed. Favourable difference-in-differences were found for Nutri-Score B and C products and unfavourable difference-in-differences for Nutri-Score D products. Shelf labeling on its own is unlikely to significantly influence consumer behaviours.
Abstract
Background
Children are susceptible to the food environment. This research assessed changes in retail food environments near schools in Flanders between 2008 and 2020 and associations with ...children’s and adolescents’ weight status.
Methods
The food environment within a 500 m and 1000 m road network distance to all primary and secondary schools was mapped using spatial indicators. The commercial Locatus database, including addresses of all food retailers in Flanders, was used to calculate the density of different types of food retailers near the school perimeter, the percentage of schools with at least one food retailer of a certain type near the school perimeter and the shortest distance from the school entrance to the nearest food retailer of a certain type. A generalized linear model was used to explore associations between these indicators and the percentage of children and adolescents with overweight at the school level.
Results
Food environments near schools in Flanders were found to be unhealthy in 2020, with a significant increase in fast food restaurants and convenience stores between 2008 and 2020. The density of fast food restaurants within a 1000 m walking distance from primary and secondary schools increased from 5.3 ±0.3 to 6.3 ±0.4 and from 10.2 ±0.7 to 12.7 ±0.9 respectively between 2008 and 2020, while the density of convenience stores increased from 3.2 ±0.3 to 3.8 ±0.4 and from 6.2 ±0.6 to 7.6 ±0.8 respectively.
Food environments near schools with a higher proportion of children from a poor socio-economic background were found unhealthier, regardless of the urbanization level. A significant positive association was found between the density of fast food restaurants as well as the density of convenience stores around primary schools and the percentage of children aged < 6 years and 6–12 years with overweight. A positive, not significant association was found between the density of fast food restaurants as well as the density of convenience stores around secondary schools and the percentage of adolescents, aged 13–14 and 15–18 years with overweight.
Conclusion
Food environments around schools in Flanders became unhealthier over time and were associated with children’s weight status.
In June 2016, the first phase of the Chilean Food Labelling and Advertising Law that mandated front-of-package warning labels and marketing restrictions for unhealthy foods and beverages was ...implemented. We assess foods and beverages reformulation after this initial implementation. A data set with the 2015 to 2017 nutritional information was developed collecting the information at 2 time periods: preimplementation (T0: January-February 2015 or 2016; n = 4,055) and postimplementation (T1: January-February 2017; n = 3,025). Quartiles of energy and nutrients of concern (total sugars, saturated fats, and sodium, per 100 g/100 mL) and the proportion of products with energy and nutrients exceeding the cutoffs of the law (i.e., products "high in") were compared pre- and postimplementation of the law in cross-sectional samples of products with sales >1% of their specific food or beverage groups, according to the Euromonitor International Database; a longitudinal subsample (i.e., products collected in both the pre- and postimplementation periods, n = 1,915) was also analyzed. Chi-squared, McNemar tests, and quantile regressions (simple and multilevel) were used for comparing T0 and T1. Cross-sectional analysis showed a significant decrease (T0 versus T1) in the proportion of product with any "high in" (from 51% 95% confidence interval (CI) 49-52 to 44% 95% CI 42-45), mostly in food and beverage groups in which regulatory cutoffs were below the 75th percentile of the nutrient or energy distribution. Most frequent reductions were in the proportion of "high in" sugars products (in beverages, milks and milk-based drinks, breakfast cereals, sweet baked products, and sweet and savory spreads; from 80% 95% CI 73-86 to 60% 95% CI 51-69) and in "high in sodium" products (in savory spreads, cheeses, ready-to-eat meals, soups, and sausages; from 74% 95% CI 69-78 to 27% 95% CI 20-35). Conversely, the proportion of products "high in" saturated fats only decreased in savory spreads (p < 0.01), and the proportion of "high in" energy products significantly decreased among breakfast cereals and savory spreads (both p < 0.01). Quantile analyses showed that most of the changes took place close to the cutoff values, with only few exceptions of overall left shifts in distribution. Longitudinal analyses showed similar results. However, it is important to note that the nonexperimental nature of this study does not allow to imply causality of these findings. Our results show that, after initial implementation of the Chilean Law of Food Labelling and Advertising, there was a significant decrease in the amount of sugars and sodium in several groups of packaged foods and beverages. Further studies should clarify how food reformulation will impact dietary quality of the population.
Abstract
Background
This study benchmarked and quantitatively assessed the transparency, specificity and comprehensiveness of nutrition-related commitments and related practices of the major ...companies within the French food industry.
Methods
To evaluate the nutrition-related commitments and practices across policy domains such as product reformulation, labelling, marketing, and accessibility, the ‘Business Impact Assessment on Obesity and population-level nutrition’ (BIA-Obesity) was applied. A total of 33 French food companies were selected using Euromonitor 2018 market share data, including major packaged food and non-alcoholic beverage manufacturers (
N =
20), quick-service restaurants (
N =
7), and supermarkets (
N =
6). During 2019-2020 the publicly available commitments were collected for each company, scored according to the BIA-Obesity, and company representatives were provided with the opportunity to complete and verify the collected data. The following performance metrics were included to assess company practices: the median Nutri-Score of product portfolios, the proportion of products with Nutri-Score A or B, the percentage of products (not-)permitted to be marketed to children according to the World Health Organisation Europe nutrient profile model and the proportion of ultra-processed food products as determined by the NOVA-classification. In addition supermarket flyers were collected over a 6-months period to assess the healthiness of product promotions. Correlations between commitments and performance metrics were assessed applying the Spearman’s rank correlation coefficient.
