Reformulation Policies Research Articles

Evolution of critical nutrients (salt, sugars and saturated fats) in Spanish foods and beverages in the last 25 years

Non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, etc.) are the leading cause of death worldwide, accounting for 71 % of global deaths. The risk factors for all of them are closely linked to lifestyle and in particular to diet. For this reason, public health policies in European Union countries, in line with World Health Organization (WHO) recommendations, include in their priority measures actions aimed at promoting healthier food environments. One of these measures are policies for the reformulation of processed foods to reduce critical nutrients: salt, saturated fats, trans fats and added sugars. In Spain, as part of the NAOS Strategy, food reformulation measures have been implemented since 2008. Of all of them, the Plan de Colaboración para la Mejora de la Composición de Alimentos y Bebidas y otras Medidas 2020 stands out, which has led to a reduction in the content of salt, sugar, saturated and total fat in foods belonging to 57 subcategories marketed by the main food manufacturing and marketing companies from 2016 to 2021. Despite this, to date no population-based study has been conducted to test the impact of the measure on the diet of the Spanish population. The present article, by way of example, shows results of the theoretical estimation of total sugar intake in the pre-reformulation period (2016) and post-reformulation period (2024) based on the consumption of beverages in Spain. Data highlight that reformulation policies could have positive effects that need to be evaluated in representative studies of the Spanish population assessing the overall diet, in order to solidly confirm their positive effects on the population's diet.

Tackling (Childhood) Obesity through a Voluntary Food Reformulation Policy: A Repeated Cross-Sectional Study Investigating Nutritional Changes in the Out-of-Home Sector.

The Childhood Obesity Plan aimed to reduce sugar and energy in foods through a voluntary sugar-reduction programme. Our primary objective was to determine whether this implementation strategy had been successful, focusing on the out-of-home sector. We used a repeated cross-sectional design to evaluate nutritional changes in desserts served by leading chain restaurants. We extracted nutrition information from online menus in autumn/winter 2020, for comparison with baseline (2017) and interim (2018) values extracted from third-party datasets. We assessed compliance with the 20% sugar-reduction target and category-specific energy targets by product category and for pooled desserts. Overall, sugar/portion and energy/portion decreased by 11% and 4%, respectively. Policy targets were achieved in one of five categories (ice-cream: -38% sugar, p < 0.001; -30% energy, p < 0.001). Secondary outcomes were analysed for subgroups with the necessary data. Few chains significantly reduced sugar and/or energy across their dessert range. Energy/portion was positively associated with portion weight and sugar/portion but not with sugar/100 g. More than half of adults' desserts contained excessive sugar and/or saturated fat compared with dietary guidelines. Children's desserts less frequently exceeded guidelines. These results demonstrate that voluntary measures can drive substantial change when technical, commercial, and operational barriers can be overcome.

Global nutritional challenges of reformulated food: A review.

Food reformulation, the process of redesigning processed food products to make them healthier, is considered a crucial step in the fight against noncommunicable diseases. The reasons for reformulating food vary, with a common focus on reducing the levels of harmful substances, such as fats, sugars, and salts. Although this topic is broad, this review aims to shed light on the current challenges faced in the reformulation of food and to explore different approaches that can be taken to overcome these challenges. The review highlights the perception of consumer risk, the reasons for reformulating food, and the challenges involved. The review also emphasizes the importance of fortifying artisanal food processing and modifying microbial fermentation in order to meet the nutrient requirements of people in developing countries. The literature suggests that while the traditional reductionist approach remains relevant and yields quicker results, the food matrix approach, which involves engineering food microstructure, is a more complex process that may take longer to implement in developing economies. The findings of the review indicate that food reformulation policies are more likely to succeed if the private sector collaborates with or responds to the government regulatory process, and further research is conducted to establish newly developed reformulation concepts from different countries. In conclusion, food reformulation holds great promise in reducing the burden of noncommunicable diseases and improving the health of people around the world.

