‘There are no good foods or bad foods.’ This food industry mantra is now being buried under a plethora of nutrition signposting systems which clearly aim to discriminate between foods on the basis of their potential effects on health. Almost all of these logos or symbols are designed to give consumers a short-hand way of identifying the ‘good foods’ to eat more of. All signposting systems are underpinned by some nutrient profiling criteria and, if the organisation responsible for the scheme is a government or public-interest non-government organisation (NGO), consumers generally have confidence in the signpost and it may influence their food choices towards more of the ‘good foods’. If, on the other hand, the scheme is run by the food industry or other for-profit enterprise, people are rightfully suspicious of it. The US food industries’ Smart Choices Program(Reference Lupton, Balentine and Black1) provided a spectacular example of this when high-sugar breakfast cereals and full-fat mayonnaise started appearing with the symbol, triggering investigations by the Food and Drug Administration and a voluntary closing down of the programme(2).
A paper published in this issue of Public Health Nutrition is an example of a nutrition signposting programme run by a reputable organisation, the Finnish Heart Association, and its Heart Symbol logo now has widespread recognition within Finland(Reference Lahti-Koski, Helakorpi and Olli3). As the authors point out, there are several potential benefits of these programmes that need to be evaluated. First, they can be used as an educational device to increase consumers’ knowledge of food and health. However, characteristically the actual dollar investment in nutrition education through these programmes is relatively low. Second, they can be used as a quick reference tool for food choice at the point of purchase. This is a key potential benefit which has been assessed for other nutrition signposting schemes(Reference Young and Swinburn4) but unfortunately it is not measured in this latest Finnish paper – the reported increase in the use of products with the Heart Symbol could just reflect an expansion of the number of products with the logo, rather than increased use of the logo for food selection. Third, and probably most importantly, the criteria create standards that food manufacturers can use to formulate and reformulate the nutrient content of their products(Reference Vyth, Steenhuis and Roodenburg5). Such changes in composition can potentially result in substantial health gains without requiring a change in consumer behaviour – the consumer continues to consume products as before but now these products are slightly lower in salt or saturated fat or sugar.
A word of warning, however, on evaluating the size of the benefits from reformulation is warranted. I was involved in one of the first publications showing the ‘tonnes saved’ approach(Reference Young and Swinburn4) to estimating benefits of product reformulation, but we did not take the analysis to the next step of modelling these changes to potential health outcomes. We estimated that about 33 tonnes of salt were removed from the New Zealand diet over one year because of the formulation and reformulation of breads, margarines and breakfast cereals stimulated by the National Heart Foundation's Pick the Tick nutrition signposting programme. It sounds a lot, but at 0·02 g/capita per d, the health impact of these changes alone would be tiny. Nevertheless, this is exactly the direction we want the food supply to move in but it will take similar changes in many more products to add up to a sufficient dose for health gains. This ‘tonnes saved’ approach is also being used by the food industry in its evaluation of progress towards a healthier food supply. For example, as part of its reformulation initiatives, McDonalds claims to have removed 49 tonnes of salt from its products in Australia between March 2007 and December 2009(6). Since McDonalds serves over a million Australian customers daily, this amounts to about 0·05 g less salt for each customer on a given day. This is not to discount the efforts McDonalds is making in its reformulation of products, since it appears to be doing far more in this area than most of its competitors. However, it does reinforce that many more formulation changes would be needed to produce significant population benefits.
To give a sense of the dose required for cost-effective changes, in a recent modelling study we evaluated the scenario of a front-of-pack traffic light labelling programme creating a 10 % shift towards healthier food choices in just four food categories (breakfast cereals, pastries, sausages, and ready-prepared meals) in 10 % of the adult population(Reference Sacks, Veerman and Moodie7). Such a programme would be effective (averting 45 000 disability-adjusted life years (DALY) in the Australian population) and cost-effective in creating health gains. This demonstrates the potential impact of nutrition signposting systems that can both promote the healthy choice and make the healthy choice the easy choice. However, the modelling needs to be done so that commentary on the size of the potential impact on health can be shifted from ‘tonnes saved’ to ‘DALY averted’, which is much more meaningful.