Results
Among the selected food companies, 13 companies verified and completed the publicly available data (response rate = 39%). Overall BIA-Obesity scores for company commitments varied between 2 and 74% with a median score of 28%. Scores for packaged food and non-alcoholic beverage manufacturers were higher than those for supermarkets and quick-service restaurants. The median proportion of foods with Nutri-Score A or B within product portfolios was 38% (range = 1-95%), while the median proportion of non-permitted products was 84% (range = 7-100%) and the median proportion of ultra-processed food products 63% (range = 5-100%). Stronger company commitments did not translate into better performance metrics.
Conclusions
There is room for significant improvement of both company commitments and performance. Current food industry action does not meet recommended best practices. The French government is urged to regulate food industry practices to create healthier food environments.
The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6-8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% ...among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to attenuate the transition, taking into consideration local contextual factors.
Purpose
To assess the dietary share of ultra-processed foods (UPF) among Belgian children, adolescents and adults and associations with diet quality.
Methods
Data from the national Food Consumption ...Surveys 2004 (
N
= 3083; ≥ 15 years) and 2014–2015 (
N
= 3146; 3–64 years) were used. Two 24-h recalls (dietary records for children) were used for data collection. Foods consumed were classified by the level of processing using the NOVA classification. The usual proportion of daily energy intake from UPF was determined using SPADE (Statistical Program to assess dietary exposure).
Results
In 2014/2015, 36.4% of foods consumed were ultra-processed, while 42.4% were unprocessed/minimally processed. The usual proportion of daily energy intake from UPF was 33.3% (95% CI 32.1–35.0%) for children, 29.2% (95% CI 27.7–30.3%) for adolescents and 29.6% (95% CI 28.5–30.7%) for adults. There were no differences in UPF consumption between 2004 and 2014/2015. The products contributing most to UPF consumption were processed meat (14.3%), cakes, pies, pastries (8.9%), sweet biscuits (7.7%) and soft drinks (6.7%). The UPF dietary share was significantly lower during consumption days when participants met the WHO salt intake recommendation (≤ 5 g/day) and when saturated fat was ≤ 10% of their total energy intake. The dietary share of unprocessed/minimally processed foods was significantly higher during consumption days when participants met the WHO salt and fruit/vegetable intake (≥ 400 g/day) recommendations and when saturated fat was ≤ 10% of their total energy intake.
Conclusions
The UPF dietary share is substantial and associated with lower diet quality. Internationally recommended policies to limit UPF accessibility and marketing need to be implemented to reduce UPF consumption.
We investigated associations between changes in national food energy supply and in average population body weight.
We collected data from 24 high-, 27 middle- and 18 low-income countries on the ...average measured body weight from global databases, national health and nutrition survey reports and peer-reviewed papers. Changes in average body weight were derived from study pairs that were at least four years apart (various years, 1971-2010). Selected study pairs were considered to be representative of an adolescent or adult population, at national or subnational scale. Food energy supply data were retrieved from the Food and Agriculture Organization of the United Nations food balance sheets. We estimated the population energy requirements at survey time points using Institute of Medicine equations. Finally, we estimated the change in energy intake that could theoretically account for the observed change in average body weight using an experimentally-validated model.
In 56 countries, an increase in food energy supply was associated with an increase in average body weight. In 45 countries, the increase in food energy supply was higher than the model-predicted increase in energy intake. The association between change in food energy supply and change in body weight was statistically significant overall and for high-income countries (P < 0.001).
The findings suggest that increases in food energy supply are sufficient to explain increases in average population body weight, especially in high-income countries. Policy efforts are needed to improve the healthiness of food systems and environments to reduce global obesity.
Background:
The global policy discourse on sustainability and health has called for dietary transformations that require diverse, concerted actions from governments and institutions. In this article, ...we highlight the need to examine sociocultural influences on food practices as precursors to food policy decisions.
Discussion:
Sociocultural food practices relate to ideas and materials that give rise to food choices and food patterns of a group. We begin with a discussion of how individuals experience, interpret, negotiate, and symbolize the food world around them. We examine primarily the ideational pathways, such as identity, gender, religion, and cultural prohibitions, and their influence on food practices. We then provide guiding questions, frameworks, and a brief overview of food choice values to support policy planning and design. Lastly, we explore how sociocultural change for sustainable or healthy diets is already happening through food movements, food lifestyles, and traditional diets.
Summary To achieve WHO's target to halt the rise in obesity and diabetes, dramatic actions are needed to improve the healthiness of food environments. Substantial debate surrounds who is responsible ...for delivering effective actions and what, specifically, these actions should entail. Arguments are often reduced to a debate between individual and collective responsibilities, and between hard regulatory or fiscal interventions and soft voluntary, education-based approaches. Genuine progress lies beyond the impasse of these entrenched dichotomies. We argue for a strengthening of accountability systems across all actors to substantially improve performance on obesity reduction. In view of the industry opposition and government reluctance to regulate for healthier food environments, quasiregulatory approaches might achieve progress. A four step accountability framework (take the account, share the account, hold to account, and respond to the account) is proposed. The framework identifies multiple levers for change, including quasiregulatory and other approaches that involve government-specified and government-monitored progress of private sector performance, government procurement mechanisms, improved transparency, monitoring of actions, and management of conflicts of interest. Strengthened accountability systems would support government leadership and stewardship, constrain the influence of private sector actors with major conflicts of interest on public policy development, and reinforce the engagement of civil society in creating demand for healthy food environments and in monitoring progress towards obesity action objectives.
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