Whether you are placed on a ventilator or not, spending any time in intensive care can be traumatic. Even the most mentally strong might find it difficult to grapple with the longer-term impact such an experience can result in, both emotionally and physically. Thankfully, for most of us, such contemplation would likely be a hypothetical one.

However, for UK Prime Minister Boris Johnson, such a scenario became a reality. As Covid-19 began its march around the world, landing on the shores of the UK at the end of 2019, it quickly began to lay roots with community transmission across the country. Just a few months later and Johnson was himself admitted to hospital. Thankfully his journey, while no doubt frightening, did not result in the fatal tragedy so many others faced.

It was an experience that arguably fundamentally changed his life. By mid-summer, he was sharing videos of him running and stories of how his encounter with Covid-19 had offered him the opportunity to evaluate his lifestyle, including his diet. In the knowledge that less healthy people were more susceptible to serious complications from the disease, Johnson announced he wanted to help people bring their weight down, but “not in an excessively bossy or nannying way, I hope”.

Trans fats linked to coronary heart disease

If Johnson’s story tells us anything, it is that while Covid-19 has brought much pain and suffering it can also be the foundation to change our thinking and our lifestyles. Health has never before been so collectively important and part of people being healthier is eating more healthily. Rooting out the bad in diets is fast becoming the mission of individuals, policymakers and industry alike and so it should, as the facts speak for themselves.

If one was to look at the impact artificial trans fats alone are having, they would be forgiven if they shuddered with concern. