Does Traffic Light Labelling Have the Potential to Reduce Obesity Rates in the Uk

10 October 2016

Does traffic light labelling really have the potential to reduce obesity rates in the UK? Student ID: c3256845 The current situation regarding obesity in the UK The past twenty years has seen obesity rates in the UK increase dramatically (HSCIC, 2013), resulting in the reduction and prevention of obesity becoming a major public health priority. The World Health Organisation (WHO) (2013) defines obesity as ‘abnormal or excessive fat accumulation that may impair health’ and body max index (BMI) is commonly used in the classification of overweight and obesity.

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A BMI of 25-29 makes an individual overweight and a BMI of 30 or above is classified as obese (WHO, 2013). A concerning statistic showed that in 2011 a mere 34% of men and 39% of women were defined as being a healthy weight; with a BMI between 18. 5 and 25 (NHS, 2013), compared with rates in 1993 where 44% of men and 50% of women fell into this category (HSCIC, 2013). The Health Survey for England in 2010 (NHS: The Information Centre, 2012) stated that 62. 8% of adults and 30. 3% of children are overweight or obese, with 26. 1% of these adults and 16% of these children being obese.

Obesity is a major risk factor for the development of diseases such as type 2 diabetes, cardiovascular disease, stroke, some cancers and may be detrimental to certain social aspects of life, such as finding work and can affect mental health (Department of Health, 2013). As a result of these obesity trends in 2011 it was found that approximately half of obese men and women suffered from high blood pressure and there were nearly 12,000 admissions to hospital for obesity related illnesses in 2011-2012, which had increased more than 11 times compared with figures in 2001-2002 (NHS, 2013).

In 2007, the Foresight Report (Department of Health, 2007) predicted that without action being taken 60% men, 50% and 25% children would be obese by 2050. Alongside these serious implications for health and quality of life, obesity is a growing burden on the economy; the Foresight report, 2007 predicts that by 2050 ? 9. 7 billion a year will be spent on treating obesity related illnesses (Department of Health, 2007). In addition to this costs to society attributable to overweight and obesity are predicted to reach ? 9. 9 billion by 2050 (WHO, 2013). Fundamentally overweight and obesity are caused by an energy imbalance over a prolonged period of time, where energy intake is higher than energy output (WHO, 2013). However there are societal influences which may contribute to the epidemic in the UK and globally: * Easy access of high energy and high fat foods, resulting in increased consumption. * Convenience and accessibility of fast foods and fast food outlets e. g. Mc Donald’s, takeaways which offer free delivery.

These foods are also often affordable and are commonly on offer in shops and supermarkets e. g. buy one get one free. * Low levels of physical activity due to factors such as sedentary jobs, increased car users, spending long periods of time watching television/ playing computer games (NHS Choices, 2013). What is being done to tackle obesity? The Government’s aim is to see evidence of a reduced prevalence of excess weight in both adults and children by 2020. Due to the wide range of factors which contribute to obesity e. g. ociety, family, education, income, there are different initiatives underway to tackle the problem including the ‘Chage4life’ programme, encouraging businesses to display calories on their menus and guidance on increased physical activity (Department of Health, 2013). All businesses have been encouraged to sign up to the Public Health responsibility deal, which has been designed to aid people in making healthier choices through pledges such as reducing consumption of harmful ingredients (salt and saturated fat) in food, increasing fruit and vegetable consumption and consuming fewer calories (Department of Health, 2013).

The initiative which will be focused on in this assignment is the single system for nutrition labelling, which aims to give consumers a universal system across the food and drink industry to make understanding of nutrition labels easier and consequently enable them to make more informed food choices. The Health Secretary Andrew Lansley said: ‘Offering a single nutrition labelling system makes common sense, it would help us all make healthier choices and keep track of what we eat. (Department of Health, 2012) This assignment will discuss the single system for nutrition labelling and assess the evidence base as to whether it could potentially reduce obesity rates. Front of Pack Labelling Currently the Food Standards Agency have recommendations in place regarding front of pack labelling, although this is not currently mandatory and is not consistently displayed across brands (Food Standards Agency (FSA), 2007). If anufacturers choose to use front of pack labelling four nutrients must be displayed, which are fat, saturated fat, salt and sugars; guidelines daily amounts (GDA’s) and energy content are optional. There are guidelines in place, set by the FSA (2007) to determine whether the product has a low (green), medium (amber) or high (red) amount of each nutrient which can be applied both per portion and per 100g (see appendix 1), which should be made clear to the consumer and what constitutes a portion should also be stated.

