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 Table of Contents  
COMMENTARY
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 30-33

Tackling chronic illnesses by regulating intake of unhealthy foods in India: A viewpoint


1 Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
2 Independent Public Health Researcher, Jammu and Kashmir, India
3 Country Coordinator, Global Health Advocacy Incubator

Date of Submission21-Nov-2021
Date of Decision21-Dec-2021
Date of Acceptance05-Feb-2022
Date of Web Publication16-May-2022

Correspondence Address:
Dr. Sudip Bhattacharya
Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jphpc.jphpc_40_21

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  Abstract 


Chronic illnesses linked to diet, such as cardiovascular disease, cancer, and diabetes, have become a serious concern for the current health-care system. Approximately 39.5 million people worldwide died of noncommunicable diseases (NCDs) in 2016, including 17.6 million from cardiovascular disease and 8.9 million from cancer. Over the past decade, worldwide mortality rates for cardiovascular diseases and cancer have increased by 14.5% and 17.8%, respectively. In France, cardiovascular disease and cancer are the leading causes of death, accounting for more than 30% of all deaths. Chronic illnesses are associated with poor nutritional quality in many countries. Considering the high burden of chronic diseases linked to poor diet, health-care authorities have adopted community-based public health strategies to improve diet and to minimize the risk of nutrition-related disorders. Front-of-pack nutrition labels (FoPLs) are gaining popularity in this arena. FoPLs aim to guide customers toward healthier choices by delivering simple, salient, and readily accessible nutritional information about food products at the time of purchase. It will be wise if we introduce FoPL by empowering public to make their informed choice during purchasing packaged food items. We hope in the future, food industry will make food policy in similar lines with healthy public health policy to prevent the future burden of NCD in India and the globe.

Keywords: Food safety, front-of-package food labeling, healthy foods, nutrition


How to cite this article:
Bhattacharya S, Saleem SM, Bera OP. Tackling chronic illnesses by regulating intake of unhealthy foods in India: A viewpoint. J Public Health Prim Care 2022;3:30-3

How to cite this URL:
Bhattacharya S, Saleem SM, Bera OP. Tackling chronic illnesses by regulating intake of unhealthy foods in India: A viewpoint. J Public Health Prim Care [serial online] 2022 [cited 2022 Jul 5];3:30-3. Available from: http://www.jphpc.com/text.asp?2022/3/2/30/345277




  Background Top


Chronic illnesses linked to diet, such as cardiovascular disease, cancer, and diabetes, have become a serious concern for the current health-care system.[1] Approximately 39.5 million people worldwide died of noncommunicable diseases (NCDs) in 2016, including 17.6 million from cardiovascular disease and 8.9 million from cancer.[2] Over the past decade, worldwide mortality rates for cardiovascular diseases and cancer have increased by 14.5% and 17.8%, respectively.[2] In France, cardiovascular disease and cancer are the leading causes of death, accounting for more than 30% of all deaths.[3] Chronic illnesses are associated with poor nutritional quality in many countries.[2] Considering the high burden of chronic diseases linked to poor diet, health-care authorities have adopted community-based public health strategies to improve diet and to minimize the risk of nutrition-related disorders. Front-of-pack nutrition labels (FoPLs) are gaining popularity in this arena.[4] FoPLs aim to guide customers toward healthier choices by delivering simple, salient, and readily accessible nutritional information about food products at the time of purchase.[4] Research has shown that FoPL enforcement can significantly boost the nutritional content of food purchases,[5],[6] which may impact dietary intakes. In addition, FoPLs act as an incentive for food makers to improve their products' nutritional content through reformulations and innovations.[7],[8]

Nutritional intake correlates directly with the risk of chronic diseases, so diet improvements through FoPLs can have a direct impact on incidence and mortality. The intake of fruits and vegetables through an increased intake of fiber is associated with a lower risk of coronary heart disease,[9] colorectal cancer, and stroke incidence.[10] It has also been shown that salt intake is positively related to blood pressure, which is closely connected to stroke risk and coronary heart disease risk.[11]

Simulation studies have examined the total effect of food intake adjustments on nutrition-related mortality at the community level.[12] In particular, it is possible to develop scenarios for food consumption changes based on research looking at the effects of specific treatments, and so adequately estimating their health consequences. This type of research is crucial to policymakers because it provides meaningful estimates of the potential health benefits of specific actions.[13] The effectiveness of FoPLs in influencing consumer behavior toward better choices at the point of purchase has been praised.[5] However, the evidence remains uncertain in terms of their potential direct effect on noncommunicable disease incidence and mortality.