To be weighed against these potential benefits are some substantial risks in the current front-of-pack symbols and information to guide consumer choice. The first is obviously the spin that the profit motive creates on information to consumers. As pointed out in the case of the Finnish programme and others run by governments and NGO(8), the funding raised from licence fees is ploughed back into the programme, so despite charging a fee, these are ‘public-interest’, not ‘commercial-interest’, programmes. The food industry has created multiple schemes with different criteria and applications but all are underpinned by the incentive for consumers to eat more of their products.
This leads to the second risk, which is the proliferation of front-of-pack claims leading to potential consumer confusion about nutrition information on packages(Reference Grunert and Wills9). The front-of-pack space is becoming very crowded with a variety of nutrition signposts and food claims. Even well-recognised and respected signposts, like the Finnish scheme, are still part of the crowd in the often-restricted space on packages. Consumers deserve the best nutrition signposting system in an age where nutrition-related disease burden is increasing around the globe, yet the nutritional content of the increasing amount of processed food on offer is often purposely masked if possible. A single, transparent, public-interest system using a credible nutrition profiling scheme backed by authoritative, independent organisations is urgently needed. In Australia, a comprehensive review of food labelling for the Federal Government(Reference Blewett, Goddard and Pettigrew10) has responded to the evidence and calls from consumers for a simplified front-of-pack system; it has recommended the multiple traffic light system which has been shown in several studies to be the preferred nutrition signpost(Reference Borgmeier and Westenhoefer11–Reference Gorton, Ni Mhurchu and Chen13). However, ‘recommendation’ and ‘implementation’ are very different, and there is no doubt that the food industry lobby will vigorously oppose the traffic light system being mandated for packaged foods and takeaway foods in Australia. The European experience is salutary. According to the Corporate Europe Observatory, the processed food industry lobby groups spent €1 billion fighting traffic light labelling in Europe(14). It is doubtful that any political institution can withstand this level of lobbying assault, so it is no surprise that the European Union did not endorse the scheme.
This relates to the third risk, which is the delay in implementing the best system for consumers. The food industry's motives in preventing this occurring are obvious but even NGO, which have been operating their own schemes in the public interest for many years, will naturally be reluctant to let their logos go unless they can be convinced that their scheme will be replaced by a better one. The WHO, as the international standard-setting body for health, has a key role to play in developing a common nutrient profiling system for countries to adopt and early progress has been made on this front(15).
Has the time come to ask the question: ‘What front-of-pack signpost sends clear, authoritative messages about what foods to eat more of AND what foods to eat less of?’ Most public-interest front-of-pack signposting schemes are like the Finnish one, in that the only products that get the logo are those that meet the criteria (i.e. fit into the ‘eat more’ category) and even then only some of them choose to join the scheme. However, the globe is in the midst of an obesity epidemic, which appears to have been driven by people eating more(Reference Swinburn, Sacks and Ravussin16). The products that we should be most worried about are those we should be eating less of. This is why the traffic light system is so appealing to consumers and public-interest groups(Reference Blewett, Goddard and Pettigrew10) and why it is so vigorously opposed by the food industry(14). In 2006, the UK Food Standards Agency recommended that food manufacturers and retailers adopted a traffic light system for four nutrients (fat, saturated fat, sugar, salt) with a green, amber and red ‘light’ for low, medium and high amounts(17). Some supermarkets took up this challenge and, while short-term empirical studies did not detect a change in sales response on a few selected items(Reference Sacks, Rayner and Swinburn18), the rationale of providing consumers with information they want on the products they are buying and for which there is modelled evidence of potential health impacts(Reference Sacks, Veerman and Moodie7) suggests that this approach is overdue.