Assessing the healthiness of UK food companies' product portfolios using food sales and nutrient composition data.

The provision and over-consumption of foods high in energy, saturated fat, free sugars or salt are important risk factors for poor diet and ill-health. In the UK, policies seek to drive improvement through voluntary reformulation of single nutrients in key food groups. There has been little consideration of the overall progress by individual companies. This study assesses recent changes in the nutrient profile of brands and products sold by the top 10 food and beverage companies in the UK. The FSA/Ofcom nutrient profile model was applied to the nutrient composition data for all products manufactured by the top 10 food and beverage companies and weighted by volume sales. The mean nutrient profiling score, on a scale of 1-100 with thresholds for healthy products being 62 for foods and 68 for drinks, was used to rank companies and food categories between 2015 and 2018, and to calculate the proportion of individual products and sales that are considered by the UK Government to be healthy. Between 2015 and 2018 there was little change in the sales-weighted nutrient profiling score of the top 10 companies (49 to 51; p = 0.28) or the proportion of products classified as healthy (46% to 48%; p = 0.23). Of the top five brands sold by each of the ten companies, only six brands among ten companies improved their nutrient profiling score by 20% or more. The proportion of total volume sales classified as healthy increased from 44% to 51% (p = 0.07) driven by an increase in the volume sales of bottled water, low/no calorie carbonates and juices, but after removing soft drinks, the proportion of foods classified as healthy decreased from 7% to 6% (p = 33). The UK voluntary reformulation policies, setting targets for reductions in calories, sugar and salt, do not appear to have led to significant changes in the nutritional quality of foods, though there has been progress in soft drinks where the soft drink industry levy also applies. Further policy action is needed to incentivise companies to make more substantive changes in product composition to support consumers to achieve a healthier diet.

Sodium Content and Labelling Completeness of Packaged Foods and Beverages in Kenya.

Increased consumption of unhealthy processed foods, particularly those high in sodium, is a major risk factor for cardiovascular diseases. Nutrition information on packaged foods can help guide consumers toward products with less sodium, however the availability of nutrition information on foods sold in Kenya is currently unknown. The aims of this study were to estimate the proportion of packaged foods and beverages displaying nutrition information for sodium and determine the amount of sodium in packaged foods available for sale in Kenya. Data was collected in 2019 from five retail supermarkets in Nairobi. The availability of sodium information provided on packaged products and the sodium content were recorded. As secondary analyses, we compared sodium content labelling of products in Kenya by manufacturing location and the sodium content of products available in Kenya and South Africa. A total of 6003 packaged products in 56 food categories were identified. Overall, 39% of products displayed sodium content, though the availability of labelling varied widely between food categories, with coverage in main categories ranging from 0% (yoghurts and yoghurt drinks) to 86% (breakfast cereals). Food categories with the highest median sodium content were herbs and spices (9120 mg/100 g), sauces (1200 mg/100 g) and meat alternatives (766 mg/100 g) although wide variabilities were often observed within categories. Imported products were more likely to provide information on sodium than locally produced products (81% compared to 26%) and reported higher median sodium levels (172 mg/100 g compared to 96 mg/100 g). Kenyan products reported a higher median sodium content than South African products in six categories while South African products had higher median sodium in 20 categories, with considerable variation in median sodium content between countries in some categories. These findings highlight considerable potential to improve the availability of sodium information on packaged products in Kenya and to introduce reformulation policies to reduce the amount of sodium in the Kenyan food supply.

The Families Resilience Issue dealing with the Village Empowerment Program: Implication for Social Development

The article explores concerning evaluation program that the government has implemented in people's villages. This study conducted a reformulation policy to increase better family resilience in the rural areas. The study uses a qualitative method and collecting data with interviews, documentation, and observation. The research finds that community development in the village showed a new social sustainability pattern with three main goals: structure, culture, and process. It is a new program considering establishing a reformulation of social policy as an objective program that promotes sustainable development. While the program's implementation faced an obstacle driven by the local elite, it gained collaborative action with the regency government. Thus, the village development's family resilience failed not to internalize to deeply life confidence, but they do not feel they have awareness. Also, they still consider that family resilience is not a part of community development program, so it is not implemented very well. In summary, the planning village development has been the case to the local elite who are still focal figures to be “a small kingship” in the village.