Numerous studies[6],[14] have found that the impact of FoPLs on customer purchases might vary significantly according to their graphical presentation. Furthermore, their impact on individual diets may differ (especially in terms of food consumption), which may also affect health outcomes. Considering these factors, evaluating the research evidence on the potential effect of different FoPLs on mortality should assist policymakers in choosing the most healthy food packaging options. As far as we know, no comparative evaluation has been conducted between alternative FoPLs forms on dietary intakes. Furthermore, even in other nations, FoPLs are implemented in distinct geographic and cultural settings, making it difficult to apply such estimates across populations. It seems very relevant, therefore, to obtain homogeneous data from a single pool of individuals and to evaluate their actual purchase behavior (rather than stated preferences).


  Current Scenario in India Top


In response to the changing demographics, food behaviors, i.e., increased inclination toward packaged foods, a modernizing retail sector, aggressive marketing strategy for packaged foods, increased consumer acceptance of processed foods through taste modification,[15] and industrial lobbying to boost food manufacturing, India's food processing sector is primed for expansion.

Food habits of a diverse Indian people vary according to taste, culture, staple goods, region, season, and a variety of other factors. The ongoing need for packaged items stems from adjusting to changing eating trends and mimicking foreign cultures, as seen in India in recent years. The food behavior transition from a traditional to a modern cultural context has been rapid, resulting in high demand for packaged food products throughout the year. For a long time, income growth has raised consumer appetites and discretionary spending in India. However, there has been a rise in urbanization and the number of working women,[16] which has led customers to seek out items that offer more convenience, particularly in the food and beverage industry. This has been in a trade-up from unpackaged to packaged items, as well as from unbranded to branded products. Furthermore, consumers have developed a level of health consciousness, which has prompted them to make more informed choices when it comes to packaged goods and the consumers are continuing to gravitate toward packaged meals as cities expand. Given the industries under penetration, more competition will boost volume growth while also increasing awareness and availability through greater distribution.

Nevertheless, to mention here, the Indian markets have mostly two types of foods available unpackaged and packed. Unpackaged street food includes foods such as samosas, matte, burgers, and sandwiches, which does not come under the legislations/packaged food regulation. On the other hand, packed foods come in perfectly packed conditions and offer quite hygienic and appropriate servings to the consumers, which may or may not contain food labels. They both come under the regulatory authority of “Food Safety and Standards Authority of India” (FSSAI).[15] The FSSAI is intended to ensure the availability of safe and healthy food for the people of India, according to the preamble of the Food Safety and Standards Act, 2006. As a result, the FSSAI has launched a large-scale effort to modernize the country.


  Tackling the Menace Top


The calories gained from foods high in fat, salt, and sweets have been increasing in diets, whereas calories obtained from fiber-rich meals have been decreasing. Globally, there has been a significant increase in the consumption of processed and ready-to-eat meals.[16] Such an unhealthy dietary threat has altered the food system, with far-reaching consequences for NCD development. The impact of this transition has altered the nutritional value of food, its availability, cost-effectiveness, and general availability to people. As the worldwide burden of unhealthy diets rises, resulting in a significant increase in the global NCD burden,[17] nutrition labeling has been identified as a critical population-level strategy for transmitting information about the nutritional content of goods to consumers.

The introduction of FoP labeling has aided in the provision of nutritional information to the public. Numerous studies[16],[18],[19],[20],[21],[22] have offered extensive evidence supporting the role of color-coded labels and warnings in influencing customers' purchase behavior toward more nutritious items, as well as the underlying psychological process of behavioral change. Each form of label had unique characteristics that should be considered when developing FoPL rules based on local settings. The studies have supported mandatory front-of-pack labeling rules as a means of guiding consumer choice and pushing the food sector to reformulate its goods.


  Role of Food Safety and Standards Authority of India in Maintaining Food Quality Top


The FSSAI's responsibility in food quality is to assure consumer safety and satisfaction. The FSSAI is responsible for providing the necessary controls. This agency develops policies to eradicate harmful and dangerous materials in the environment. As a consequence, every client receives the same degree of food safety guarantee. The product packaging tells the buyer about the product quality and, as a result, the safety regulations.[23] These requirements must be followed by food makers in order to control food deterioration. This is excellent for gaining the customer's trust while also satisfying the food regulators. Various food items have different specifications. The goal is to guarantee that the appropriate precautions for that specific food product are executed. Other malpractices, such as fraud, adulteration, and making false promises to deceive customers, must be forbidden.[23],[24]

