AIIMS Study: ‘Warning Labels’ On Packaged Food Is People’s Choice

With consumption of packaged foods soaring to unprecedented levels, India is prioritizing the adoption of Front of Pack Labelling (FOPL).

. In a modelling study published in PLOS Medicine, 2020 after implementing warning labels in Mexico it is estimated that warning labels may effectively reduce obesity and obesity-related costs

With consumption of packaged foods soaring to unprecedented levels, India is prioritizing the adoption of Front of Pack Labelling (FOPL). In a unique initiative, Government of India’s apex medical institutions, AIIMS, has conducted a study to determine what type of labelling system would be most effective for Indians. According to the study unveiled at a pan-Indian gathering of top medical experts, when respondents were asked to choose among various FOPL designs such as the multicoloured traffic light system or the star rating system, ‘high-in style’ warning labels emerged the clear winner.

Even as the apex food regulator of the country, FSSAI deliberates on a labelling system, findings of this study by the top medical minds of the country, is expected to inform the policy making process. Senior doctors from AIIMS Delhi, Rishikesh, Jodhpur, Gorakhpur, Bhatinda, Bibinagar, Assam and Srinagar, and representatives from Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM), Indian Institute of Biliary Sciences (IBLS) among others, gathered at the National Academy of Medical Science to release this study.

An FOPL is regarded as the most effective policy solution which can inform consumers in an easy-to-understand manner about high levels of sugar, sodium and saturated fat that may be present and discourage the purchase of unhealthy packaged food. The ‘KAP study on FOPL in India’ reveals that people are ready to make healthier food choices and find simple ‘warning labels’ as easy to read and understand. Stressing on the need to choose correctly and scientifically, Dr Umesh Kapil, President of the Epidemiological Foundation of India said, “Research shows that labels which only highlight nutrients of concern, ie, warning labels, work best to safeguard public health. It is heartening to note that Indians have almost unanimously voted ‘high-in warning labels for salt, sugar, fats’ as the easiest to understand. Front of Pack Warning Labels (FOPWL) can result in immediate public health benefits – all the more reason why India, which accounts for 25% of the global burden of heart disease, cannot afford not to get it right the first time.”

An overwhelming majority are of the opinion that FOPL should be made mandatory and 87% find nutrition labelling helpful. Applauding this initiative as timely, Dr Sanjay Rai, Professor, Community Medicine, AIIMS

Delhi and President of the IPHA said, “People are ready to shift to healthier decisions regarding purchase of packaged and processed food and this perception study has shown that warning labels have the widest appeal. We are witnessing a worldwide tipping effect of diet related NCDs. A momentous shift is required and if done in a scientific, evidence-based manner, FOPL can bring about this change swiftly. No time must be lost as millions of lives are at risk. This study by India’s top doctors is an important step. I hope it can

positively inform the policy process that has already been initiated by FSSAI and we can take decisive steps in the right direction while adopting an FOPL that is best for India.”

Considered to be practical and inexpensive, FOPL is quickly gaining traction world over as an effective tool with cascading health benefits for the population. More than 8 countries including Argentina, Brazil, Chile and Turkey have already adopted mandatory FOPLs and are in the process of regulating all foods and beverages. Sharing the learnings from implementations of warning labels in Chile and Mexico, Ms Vandana Shah, Regional Director, Global Health Advocacy Incubator said, “Front-of-pack warning labels (FOPWL) help consumers quickly identify products with high contents of unhealthy nutrients and encourages industry to reformulate. Studies coming in from Chile which was one of the first countries to implement simple warning labels on packaged foods, are already showing a significant reduction in consumption of sugar and salt consumption leading to industry taking steps to make their products healthier based on consumer shifts. All this has resulted in no economic or job losses for the food industry creating a win-win situation for public health and industry.”

According to global nutrition experts, the Health Star Rating or Nutri-Score system which highlights positive nutrients along with the harmful ingredients end up sending a mixed and confusing message to the consumer. There is growing consensus based on results from Australia and New Zealand that have adopted such labels that these have not resulted in any public health gains. The industry is known to prefer a ‘star rating’ system since it has minimal effect on the market and does not bring about large scale reformulation of food products that are extremely high in salt, sugar and saturated fat.

Talking about industry’s hesitation to embrace ‘warning labels on the front-of-pack’ and its various delaying tactics, Dr Suneela Garg, National President IAPSM, said, “The corporate play book uses multiple strategies like ‘corporate washing’ to dilute the basis for a strong FOPL. Big Food diverts attention from

health harm to consumer behaviour. They may also use false claims such as the world’s largest sugar sweetened beverage company ironically committing to protecting people from NCDs. Labels like HSR make such claims possible. I hope that the findings of the AIIMS study which reaffirm the global gold standard that warning labels are the most beneficial for people.”

More than 5.8 million Indians die every year from Non-Communicable Diseases (NCDs) such as cancer, diabetes, uncontrolled hypertension, and cardiovascular diseases. By 2024, the diabetic population of the country is estimated to hit almost 70 million and India is already emerging as the obesity capital of the world. Heart attack and stroke are the top killers in the country. Most of these deadly diseases, although hard to treat, can be prevented by modifying diets and supporting a healthier, sustainable food system. As is the case with other developing economies, there has been a significant boom in consumption of packaged foods, usually high in sugar, salt and bad fats, even in the rural areas and across all socio-economic groups. According to sales data from Euromonitor, per capita sales of ultra-processed foods grew from about 2 Kg in 2005, to about 6kg in 2019 and is projected to grow to about 8 kg by 2024. Similarly ultra-processed beverages are up from 2 L in 2005 to about 6.5 L in 2019 and projected to be about 10 L in 2024.

Administered to a varied demographic across 15 states, this study was designed and led by AIIMS Rishikesh along with its counterparts in various locations. Speaking about the objective and methodology, Dr Pradeep Agarwal, AIIMS Rishikesh said, “As doctors we are witnessing the debilitating impact caused by excessive consumption of foods high in salt, sugar and saturated fats, on the health of this country, particularly on our youth and children. This observational survey has ascertained which type of label people find easiest to read and most helpful in guiding their purchase decisions. We also found that 93% Indians concur that simple front-of-pack label on all food and beverage is a necessity.”

The AIIMS study comes at a time when India is deliberating on an FOPL policy and public health experts across the world are keenly watching India’s choice of label design.
















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