‘There are no good foods or bad foods.’ This food industry mantra is now being buried under a plethora of nutrition signposting systems which clearly aim to discriminate between foods on the basis of their potential effects on health. Almost all of these logos or symbols are designed to give consumers a short-hand way of identifying the ‘good foods’ to eat more of. All signposting systems are underpinned by some nutrient profiling criteria and, if the organisation responsible for the scheme is a government or public-interest non-government organisation (NGO), consumers generally have confidence in the signpost and it may influence their food choices towards more of the ‘good foods’. If, on the other hand, the scheme is run by the food industry or other for-profit enterprise, people are rightfully suspicious of it. The US food industries’ Smart Choices Program(Reference Lupton, Balentine and Black1) provided a spectacular example of this when high-sugar breakfast cereals and full-fat mayonnaise started appearing with the symbol, triggering investigations by the Food and Drug Administration and a voluntary closing down of the programme(2).
A paper published in this issue of Public Health Nutrition is an example of a nutrition signposting programme run by a reputable organisation, the Finnish Heart Association, and its Heart Symbol logo now has widespread recognition within Finland(Reference Lahti-Koski, Helakorpi and Olli3). As the authors point out, there are several potential benefits of these programmes that need to be evaluated. First, they can be used as an educational device to increase consumers’ knowledge of food and health. However, characteristically the actual dollar investment in nutrition education through these programmes is relatively low. Second, they can be used as a quick reference tool for food choice at the point of purchase. This is a key potential benefit which has been assessed for other nutrition signposting schemes(Reference Young and Swinburn4) but unfortunately it is not measured in this latest Finnish paper – the reported increase in the use of products with the Heart Symbol could just reflect an expansion of the number of products with the logo, rather than increased use of the logo for food selection. Third, and probably most importantly, the criteria create standards that food manufacturers can use to formulate and reformulate the nutrient content of their products(Reference Vyth, Steenhuis and Roodenburg5). Such changes in composition can potentially result in substantial health gains without requiring a change in consumer behaviour – the consumer continues to consume products as before but now these products are slightly lower in salt or saturated fat or sugar.
A word of warning, however, on evaluating the size of the benefits from reformulation is warranted. I was involved in one of the first publications showing the ‘tonnes saved’ approach(Reference Young and Swinburn4) to estimating benefits of product reformulation, but we did not take the analysis to the next step of modelling these changes to potential health outcomes. We estimated that about 33 tonnes of salt were removed from the New Zealand diet over one year because of the formulation and reformulation of breads, margarines and breakfast cereals stimulated by the National Heart Foundation's Pick the Tick nutrition signposting programme. It sounds a lot, but at 0·02 g/capita per d, the health impact of these changes alone would be tiny. Nevertheless, this is exactly the direction we want the food supply to move in but it will take similar changes in many more products to add up to a sufficient dose for health gains. This ‘tonnes saved’ approach is also being used by the food industry in its evaluation of progress towards a healthier food supply. For example, as part of its reformulation initiatives, McDonalds claims to have removed 49 tonnes of salt from its products in Australia between March 2007 and December 2009(6). Since McDonalds serves over a million Australian customers daily, this amounts to about 0·05 g less salt for each customer on a given day. This is not to discount the efforts McDonalds is making in its reformulation of products, since it appears to be doing far more in this area than most of its competitors. However, it does reinforce that many more formulation changes would be needed to produce significant population benefits.
To give a sense of the dose required for cost-effective changes, in a recent modelling study we evaluated the scenario of a front-of-pack traffic light labelling programme creating a 10 % shift towards healthier food choices in just four food categories (breakfast cereals, pastries, sausages, and ready-prepared meals) in 10 % of the adult population(Reference Sacks, Veerman and Moodie7). Such a programme would be effective (averting 45 000 disability-adjusted life years (DALY) in the Australian population) and cost-effective in creating health gains. This demonstrates the potential impact of nutrition signposting systems that can both promote the healthy choice and make the healthy choice the easy choice. However, the modelling needs to be done so that commentary on the size of the potential impact on health can be shifted from ‘tonnes saved’ to ‘DALY averted’, which is much more meaningful.