Any addition nutrition claims e. g. fibre, iron, calcium which are made should be displayed separately from the signpost displaying information on fat, saturated fat, salt and sugars and must also comply with legislative amounts. The recommendations are not applied to all food products but are applicable to foods such as processed foods and meat; prepared meals, both hot and cold e. g. ready meals, pasta salads, sandwiches, burgers, pies, breaded meats, fish in sauce, pizzas and breakfast cereals (FSA, 2007).

Currently 80% of products use a type of hybrid front of pack labeling but as it is not consistent this can be confusing for consumers to understand, compare products and consequently make informed choices on food. If the seven biggest supermarkets used the system on all their own brand foods it would cover 50% of all foods and would encourage other brands to adopt the system (Department of Health, 2012). The new single nutrition labelling system is currently being developed and it is hoped that by 2016 it will be mandatory for most pre packed foods to use the same system (Department of Health, 2012).

The new system would incorporate colour coding, percentage GDA and the high, medium and low text to display information on energy, fat, saturated fat, sugars and salt (see appendix 2) (Department of Health, 2012). The evidence base Several studies have researched different labelling systems and which is best understood by consumers. Borgmeier and Westenhoefer (2009) and Roberto et al. (2012) both found that in when compared with other labelling systems (see appendix 3 and 4) that the traffic light labelling group performed best when tested for nutrition knowledge and healthy decisions.

It was also noted that the more information consumers were given the more likely they were to make a healthy decision and had greater label perception. Unlike other studies who such as Kelly et al. (2009) used a limited selection of food types, Roberto et al. (2012) included a range of products in their study (see appendix 4) which supports that traffic light labelling is the easiest labelling system and can be generalised to a wider range of food products. However participants were recruited online, meaning those without access to the internet were not included in the study, missing a whole population.

The study conducted by Borgmeier and Westenhoefer (2009) did not record nutritional knowledge of the participants, meaning knowledge levels may have differed, influencing decisions and answers, consequently affecting the validity of results. The interviewers also recruited participants themselves increasing the chance of reporter bias and a less varied sample. Another issue with both studies was the self reporting of body weight which may have led to misclassification and issues when results were adjusted for weight. The location of both studies (America and Hamburg, Germany) limits the application of results to other populations.

In 2009, Kelly et al. compared different types of front of pack (FOP) labelling in Australian supermarkets to determine which design was preferred by consumers and also which one produced most accurate identification of healthy products. The majority participants agreed FOP labelling would be useful, especially for fat, saturated fat and salt and 90% thought consistent messages would be easier to understand. Four FOP systems were used in the study (see appendix 5), two using traffic light labelling and two using percentage dietary contribution (%DI) per nutrient based on the estimated nutrient requirements of an average Australian adult.

Results found both the traffic light systems to be significantly easier to compare healthiness of product that %DI and a consumer was five times less likely to identify a healthy product using monochrome-%DI and three times less likely using colour coded-%DI than either traffic light system. This study has numerous strengths; there was a large sample size of 790 participants, all of whom were responsible for the food shopping in their household. Dieticians, nutritionists and other health professionals who may have had superior knowledge to the general population were excluded and results were controlled for gender, age, education and income.

