APPENDIX 47
Memorandum by J T Winkler (OB 98)
There are two policy approaches to diet and
obesity, changing people and changing food. The first seeks to
modify individuals' eating habits, the second to improve the nutritional
quality of products. One tries to shape people's choices, the
other to reformulate the foods from which those choices are made
designing foods with weight control in mind.
They are complementary, not alternatives. One
works on demand, the other on supply; one with consumers, the
other with producers. A comprehensive obesity policy requires
both.
| People | Food
|
| Consumers | Producers |
| Demand | Supply |
However, there is an imbalance between them. The obesity
epidemic has reached a scale where policies to reduce and prevent
it are imperative. But the vast majority of current proposals
focus only on changing consumers' behaviour.
There is much talk of labelling, claims, advertising, endorsements,
portion sizes, vending machines, nutrition education, health campaigns,
food deserts, even taxes on food—all designed to change
food habits. Little attention is paid to improving the composition
of mainstream processed foods, which most people eat most of the
time. Still less to new functional foods for weight control.
References to the food industry in official documents on
obesity are scant. Food manufacturers, who supply over 75% of
our intake, appear just three times, for example, in the UK's
National Audit Office report. The new WHO Global Strategy on Diet
covers the whole private sector in two paragraphs. In the US Surgeon-General's
Call to Action on Obesity, the food industry is not mentioned
at all.
Where possible actions by industry are raised, as in health
advocacy groups' campaigns, they focus on companies' promotional
activities, not on the nutritional profile of their products.
The food industry itself, naturally, deflects attention away from
its brands, emphasizing consumers' physical inactivity as the
cause of the problem.
The option of developing functional foods for obesity is
being overlooked. Miracle supplements proliferate, promising effortless
weight loss, the patent medicines of the 21st century. Meal replacements
for dieters continue to fill a niche. But reforming the foods
on which whole nations grew fat has not yet made it onto the agenda.
All this is perverse. It is easier to change food than to
change people. Altering the food habits of millions is a complex,
long-term challenge. And neither experience nor research provides
much guidance on how to do it.
In contrast, in most countries, the food industry has an
oligopolistic structure, a handful of companies dominate most
product sectors. The new British Minister for Public Health, Melanie
Johnson, quickly grasped the potential: "a dozen or two big
players could make a big difference . . ."
Specifically, they could do what they do best—design
foods. WHO does briefly mention this option, repeating ritual
injunctions to reduce fat, sugar and salt content. But, beyond
that, it merely suggests that companies "review the case
for introducing new products with better health profiles".
In fact, advances in nutrition and food technology have created
abundant options to reformulate foods for weight control. There
are six strategies food manufacturers could adopt, some immediately,
others in future. They offer benefits to public health, plus the
incentive of commercial opportunities.
STRATEGIES
1. Energy Density:
The purpose is to lower the energy density of products, that
is, reduce the number of calories per 100g, or in a standard portion.
The principal mechanisms for achieving this goal include
reducing the fat and/or sugars content of products; their substitution
with less energy dense and otherwise beneficial vegetables and
fruit; their replacement with sweeteners or fat substitutes; and
the addition of non-absorbed ingredients (like fibre and bulking
agents) or energyless ingredients (like water and air).
2. Macronutrient Balance:
The most obvious strategy is to alter the ratio of fats and
carbohydrates in products. The direction of the change depends
on which of the current alternative theories of weight loss is
favoured, the low fat or low carb approach. But there is also
mounting evidence that higher protein intakes are beneficial,
still within safe levels.
The mechanisms are to reduce the fat content of products,
especially saturated and trans fats; to cut down on sugars and/or
starch; to eliminate or reduce fructose, especially from soft
drinks containing high fructose corn syrup; and to increase the
animal and/or vegetable protein components.
3. Glycaemic Index/Load:
For adherents of carbohydrate theories of weight gain, the
goal is to lower the glycaemic response to foods—their capacity
to raise blood sugar, stimulate insulin release, and ultimately
fat storage.
The mechanisms include replacing high with low glycaemic
index ingredients; reducing total glycaemic load; adding functional
ingredients (eg non-absorbed starch derivatives); processing ingredients
to slow digestion (eg micro-encapsulation); or genetically modifying
starches, also to retard their digestion.
4. Appetite Control:
The aim is to limit food intake by incorporating ingredients
that reduce hunger or increase satiety.
Mechanisms include altering macronutrient balance; adding
soluble or insoluble fibre; incorporating new functional ingredients;
or altering the structure of foods, for example, the micro-structure
of fat.