The food safety enforcement and state food authorities are a part of FSSAI which shares the responsibility and challenging task of compliance of food standards and safety enforcement at the field level. They also carry out surveys of the industrial units engaged in the manufacture or processing of food in the states to find out compliance. They also conduct and organize training programs for the personnel of the filed team. Moreover, they ensure an efficient and uniform implementation of the standard and other requirement and sanction prosecution for offenses punishable with imprisonment.[24],[25],[26]


  Way Forward and Recommendations Top


From the above discussion, it is clear that, in India, we must deal with unhealthy foods we propose that FSSAI can adhere their guidelines with the packaged food, it will be wise if we introduce FoPL by empowering public to make their informed choice during purchasing packaged food items. As we know that it would not be an easy task because there are competing interests between public health and industry like tobacco industry. However, we have witnessed the success stories for the advocacy of anti-tobacco initiatives. We hope in the future food industry will make food policy in similar lines with healthy public health policy to prevent the future burden of NCD in India and the globe.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Diet, nutrition and the prevention of chronic diseases. In: WHO Technical Report Series. Geneva, Switzeland: WHO; 2003. p. 916.  Back to cited text no. 1
    
2.
GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1151-210.  Back to cited text no. 2
    
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The state of health of the population in France - Report 2017 | Directorate of Research, Studies, Evaluation and Statistics [Internet]. Available from: https://drees.solidarites-sante.gouv.fr/publications-documents-de-reference/rapports/letat-de-sante-de-la-population-en-france-rapport-2017. [Last accessed on 2022 Mar 07].  Back to cited text no. 3
    
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World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. Geneva: World Health Organization; 2013.  Back to cited text no. 4
    
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Young L, Swinburn B. Impact of the Pick the Tick food information programme on the salt content of food in New Zealand. Health Promot Int 2002;17:13-9.  Back to cited text no. 8
    
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Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: A meta-analysis of cohort studies. J Nutr 2006;136:2588-93.  Back to cited text no. 9
    
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Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: A comprehensive review. Circulation 2016;133:187-225.  Back to cited text no. 11
    
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Scarborough P, Harrington RA, Mizdrak A, Zhou LM, Doherty A. The preventable risk integrated ModEl and its use to estimate the health impact of public health policy scenarios. Scientifica (Cairo) 2014;2014:748750.  Back to cited text no. 12
    
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Gortmaker SL, Swinburn BA, Levy D, Carter R, Mabry PL, Finegood DT, et al. Changing the future of obesity: Science, policy, and action. Lancet 2011;378:838-47.  Back to cited text no. 13
    
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Hawley KL, Roberto CA, Bragg MA, Liu PJ, Schwartz MB, Brownell KD. The science on front-of-package food labels. Public Health Nutr 2013;16:430-9.  Back to cited text no. 14
    
15.
Bhattacharya S, Thakur JS, Singh A. Knowledge attitude, and practice regarding dietary salt intake among urban slum population of North India. J Family Med Prim Care 2018;7:526-30.  Back to cited text no. 15
[PUBMED]  [Full text]  
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Bhattacharya S, Thakur JS, Singh A. Knowledge attitude, and practice regarding dietary salt intake among urban slum population of North India. J Fam Med Prim Care 2018;7:526-30.  Back to cited text no. 16
    
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FSSAI. Available from: https://www.fssai.gov.in/. [Last accessed on 2021 Nov 14].  Back to cited text no. 17
    
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Bera OP, Saleem SM, Bhattacharya S. Promoting healthier diets in India through “Front of pack age food labeling.” Indian J Community Heal 2021;33:25-9.  Back to cited text no. 18
    
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Goodman S, Vanderlee L, Acton R, Mahamad S, Hammond D. The impact of front-of-package label design on consumer understanding of nutrient amounts. Nutrients 2018;10:E1624.  Back to cited text no. 19
    
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Song J, Brown MK, Tan M, MacGregor GA, Webster J, Campbell NRC, et al. Impact of color-coded and warning nutrition labelling schemes: A systematic review and network meta-analysis. PLoS Med 2021;18:e1003765.  Back to cited text no. 20
    
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Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, et al. Implementation of childhood obesity prevention and control policies in the United States and Latin America: Lessons for cross-border research and practice. Obes Rev 2021;22 Suppl 3:e13247.  Back to cited text no. 22
    
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Kelly B, Jewell J. What is the Evidence on the Policy Specifications, Development Processes and Effectiveness of Existing Front-of-Pack Food Labelling Policies in the WHO European Region? Geneva: World Health Organization; 2018. p. 80.  Back to cited text no. 23
    
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