Public health experts and doctors, in a multi-stakeholder session on childhood obesity in India, highlighted the need for urgent policy action to establish strong limits for salt, sugar, saturated fats and other harmful ingredients in packaged and ultra-processed food and beverages.
With more than 14.4 million obese children, India has the second-highest number of children with childhood obesity in the world. By 2025 this number will reach a staggering 17 million. As is the trajectory in other developing nations, the proportion of packaged and ultra-processed foods is on the rise.
The experts representing leading institutions such as AIIMS, Rishikesh; Indian Academy of Paediatrics and Indian Institute of Liver and Biliary Sciences said that the only way to control this growing epidemic of obesity is by establishing scientific cut-off limits for harmful ingredients and front of the pack labels or FOPL on packaged products which can educate the public and help consumers make informed, correct choices.
From a nation that was struggling with infant malnutrition till very recently, childhood has emerged as a major area of concern in India. The steady rise in childhood obesity in India is a result of changing dietary preferences and a shift towards increased consumption of ultra-processed food. The ultra-processed food industry is growing at a record pace in India which is also second among the top five global markets for sugary beverages. Some studies have shown that despite the need to promote and adopt healthy diets, particularly in the wake of this pandemic, multinational food companies have continued to promote unhealthy, ultra-processed foods and sugary drinks with no governmental limits on any of the harmful ingredients.
There is growing evidence that the Covid-19 pandemic could potentially increase the risk of children becoming obese. School closures and lockdowns have already deprived millions of children of nutritional school meals, sports and adequate physical exercise.
Being overweight or obese is directly associated with life-threatening non-communicable diseases such as cardiovascular disease, diabetes and cancer. Obesity is a result of an imbalance between calories consumed and calories expended, according to Dr Rekha Harish, Chairperson, Indian Academy of Paediatrics, NCD Prevention. “Usually, increased consumption of unhealthy or processed food coupled with physical inactivity leads to this preventable condition. It is fast emerging as the most serious public health challenges of the 21st century. Studies have shown that 75-80% of severely obese children will remain obese as adults and be at heightened risk of various NCDs. At least 15% of children in India are obese or overweight and these numbers will steadily rise if left unchecked. We need strong policy regulating harmful ingredients in ultra-processed and packaged foods including food labels that can help parents make an informed choice.”
Mithani, mother and homemaker talked about her inability to read and interpret food labels on packed snacks that her children, aged 11 and 15 years, love to munch on. “In the last one year, with no school and minimal to zero physical exercises, my children have gained weight. It is difficult to always prevent them from consuming junk food which is associated with fun due to the way in which they are advertised and also because of their high sugar, salt and fat content. I wish there was a way to know which foods we should not be buying for our children.”
Dr Umesh Kapil, Professor, Clinical Epidemiology, Indian Institute of Biliary Sciences (ILBS) said that India needs to establish clear cut-offs for salt, sugar and saturated fats. “There is enough scientific evidence and a globally agreed on WHO SEARO framework for evidence-based cut-offs for anti-nutrients like sugar, salt and saturated fat present in packaged food. The Government of India should rapidly adopt these WHO recommended limits and also introduce simple, smart and interpretative front-of-package labelling (FOPL). Food Labels should provide clear guidance, for example, black octagons adopted in Chile that says up front whether or not foods contain excess fats or sugars. Simple to understand labels with evidence-based nutrition cut-off is a need of the hour and will go a long way to address the crisis of childhood obesity in the country.” He also warned that implementing a strong and effective FOPL will face hurdles as the food industry is likely to delay or divide the scientific community.
Drawing attention to clinical evidence that clearly correlates consumption of ultra-processed food to a number of serious health conditions, Dr Manoj Kumar Gupta, Dean, All India Institute of Medical Sciences, Rishikesh, said, “Children are, particularly at risk. As doctors, we want to assert that the onus should not be on children or their families alone to prevent or fight this condition. It is the collective duty of policymakers, the food industry and us as doctors to safeguard children and enable a nutritious food system for them.”
Dr Ravi Kant, Director and CEO, All India Institute of Medical Sciences, Rishikesh emphasised the importance of ensuring a healthy and nutritious food environment for children. “As doctors, we are concerned with this rising trend. Childhood obesity has several long-term impacts, some of which are irreversible. We need to set evidence-based limits on the high concentration of salt, sugar and fats in packaged foods so families have clear guidance when buying these products.” Strong regulations to cap salt, sugar and other ingredients of concern and simple to understand front of Package Labelling (FOPL) on the food are critical to helping consumers and parents understand how much empty calories and harmful nutrients are being consumed by children.
WHO has identified FOPL as “one of the policy tools that can support healthy diets, both in stimulating consumers to make informed healthier food choices and in driving manufacturers to reformulate products to avoid making unfavourable nutrient content disclosure.” The objective of a FOPL policy is to inform consumers in a simple and fast way about the content of sugar, sodium and saturated fat, to discourage the purchase of unhealthy packaged food. Thus far, 11 countries across the world have enacted laws making FOPL mandatory.
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. In December 2020 it restarted the process 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.