The Chilean way to shape healthier food environment

In recent decades, obesity has shown a continuous rise worldwide. Chile is one of the countries with the highest rates of obesity in the Pan-American region, affecting 31% of the adult population (>15y)¹, 24% of 6-7y school c
children², and more than 10% of young children (<6y)³. Simultaneously, consumption of ultra-processed foods reach about 30% of the energy intake⁴ and sales of sugary beverages are the highest in the region⁵. Chile has arrived to the current critical situation despite several health/nutritional campaigns and individually-focused actions.

To address this situation, in 2012 the Senate approved the Chilean Law of Food Labeling and Advertising, which was implemented in June 2016⁶. This law is an innovative package of actions that focus on building healthier food environments in order to contribute to obesity prevention, especially among children. It has 3 main components that discourage the consumption of foods and beverages with high content of energy, total sugars, saturated fats and sodium, if in their processing, ingredients that increase these nutrients, are added. These foods, when prepackaged, must have (up to four) visible and easy-to-understand front-of-package warning labels stating ‘high in ’ (see Figure 1)⁷. Besides, such foods (either prepackaged or not) cannot be sold or offered for free within schools or nurseries (ie. kiosks, canteens, or school feeding programs) nor be marketed to children (ie. using channels or strategies targeted to children under 14y)^6,8.

Figure 1. Communicational campaign launching the regulation

‘Choose foods with less seals (warning labels), and even better if they don’t have any’.

Warning labels from left to right: ‘high in calories’, ‘high in saturated fats’, ‘high in sugars’, ‘high in sodium’.

The regulation provided 12 adaptations months before starting a staggered implementation in three phases, in which nutrient cutoffs became increasingly stricter over time (Table 1). This gradualness allowed the food industry to adapt by adding the corresponding seals, eliminating child-targeted strategies as characters or toys from their packages, or reformulating their products to avoid the regulation (ie. decreasing the amount of regulated nutrients).

Table 1. Staggered cutoffs for defining regulated foods and beverages in three years of implementation

The research team from the Center for Research in Food Environments and Nutrition-Related Chronic Diseases (CIAPEC), at the Institute of Nutrition and Food Technology (INTA), University of Chile, in collaboration with the Food Research Program at University of North Carolina (UNC), has been evaluating the implementation and first changes of the policy. This work is funded by the International Development Research Center (IDRC), Bloomberg Philanthropies and the Chilean Science Research Fund (CONICYT). After 6-10 months the law entered into force, over 95% of ‘high-in’ prepackaged foods were properly labeled, most children-targeted marketing strategies were removed from packages of ‘high in’ foods, and TV ads of such foods has importantly decreased^9,10.

Our studies also showed the regulation is broadly known and understood by children and their mothers, and has the ability to improve the classification of food according to their healthiness (unpublished results). Mothers have also highlighted the role of young children in driving positive changes when selecting foods¹¹. Other reports also showed auspicious results about the healthiness of school food environments and the understanding and use of the warning labels^12,13. Our preliminary results (based on about 2,000-households panel) also showed a reduction on the purchase of ‘high in’ beverages, and important improvement in the content of sugars and sodium in several food categories and beverages (ie. milks and yogurts, breakfast cereals, cheese, sausages, savory spreads, among others). According to the nutritional composition of prepackaged food on 2017, if no further reformulation or innovation of foods happened, about 60% of prepackaged products available in supermarkets would have at least one seal, which would cover about 30% of the dietary share of calories and about 60% of the dietary share of sugars in Chilean preschoolers and adolescents’ diet (based on dietary data collected in 2016).

Overall, this package of measures is one of the most comprehensive regulatory efforts to date to tackle obesity, shaping healthier food environments to make healthier options easier on a day-to-day basis. Even when preliminary results show the regulation goes in the right direction, it is unlikely that it will be enough to change the huge burden of obesity in Chile. Thus, this regulation should be understood as the first set of actions toward promoting healthier diets, which needs to be complemented with additional actions improving the food environments as establishing a zone around schools and nurseries where ‘high in’ foods cannot be sold or promoted, increasing prices of ‘high in’ foods, among others. The long-term evaluation of this package of measures is pivotal for informing Chile and the rest of the world on the success of structural measures to improve diet and ultimately health.

References

1.            MINSAL. Encuesta Nacional de Salud (ENS). Primeros resultados. 2017.

2.            Junta Nacional de Auxilio Escolar y Becas (JUNAEB). Mapa Nutricional 2018. Resumen Estado Nutricional. Santiago, Chile: JUNAEB, 2018.

3.            DEIS. Indicadores Básicos de Salud MINSAL. http://www.deis.cl/indicadores-basicos-de-salud/, 2018.

4.            Cediel G, Reyes M, da Costa Louzada ML, Martinez Steele E, Monteiro CA, Corvalán C, Uauy R. Ultra-processed foods and added sugars in the Chilean diet (2010). Public Health Nutr 2018;21(1):125-133.

5.            Popkin BM, Hawkes C. Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. Lancet Diabetes Endocrinol 2016;4(2):174-86.

6.            Ministerio de Salud, Subsecretaría de Salud Pública. LEY 20606 SOBRE COMPOSICIÓN NUTRICIONAL DE LOS ALIMENTOS Y SU PUBLICIDAD. In: Ministerio de Salud, ed. Santiago, Chile, 2012.

7.            Reyes M, Garmendia ML, Olivares S, Aqueveque C, Zacarías I, Corvalán C. The Chilean front-of-package food warning label: a stepwise development process. [under review], 2018.

8.            Corvalan C, Reyes M, Garmendia ML, Uauy R. Structural responses to the obesity and non-communicable diseases epidemic: Update on the Chilean law of food labelling and advertising. Obes Rev 2019;20(3):367-374.

9.            Mediano Stoltze F, Barker JO, Kanter R, Corvalán C, Reyes M, Taillie LS, Dillman Carpentier FR. Prevalence of child-directed and general audience marketing strategies on the front of beverage packaging: the case of Chile. Public Health Nutr 2018;21(3):454-464.

10.         Correa T, et al. Changes in the content of food TV advertising after the implementation of Chile’s 2016 unhealthy food marketing regulation: A pre-post study. . Under peer review 2019.

11.         Correa T, Fierro C, Reyes M, Dillman Carpentier F, Corvalan C. “Responses to the Chilean law of food labeling and advertising: exploring knowledge, perceptions and behaviors of mothers of young children”. International Journal of Behavioral Nutrition and Physical Activity 2019;16(1).

12.         MINSAL. INFORME DE EVALUACIÓN DE LA IMPLEMENTACIÓN DE LA LEY SOBRE COMPOSICIÓN NUTRICIONAL DE LOS ALIMENTOS Y SU PUBLICIDAD. 2018.

13.         Massri C, Sutherland S, Källestål C, Peña S. Impact of the Food-Labeling and Advertising Law Banning Competitive Food and Beverages in Chilean Public Schools, 2014-2016. Am J Public Health 2019;109(9):1249-1254.