Can Food Reformulation Policy Reduce Calorie Intake and Tackle Childhood Obesity?

Context: Childhood obesity has become one of the most concerning public health issues and several innovative strategies are being applied to tackle the issue. Reformulation of children-oriented food products may play a role in improving childhood obesity. However, there is not sufficient evidence that shows the effectiveness of this policy. This paper provides a systematic review of the evidence to examine the efficacy of food product reformulation on calorie intake and weight modification of children with obesity. Evidence Acquisition: A comprehensive literature search was undertaken for different types of studies. PubMed, Cochrane Library Database, EMBASE and SCOPUS were referred to as the source of literature. Results: Seven thousand four hundred and three results were entered into our study for screening and evaluation. Our study showed that there was no clear evidence that supported the effectiveness of this intervention. However, some bodies of literature show calorie intake reduction, but no weight modification. Conclusions: Although there is enough evidence to show that reformulation may promote healthy dietary patterns, its impact on weight status is not convincing. Long term running intervention needs to be applied to examine the possible implications of food reformulation policy on the weight status of the children.

Healthy Foods and Healthy Diets. How Government Policies Can Steer Food Reformulation.

Food reformulation policies aimed at reducing the risk of diet-related non-communicable diseases have been implemented in many countries. The degree of success of reformulation policies in changing the range of food options available to consumers has been a function of the design of these policies. Our objective was to review the different factors making the design and implementation of a food reformulation policy effective at improving populations’ diets and health. In this narrative review, we present a logic model of the action of reformulation policies on consumer behaviour, dietary intake and population health. We set out how policy design could drive outcomes, and highlight the role for governments and public health agencies in promoting food reformulation that is effective in improving diet and health. The key drivers of success for reformulation policies include strong incentives, a tight implementation strategy, a focus on the overall nutritional quality of food products, rather than on individual nutrients, and effective monitoring and evaluation. Additionally, policies should mark the distinction between product reformulation and product differentiation, which have different nutrition and health outcomes.

Sugar Content and Nutritional Quality of Child Orientated Ready to Eat Cereals and Yoghurts in the UK and Latin America; Does Food Policy Matter?

Ready to eat breakfast cereals (REBCs) and yoghurts provide important nutrients to children’s diets, but concerns about their high sugar content exist. Food reformulation could contribute to sugar reduction, but policies across countries are not uniform. We aimed to compare the sugar content and nutritional quality of child-orientated REBCs and yoghurts in Latin American countries with the UK. In a cross-sectional study, nutritional information, marketing strategies, and claims were collected from the food labels and packaging of products available in Guatemala, Mexico, Ecuador and the UK. Nutritional quality was assessed using the UK Ofcom Nutrient Profiling System. In total, 262 products were analysed (59% REBCs/41% yoghurts). REBCs in the UK had a lower sugar content (mean ± SD) (24.6 ± 6.4) than products in Ecuador (34.6 ± 10.8; p < 0.001), Mexico (32.6 ± 7.6; p = 0.001) and Guatemala (31.5 ± 8.3; p = 0.001). Across countries, there were no differences in the sugar content of yoghurts. A large proportion (83%) of REBCs and 33% of yoghurts were classified as “less healthy”. In conclusion, the sugar content of REBCs in Latin America is higher than those of the UK, which could be attributed to the UK voluntary sugar reduction programme. Sugar reformulation policies are required in Guatemala, Mexico and Ecuador.