5. Functional Ingredients:
Add food components to alter metabolic processes relevant
to weight control—decreasing absorption, increasing lean
tissue, and raising thermogenesis, as well as those mentioned
above, lowering glycaemic response and increasing satiety.
Many candidate ingredients are now being evaluated, by many
different organisations. For example, Unilever has a programme
for systematic assessment, now covering more than 30 potential
ingredients. Examples include conjugated linoleic acid, chitosan,
hydroxycitric acid, flavonoids, synephedrine.
6. Nutrigenomics:
The principle is to adapt foods to individuals' distinct
genetic inheritance, relevant to weight management. The process
of identifying relevant genes is still in its early stages, but
genetic vulnerabilities will certainly be multiple and complex.
In time, many specialist foods will be developed, designed for
different susceptibilities, targeted on sub-groups of the overweight
population.
POLICIES
Some reformulation will happen spontaneously. Some companies
will see obesity as a market opportunity. At its best, this will
stimulate a virtuous upward spiral of competition to produce healthier
new products.
But laissez-faire has limits. Many "energy dense,
nutrient poor" products will remain because producers have
invested heavily in brands and market share. Many new products
will be promoted as niche "healthy" products, restricting
their appeal. Crucially, most "healthy alternative products"
are more expensive than traditional variants. They do not reach
the poor, who need them most.
So, food reformulation for weight management, in all forms,
will need stimuli from government, both carrots and sticks. Listed
below are some of the options, in increasing order of severity.
— Encourage product innovation and market competition.
This could be done formally through financial support for applied
food research schemes, common in many countries, and for nutrigenomics
programmes at some of the many new genetic research centres.
— Provide economic incentives through preferential
government purchasing of reformulated foods for government catering
operations and food welfare schemes. This delivers healthier food
immediately to consumers, especially schoolchildren. It also quickly
develops economies of scale for innovative foods and radically
reduces the marketing costs of new product launches.
— In Europe, reform the CAP fruit and vegetable
regime, which destroys supplies at times of glut, maintains high
prices, and reduces demand. One alternative is to sell at low
market prices while reimbursing farmers. Another is reduced price
sales to industry, a healthy version of the established scheme
for butter. Both stimulate use by price-sensitive manufacturers,
raising the consumption of fruit and vegetables, while also lowering
the energy density of recipe products.
— Establish technical "Composition Improvement
Committees" in product sectors important for obesity. These
would include industry, government and health groups. They would
negotiate sectoral agreements for reformulation, so all competitors
move together. Such plans, for the incremental reduction of salt
in the bread, soup and sauce sectors, are already working in the
UK.
— Create credible controls on weight loss advertising,
either statutory, self-regulatory or combined, according to the
country. They must simultaneously permit substantiated claims
for established and future functional products, while reducing
the current astronomic levels of false claims (over 50% in the
US).
— Require health guidance on pack. This may take
the form of positive symbols on foods meeting nutritional criteria
(already widespread in Australia); negative warnings on products
high in energy, fat, and sugar (like Finnish salt warnings); or
both, through nutrition banding (as in the UK Co-op's high-medium-low
labelling). All guide consumers to healthy choices, but also stimulate
companies to reformulate products, to avoid the negative or achieve
the positive. So they work on both demand and supply simultaneously.
— Establish compositional regulations over products
important for obesity, especially foods targeted at or highly
consumed by children. These would establish general standards
for reformulation, to balance the recent emphasis on labelling
and claims in food law.
— Raise the prices of key foods contributing to
obesity. Selective taxes are one option, but unpopular. Less visible
and more effective is adjusting some of the many financial instruments
in agricultural policies, for example, by ending cut-price disposals
of fat to industry or raising support prices for sugar and fat.
Higher prices influence consumer demand directly, but also stimulate
product reformulations to cut costs.
The need for new functional foods for weight control is obvious.
The technology is available. A few policy initiatives could yield
substantial benefits for both public health and private business.
2003
Annex
POPULAR OB ESITY POLICY PROPOSALS 2003
FOCUS ON
CHANGING CONSUMERS'
FOOD CHOICES
Claims.
Labelling.
Endorsements.
Health Warnings.
Advertising Controls.
Taxes on Fat / Junk Foods.
Health Promotion Campaigns.
New Nutrition Guidelines.
Nutrition Education.
Vending Machines.
Menu Labelling.
Food Deserts.
Portion Sizes.
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