Mock brands were also used to reduce risk of bias towards well known brands and all other information which may have influenced the decision making process was removed from the packaging. This being said, removing information takes away other factors influencing food choice and so may not be representative of normal choice. There were only three products tested (cereal, crisp bread and lasagne) which bears the question of whether these results could be generalised to other foodstuffs. Although there was a large sample size there was a low response rate of just 15. % and so may not be representative of the population and as the study was carried out in Australia may not be applicable to other countries. There have been few evaluations of the successfulness of the traffic light labelling system. In spite of this one study that was conducted in the UK used the sales of a major UK retailer in 2007 to measure the percentage change in sales of sandwiches and ready meals before the traffic light system was introduced and four weeks later. There was no significant change in sales of sandwiches and sales of ready meals increased by 2. %, suggesting no association between sales of these foods and healthiness of product (Sacks et al. , 2009). However, this was in 2007 and now the traffic light labelling has been present in the food industry for longer, consumer are more aware and results may be more significant. This study was also carried out over an extremely short period of time and only evaluated the sales of two products, limiting the application of the findings. In order to fully evaluate the effect of the system it would be necessary to carry out a more detailed and lengthy evaluation study.

A modelled cost effective analysis carried out which estimated change in energy intake on a 10% shift in consumption of healthier foods in just 10% of adults. This was then used to calculate predicted change in weight and body mass and then applied to the effect on disability adjusted life years (DALY’s). Cost was discounted at 3%. Results found a mean weight reduction of 1. 3kg, 45100 DALY’s prevented and cost outlays of 81 million Australian dollars. However, these were based on the Australian population in 2003 which limits application to other populations and present figures on weight and cost.

In addition only four categories of food were included (breakfast cereals, pastries, sausages and pre-prepared foods) (Sack et al. , 2011). The analysis was also modelled so is a prediction rather than evidence of the traffic light labelling system being successful. On the other hand, it does suggest that a very small change would be a worthwhile financial investment by the Government. From the research studied in this assignment it appears current evidence suggests the traffic light labelling is the most effective system to understand, as ighlighted in several of the studies above e. g. Roberto et al. , 2012. Kelly et al. (2009) indicated the majority of consumers felt they would benefit from having a universal system, as it would cause less confusion when trying to compare products and make healthy choices. Although it is important to discover what the consumer wants and educate and equip them to make informed choices, the primary aim of introducing a universal FOP labelling system is to reduce obesity rates (Department of Health, 2012).

However, there is a lack of evidence suggesting that obesity rates would be reduced; it is more an assumption that this will be the case. The evaluation comparing consumer purchasing before and after the traffic light system being introduced found no significant difference, which despite being several years ago would indicate traffic light labelling does not influence consumers to purchase healthy foods (Sacks et al. , 2009). Conclusions and Implications for Public Health Nutritionists (PHN’s) There will be implications for PHN’s when the new single system of nutrition labelling is launched.

The main outcomes of the research discussed found that consistent messaging could be easier for consumers to make informed decisions on food and the traffic light labelling system is the most comprehensible. Whilst the system will be a beneficial tool for consumers to compare products and make healthy decisions, it is also essential that communities are aware of the nutrition labelling, how to interpret this and incorporate it into a healthy balanced diet.

Many of the foods which use FOP labelling are pre-prepared and processed foods (Department of Health, 2013), so it is important that communities are provided with services that will allow them to develop their cooking skills and eat fresh foods, both healthily and on a budget e. g. cook and eats, tasting sessions and neighbourhood fruit schemes, which was found to be successful in low income seniors in America (AbuSaba, 2011).

Health promotion interventions could be run to increase awareness of the health implications associated with these nutrients commonly found in processed foods e. g. fat, saturated fat, sugar, salt (NHS Choices, 2013). It is also important that communities are made aware of the other contributing factors to obesity such as lack of physical activity and are given opportunities to increase levels by participated in physical activity e. g. exercise classes in community centres, running clubs.

In conclusion, from the existing evidence it is difficult to say whether the traffic light system would be an effective obesity intervention. Evidence around the effectiveness of consumer purchasing and the traffic light system is limited and to effectively evaluate the single system of nutrition labelling it would be necessary to monitor statistics from supermarkets regarding purchasing trends and obesity trends in the UK. It would not be possible to do this until the system had been scaled out over a large area, allowing trends to be monitored for a substantial period of time.

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