The effect of single-nutrient reformulation initiatives on the nutrient profile of foods: a systematic review

AbstractIn an effort to promote population health, governments and businesses are promoting food reformulation initiatives. In most instances, these initiatives have focused on reducing the amount of individual nutrients such as trans-fatty acids (TFA) or sodium, and generally they have been successful at doing so. However, the impact of single-nutrient reformulation on the broader nutrient profile of foods, and on the overall quality of people's diet, remains unclear. We have undertaken a systematic review of evidence of the impact of single-nutrient reformulation on the overall nutrient profile of foods, covering both peer-reviewed studies and grey literature. The outcome of interest was the nutrient composition of the reformulated food or food category. Only 17 studies reported the effect of initiatives on reformulated products’ nutrient profile (44 studies reported on only the targeted nutrient). Results are heterogeneous. Six studies investigated the impact of TFA reduction initiatives, showing different impacts on the reformulated products’ fat profile, with saturated fats (SFA) decreasing in parallel in some studies, but increasing in others. Similarly, when sodium was reduced, sugar, SFA and calories changed in different directions in different studies. Six studies assessed the effect of mandatory calorie labelling in restaurants, two leading to a reduction in energy intake, one to an increase in sugar and a decrease in unsaturated fatty acids, suggesting a worsened nutrient profile. Of the companies participating in England's sugar reformulation initiative, only 13% also reduced total energy. Results highlight the limited research on the effect of reformulation strategies on the overall nutrient composition of foods. Only 28% of the studies that analyse the impact of policies incentivising single nutrient reformulation report the effect on the foods’ complete nutrient profile after reformulation. Over a third of the studies show that reducing the targeted nutrient comes at a cost – namely other nutrients may be increased. To produce the desire health impact, reformulation policies must incentivise improvements of the overall nutrient profile of products.

The evolution of Coca-Cola Australia’s soft drink reformulation strategy 2003–2017: A thematic analysis of corporate documents

Governments around the world are pressuring the soft drink industry to reformulate sugary drinks, in particular through taxes on sugar content or front-of-pack labels identifying products high in sugar. Even in countries with no sugary drink tax, such as Australia, the soft drink industry has a reformulation policy. While reformulation is often framed as a “win-win” solution for business and public health, many public health experts consider it to be a political strategy to improve corporate reputations and minimise the threat of regulation. We use a case study of Australia’s largest soft drink company, Coca-Cola Australia, to examine the evolution of corporate reformulation policies. We analysed a dataset of 144 corporate documents published between 2003 and 2017 to analyse how Coca-Cola’s policies changed and how it described and justified its reformulation initiatives. Between 2003 and 2017, Coca-Cola Australia shifted its reformulation strategy from “offering choice” to “systematic” sugar reformulation. It also presented two predominant rationales for reformulation: that it would grow its business and that it was “part of the solution” to obesity. We discuss these findings in relation to market and regulatory challenges facing the soft drink industry globally, including the spread of sugary drink taxes as well as consumer rejection of artificial sweeteners. This paper examines how a regional branch of the world’s largest soft drink company is adapting to pressures to reduce the sugar in its products as well as the tensions and barriers it faces in negotiating different consumer and public health interpretations of healthy beverages.

Abstract 057: Estimating the Benefits of the Proposed FDA Sodium Reformulation Policy on Cardiovascular Disease, Disparities and Economic Costs

