Leaders from top medical institutes urge immediate action on FOPL to address India’s NCD crisis

Nearly 5.8 million people or 1 in 4 Indians are at a risk of dying from an NCD before they reach the age of 70

Leaders from All India Institute of Medical Sciences (AIIMS), Post Graduate Institute of Medical Education and Research (PGIMER), Institute of Liver and Biliary Sciences, Indian Association of Preventive and Social Medicine (IAPSM), Indian Public Health Association (IPHA), Indian academy of Paediatrics and Epidemiological Foundation of India (EFI), along with leading doctors from other top medical institutes have issued a clarion call for mandatory front-of-pack food labels (FOPL). With 135 million people obese and deaths due to non-communicable diseases (NCDs) on the rise, India is facing the devastating impact of unhealthy diet.  Packaged junk food which is a major component of unhealthy diets is responsible for more deaths worldwide than any other risk factor and a leading cause of obesity, type 2 diabetes, cardiovascular disease (CVD) and cancer. Citing an exponential rise in market availability of ultra-processed foods containing high levels of sugars, sodium and saturated fats as a key contributor to this obesity epidemic and upsurge in NCD prevalence, India’s top medical experts urged that adoption of an effective FOPL is the need of the hour.

At an event organised by AIIMS Rishikesh, experts from the nationwide network of AIIMS, the Indian Academy of Paediatrics, Indian Institute of Liver and Biliary Sciences, PGIMER, IPHA and other medical institutions asserted that millions of lives will be saved if India establishes scientific cut-off limits for salt, sugar, saturated fats and mandates clear and simple warning label on packaged products as has been done in countries like Chile, Mexico and Brazil.

While delivering the keynote address, Dr Ravi Kant, Director, AIIMS Rishikesh said, “A strong and effective FOPL is a public health priority for India. The medical community of India stands in solidarity with this important policy measure that will protect thousands of Indian lives.”

Nearly 5.8 million people or 1 in 4 Indians are at a risk of dying from an NCD before they reach the age of 70. India’s deadly second wave of Covid-19 has demonstrated that NCDs also compound the burden of infectious diseases on health systems, with hospitals ill-equipped to meet the sudden surge of demand for patient care. Poor diet, as a result of packaged and ultra-processed food, is a leading cause for this gradual epidemiological shift in India’s disease burden.

According to Dr Suneela Garg, President, Indian Association of Preventive and Social Medicine (IAPSM), “All of these conditions such as diabetes, obesity, heart disease or cancers are closely linked to excessive intake of energy-dense and nutrient poor foods and beverages. World over, countries are recognising that consumers have the right to accurate health information regarding these products as part of their right to health. Having incomprehensible or misleading information about a food product puts them at a higher risk of making uninformed choices that lead to overweight, obesity and other diet-related conditions.”

Front-of-package warning labelling is a key component of a comprehensive strategy to promote healthier lives, as it enables consumers to identify in a quick, clear and effective way, products that are high in nutrient of concern associated with the NCD burden in India. As India observes the national nutrition month and leading up the UN Food Summit, the spotlight is more than ever on excessive intake of these “nutrients of concern.” Even as countries were being ravaged by the COVID-19 pandemic, the food and beverage industry expanded their market of unhealthy, ultra-processed foods and sugary drinks.  According to Euromonitor estimates, in India, the sale of ultra-processed food has increased from 2 kg per capita in 2005, to 6kg in 2019 and is expected to grow to 8kg in 2024. Similarly, beverages have gone up from less than 2 L in 2005 to about 8 L in 2019 and are expected to grow to 10 L in 2024.

Dr Sanjay Rai, President, Indian Public Health Association (IPHA), emphasised that “While an FOPL is indeed one of the most effective approaches to positively impact public health, it is also important to choose the correct format. Evidence from across the world indicate a warning label system of FOPL – such as the “high in” warning symbols adopted in Chile. These interpretive and direct labels are most effective in supporting healthy food choices. They also are most likely to motivate product reformulation. Given the evidence, we should consider adopting these nutrient-based labels without further delay.”

Besides, the design, an FOPL is successful when it is mandatory and guided by a scientific nutrient profile model. The single threshold nutrient profile model – for food and beverages – has been the most effective solution for implementing and monitoring the FOPL policy. Countries such as Chile, Israel and Mexico with robust FOPL policies have adapted models with a single nutrient threshold.

Stressing on the importance of acting swiftly and not ignoring the science that informs the setting of these thresholds, Dr Umesh Kapil said, “Experts across the world have conducted research and compiled field level studies to develop the NPM frameworks. The WHO SEARO model was put together in consultation with member countries in the region and is perfectly aligned to the Codex Alimentarius or food code. Industry will continue to use diversionary tactics. We need to adopt what is scientifically established as a healthy limit and waste no more time on negotiations.”

All the experts present have agreed to send set of recommendations to the Ministry of Health and hope to work with the government of India towards a healthier and accountable food system. They said it is encouraging to note that the FSSAI has revived FOPL related consultations.

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 and is currently seeking inputs from consumer rights organisations, industry and nutrition experts for a viable model for India.