To be weighed against these potential benefits are some substantial risks in the current front-of-pack symbols and information to guide consumer choice. The first is obviously the spin that the profit motive creates on information to consumers. As pointed out in the case of the Finnish programme and others run by governments and NGO(8), the funding raised from licence fees is ploughed back into the programme, so despite charging a fee, these are ‘public-interest’, not ‘commercial-interest’, programmes. The food industry has created multiple schemes with different criteria and applications but all are underpinned by the incentive for consumers to eat more of their products.
This leads to the second risk, which is the proliferation of front-of-pack claims leading to potential consumer confusion about nutrition information on packages(Reference Grunert and Wills9). The front-of-pack space is becoming very crowded with a variety of nutrition signposts and food claims. Even well-recognised and respected signposts, like the Finnish scheme, are still part of the crowd in the often-restricted space on packages. Consumers deserve the best nutrition signposting system in an age where nutrition-related disease burden is increasing around the globe, yet the nutritional content of the increasing amount of processed food on offer is often purposely masked if possible. A single, transparent, public-interest system using a credible nutrition profiling scheme backed by authoritative, independent organisations is urgently needed. In Australia, a comprehensive review of food labelling for the Federal Government(Reference Blewett, Goddard and Pettigrew10) has responded to the evidence and calls from consumers for a simplified front-of-pack system; it has recommended the multiple traffic light system which has been shown in several studies to be the preferred nutrition signpost(Reference Borgmeier and Westenhoefer11–Reference Gorton, Ni Mhurchu and Chen13). However, ‘recommendation’ and ‘implementation’ are very different, and there is no doubt that the food industry lobby will vigorously oppose the traffic light system being mandated for packaged foods and takeaway foods in Australia. The European experience is salutary. According to the Corporate Europe Observatory, the processed food industry lobby groups spent €1 billion fighting traffic light labelling in Europe(14). It is doubtful that any political institution can withstand this level of lobbying assault, so it is no surprise that the European Union did not endorse the scheme.
This relates to the third risk, which is the delay in implementing the best system for consumers. The food industry's motives in preventing this occurring are obvious but even NGO, which have been operating their own schemes in the public interest for many years, will naturally be reluctant to let their logos go unless they can be convinced that their scheme will be replaced by a better one. The WHO, as the international standard-setting body for health, has a key role to play in developing a common nutrient profiling system for countries to adopt and early progress has been made on this front(15).
Has the time come to ask the question: ‘What front-of-pack signpost sends clear, authoritative messages about what foods to eat more of AND what foods to eat less of?’ Most public-interest front-of-pack signposting schemes are like the Finnish one, in that the only products that get the logo are those that meet the criteria (i.e. fit into the ‘eat more’ category) and even then only some of them choose to join the scheme. However, the globe is in the midst of an obesity epidemic, which appears to have been driven by people eating more(Reference Swinburn, Sacks and Ravussin16). The products that we should be most worried about are those we should be eating less of. This is why the traffic light system is so appealing to consumers and public-interest groups(Reference Blewett, Goddard and Pettigrew10) and why it is so vigorously opposed by the food industry(14). In 2006, the UK Food Standards Agency recommended that food manufacturers and retailers adopted a traffic light system for four nutrients (fat, saturated fat, sugar, salt) with a green, amber and red ‘light’ for low, medium and high amounts(17). Some supermarkets took up this challenge and, while short-term empirical studies did not detect a change in sales response on a few selected items(Reference Sacks, Rayner and Swinburn18), the rationale of providing consumers with information they want on the products they are buying and for which there is modelled evidence of potential health impacts(Reference Sacks, Veerman and Moodie7) suggests that this approach is overdue.