Chile’s Healthy Food Policies

Welcome back. Reducing the consumption of sugary beverages by law, tax or public campaign is a topic I’ve revisited a few times (Research Sponsor Bias, Sugary Beverage Addendum, Taxing Sugary Beverages). I felt it was important to promote the health benefits. Equally important was to show the ways beverage and sugar industries have fought the reductions, just as the tobacco industry resisted smoking restrictions and the fossil fuel industries denied their effect on climate.

Rethink Your Drink poster included in Sugary Beverage Addendum post (2013 poster by Hawaii Academy of Nutrition and Dietetics, eatrighthawaii.org/2013/11/14/rethink-your-drink-campaign/).

While actions in the U.S. have largely been either local, by nonprofits, or lately, by beverage companies in response to consumer preferences, Chile has led the world in national policies to reduce sugary beverage purchases and promote healthy foods.

Chile’s Law of Food Labeling and Advertising, implemented in three progressively stricter phases between 2016 and 2019, was the world’s first national regulation to mandate policy strategies recommended by the World Health Organization.

These included front-of-package warning labels on unhealthy foods and beverages; restrictions on child-targeted marketing of these foods and beverages; and a ban on sales in schools of all foods and beverages containing added sugars, sodium or saturated fats that exceeded set thresholds.

Front-of-package warnings from Chile’s Law of Food Labeling and Advertising; clockwise from upper left--high in sugars, saturated fats, calories, sodium (from photo by Aeveraal posted on commons.wikimedia.org/wiki/File:Etiquetado_minsal_Chile.jpeg).

Evaluating the Law’s First Phase
Researchers with the University of North Carolina, University of Chile and Mexico’s National Institute of Public Health reported their initial evaluation of the law’s first-phase effect on sugary beverage purchases in a February 2020 publication. But the law’s first-phase effects go much further, and a broader scope investigation by most of the same researchers was recently released.

This study monitored 2,381 Chilean households, collecting demographic data and changes in food and beverage purchases from January 2015 through December 2017, thereby encompassing the law’s first phase implementation in June 2016.

Nutrition data were linked to household purchases using barcode, brand name and product description. Nutritionists checked accuracy and categorized the products as “high-in” if added sugar, sodium or saturated fat exceeded first-phase cut-offs.

For the main analyses, the researchers used a pre- and post-modeling approach to examine changes in nutrient content (calories, sugar, saturated fat and sodium) of overall food purchases before and after the policy was implemented. Nutrients purchased from high-in and “not high-in” foods and beverages were examined separately, as well as by food and beverage subgroup.

Observed Changes
The proportion of households that purchased any high-in product or high-in food remained almost unchanged after the law was implemented; however, the proportion that purchased high-in beverages dropped by 12%.

The largest decreases in high-in purchases were for commercial fruit and vegetable juices (–47%), dairy-based beverages and substitutes (–31%), condiments and sauces (–33%), meat, poultry and meat substitutes (–11%), breakfast cereals (–11%), and sweets and non-grain-based desserts (–8%).

Calories, sugar, saturated fat (each measured in kilocalories/capita/day) and sodium (milligrams/capita/day) from high-in purchases declined respectively by 24%, 27%. 16% and 37%.

In contrast, calories, sugar, saturated fat and sodium from not-high-in purchases increased, though not enough to offset the declines from high-in products. Not-high-in calories increased by 13%, sugar by 26%, saturated fat by 24% and sodium by 21%.

The results suggested that more educated households had larger decreases in overall and high-in calories purchased, the least educated households had the largest increases in not-high-in calories purchased, and that households with lower assets had larger decreases in overall and high-in calories purchased as well as smaller increases in calories purchased from not-high-in foods.

Wrap Up
The first phase of Chile's Law of Food Labeling and Advertising generated significant decreases in overall purchases of calories, sugar, saturated fat and sodium, driven largely by reduced high-in food and beverage purchases. It's likely that the more stringent nutrient thresholds of the second and third phases of the law produced even greater impacts, but these remain to be studied.

Chile’s Law of Food Labeling and Advertising three-phase cut-off values for calories, sodium, sugar and saturated fats (graphic from www.who.int/conferences/global-ncd-conference/workshop2-6-Melanie-Paccot-Entornos-saludables.pdf).

The results highlight the importance of policies that apply to both beverages and foods. Chile is one of the world's top consumers of sugary beverages, yet beverages comprise only about 10% of daily calorie intake.

Finally, the researchers note that Brazil, Israel, Mexico and Peru have instituted similar high-in warning labels, and at least five other countries are considering doing the same. No, not the U.S. Thanks for stopping by.

P.S.
Coca-Cola’s changes in response to consumer demands: www.coca-colacompany.com/sustainable-business/in-our-products/sugar-reduction
Chile’s Law of Food Labeling and Advertising: en.wikipedia.org/wiki/Food_labelling_and_advertising_law_(Chile)
2020 study of effect of Chile’s Law of Food Labeling and Advertising in PLOS Medicine: journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003015
Recent study of effect of Chile’s Law of Food Labeling and Advertising in The Lancet Planetary Health: www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00172-8/fulltext
Article on recent study on EurekAlert! website: www.eurekalert.org/news-releases/924895