A recent report published by theUK innovation agency for social good (Nesta) showed how reducing the 216-calorie intake in the daily diet of overweight or obese people would halve obesity by 2030 in England. (1)
The study is part of the ‘Healthy Living’ mission, which aims to increase the number of years lived in health. The research also identifies current barriers that need to be addressed to achieve this goal. Further progress is currently needed to make a healthier diet more accessible to all.
Introduction
Excess weight (or high BMI) has been identified as the third leading risk factor for death and disability in the UK in 2019 (2). High blood pressure, type 2 diabetes, heart disease, stroke, and cancer are all diseases related to obesity and diet (3,4).
Obesity rates have nearly tripled since 1975, and today more than 650 million people are obese.
The World Obesity Federation predicts that at this rate the number of people with obesity could rise to 850 million by 2025, increasing deaths related to noncommunicable diseases (NCDs, Non-Communicable Disease). (5) A failed outcome also with respect to Sustainable Development Goal (SDG) 3.4 (reduce deaths from NCDs by one-third), which would slip by more than five years, compared to the 2030 deadline. (6)
The social responsibility of obesity
About 40 percent of the foods we buy are high in fat, salt and sugar (HFSS) (7), leading us to consume additional calories with little nutritional benefit and increasing the risks of excess weight.
Reformulation can contribute to the reduction from obesity by directing consumers’ purchasing choices toward healthier alternatives. This would also impact the reduction of health care costs caused by diet-related diseases, which affect significantly.
In fact, a study in 2022, estimated that the annual cost of obesity to UK society was about £54 billion. (8) Reducing the incidence of obesity is not only an individual responsibility but primarily a societal one. (9)
Nesta’s report
Research on‘The future of food: opportunities to improve health through reformulation‘ showed that to reach the goal of halving obesity by 2030, one would have to eliminate the following from the daily diet on average
- 165 calories for men and 115 for women, in the generality of the healthy adult population,
- 222 calories for women and 307 for men in obese individuals,
- 216 calories for overweight people.
Targeted measures, such as reformulating foods to reduce their calorie intake, would achieve up to one-fifth (18%) of the goal of halving the incidence of obesity in the UK by 2030.
Food categories to be reformulated
Reformulation is the process of using new ingredients, changing recipes, or food and beverage production processes.
The categories of foods to be reformulated for calorie intake reduction were identified by creating three indicators for deciding whether a product should be reformulated:
- Impact on diet: the volume of calories purchased and consumed within these categories in the population.
- Feasibility of reformulation: metrics that indicate whether reformulating a product is commercially and technically feasible, including the variance in caloric density within a category (e.g., of other products within that category that have a caloric density, thus showing the possibility of creating similar products with a lower caloric content).
- Inclusion: to understand whether reformulation of certain products or categories can have a greater or lesser impact on groups in society, particularly the most disadvantaged.
Barriers and opportunities
The report also highlights the main barriers and opportunities related to the implementation of the reformulation plan:
1. Reformulation should affect those product categories with the highest caloric intake
Most of these categories come under the name of ‘discretionary’ foods, that is, foods that contribute little to the nutritional value of people’s diets.
Reformulating these foods (Fig. 1) to reduce their respective calories by 10 percent would result in a median reduction of 38 calories per day. This would result in 1 billion daily calories in the entire population. An average reduction of 38 calories per day would save about 300,000 healthy life years (a QALY is one year of perfectly healthy life) over 25 years in the entire population.
2. Low-calorie options are not always available and affordable to all consumers
Reformulated products are usually offered at a higher price than the higher-calorie alternative, which leads the consumer to have to choose between cost and health. Also, very often reformulates are not available in smaller outlets.
3. A ‘level playing field’ is needed throughout the food sector
The lack of transparency, accountability, and a level playing field in the food sector makes it difficult to assess progress and identify good or poor performance. There is limited public data available, targets are voluntary, and there is no single body responsible for the entire food supply chain.
Robust, accurate, and up-to-date data on sales and health or nutritional metrics should be the basis for allowing accurate monitoring of changes to products and for targeting regulation to those food categories where more progress could be made. In addition, there is a lack of collaboration and knowledge sharing within the industry prevented by inter-firm competition.
4. The risk and initial investment
The risk also associated with the initial investment required for industry to prioritize reformulation for health, without a level playing field, is a significant obstacle.
Reformulation involves initial investment, such as upgrading production equipment or sourcing new ingredients, and long time to devote to the process.
Being able to state on the label that a product is reduced in sugar and fat (10) also requires a 30 percent reduction from the initial content. For some HFSS products, this is not possible. This limits the motivation to make products healthier.
Incentives for industry to reformulate are limited. Fiscal and non-fiscal support (regulation) to industry is critical to enable it to prioritize reformulation.
The recommendations for achieving the goals
Reformulating particularly caloric foods and reducing salt, sugar, and fat levels is an area where the food industry can proactively contribute to dietary improvement.
To this end, possible implementations are outlined for each stakeholder:
- Set calorie reduction targets for specific categories of foods that contribute most to excess calorie consumption, along with incentives such as research and development credits from the government.
- Lead through a designated institution reformulation efforts, with statutory powers to design, establish and monitor calorie reduction targets by manufacturers and stores, with the power to impose fines if targets are not met.
- Create a collection of sales data from all retailers, including major supermarkets, to publicly rank stores on their progress in making healthier food categories and to provide consumers with more information about the healthiest supermarkets.
- Offer the reformulated product for the identified categories as the only alternative or at least as the cheapest, rather than creating two levels of products.
To achieve a successful outcome, the maneuver must be implemented through concerted action with various actors, as obesity is a political, health and social responsibility, not just an individual one.
Giulia Pietrollini
Notes
(1) Nesta(UK innovation agency for social good). The future of food: opportunities to improve health through reformulation https://www.nesta.org.uk/report/the-future-of-food-opportunities-to-improve-health-through-reformulation/ Gift (Great Italian Food Trade) 23.1.23
(2) GBD 2019. Risk Factors Collaborators (2020) Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30752-2/fulltext
(3) Marta Strinati. Preventing and treating obesity and overweight for cardiovascular health. GIFT (Great Italian Food Trade). 3.9.22
(4) Sabrina Bergamini, Dario Dongo. Obesity, childhood obesity, and marketing. WHO Europe 2022 Report. GIFT (Great Italian Food Trade). 16.6.22
(5) Dario Dongo and Andrea Adelmo Della Penna. Italy, overweight and obesity in adults and the elderly. ISS studies. GIFT (Great Italian Food Trade). 8.1.22
(6) World Obesity, COVID-19 and Obesity: The 2021 Atlas. https://www.worldobesityday.org/assets/downloads/COVID-19-and-Obesity-The-2021-Atlas.pdf. 03.21
(7) Kantar (2021). Competing effectively in an HFSS- regulated world. https://www.kantar.com/uki/inspiration/fmcg/2021-wp-competing-effectively-in-ahfss-regulated-world
(8) Nesta (2022), Modeling ways to improve our health. https://www.nesta.org.uk/project-updates/modelling-ways-to-improve-our-health-what-wouldbe-required-to-half-obesity
(9) Marta Strinati. Sugar tax. Fewer 5,000 cases of obesity among British girls. GIFT (Great Italian Food Trade). 28.1.23
(10) Diabetes UK (2022). Understanding Food Labels. https://www.diabetes.org.uk/guide-todiabetes/enjoy-food/food-shopping-for-diabetes/understanding-food-labels.
Graduated in industrial biotechnology and passionate about sustainable development.