Background: Sodium consumption is a leading modifiable risk factor for CVD mortality and morbidity in the US. In 2016, the US Food and Drug Administration (FDA), following recent effective examples in several other countries, proposed voluntary sodium targets for industry to reduce sodium in processed foods. Aim: We aimed to estimate the potential CVD, equity and economic impacts of implementing this policy. Methods: We used the validated US IMPACT Food Policy microsimulation model to estimate the CVD cases averted, quality-adjusted life-years (QALYs) gained and cost-effectiveness from 2017-2036 of the FDA sodium reformulation policy in US adults (30+ years). Model inputs included national demographics and sodium intakes from NHANES, FDA short- and long-term sodium reformulation targets, sodium effects on blood pressure and of blood pressure on CVD from meta-analyses, government costs to administer and monitor the policy and industry reformulation costs, and validated healthcare and productivity costs. We modelled 3 scenarios: a) Optimal, 100% compliance of 10-year reformulation targets b) Modest, 50% compliance of 10-year reformulation targets c) Pessimistic, 100% compliance of 2-year reformulation targets with no further progress Costs were inflated to 2017 US dollars and outputs were discounted annually by 3%. We took a societal perspective for this analysis. Rigorous probabilistic sensitivity analyses were conducted. Results: The optimal scenario achieving the 10-year sodium reduction targets could prevent ~ 450,000 CVD cases (95% Uncertainty Interval: 240,000-740,000), gain 2.1 million QALYs (1.7m-2.4m), and produce $41billion ($14bn-$81bn) cost-savings from 2017-2036. The modest and pessimistic scenarios were also cost-saving, with both health gains and savings about one half and one quarter, respectively, of the optimal scenario. Relative disparities between non-Hispanic white and non-Hispanic black populations would be reduced in all scenarios. The pessimistic scenario yielded the largest reduction in absolute disparities (70,000 CVD cases (33,000-120,000) prevented in non-Hispanic blacks vs. 13,000 (0-54,000) in non-Hispanic whites). The optimal scenario would prevent approximately 4.6% (130,000 cases (65,0000-220,000)) of all CVD cases in non-Hispanic blacks compared to 1.5% (220,000 cases (120,000-360,000)) in non-Hispanic whites. Despite a smaller population, total net savings would be over 50% larger in non-Hispanic blacks than non-Hispanic whites ($19bn vs $12bn) in the optimal scenario. Conclusions: Implementing and even partly achieving the FDA sodium reduction targets could generate substantial health gains and net cost savings. Crucially, this policy could also reduce CVD disparities between non-Hispanic black and non-Hispanic white populations.

Ultra-processed foods and the limits of product reformulation.

The nutritional reformulation of processed food and beverage products has been promoted as an important means of addressing the nutritional imbalances in contemporary dietary patterns. The focus of most reformulation policies is the reduction in quantities of nutrients-to-limit - Na, free sugars, SFA, trans-fatty acids and total energy. The present commentary examines the limitations of what we refer to as 'nutrients-to-limit reformulation' policies and practices, particularly when applied to ultra-processed foods and drink products. Beyond these nutrients-to-limit, there are a range of other potentially harmful processed and industrially produced ingredients used in the production of ultra-processed products that are not usually removed during reformulation. The sources of nutrients-to-limit in these products may be replaced with other highly processed ingredients and additives, rather than with whole or minimally processed foods. Reformulation policies may also legitimise current levels of consumption of ultra-processed products in high-income countries and increased levels of consumption in emerging markets in the global South.

Are food composition databases ready to support food reformulation policies?

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The usefulness of air quality monitoring and air quality impact studies before the introduction of reformulated gasolines in developing countries. Mexico City, a real case study

Urban air pollution is a major environmental problem in several developing countries in the world. This phenomenon seems to be related to the growth of both the urban population in large cities and the number of old and poorly maintained car fleets. The expected rise of population in the next century in countries which suffer from lack of capital for air pollution control, means that there is a great potential for the worsening of the air quality. The worldwide promoted policy to phase out lead in gasolines has not proved to be an adequate option in improving the environmental quality. Mexico City Metropolitan Area (MCMA) represents a case in which the introduction of reformulated gasolines in an old car fleet has given as a result the reduction of the airborne lead levels but has worsened the ozone concentration of its urban atmosphere. This paper critically analyzes the chronological evolution of the ozone air pollution problem in MCMA after the successive occurrence of several changes in the formulation of low leaded and unleaded gasolines. It also presents evidences of the usefulness potential of air quality monitoring activities and air quality impact studies on the definition of realistic fuel reformulation policies of developing countries.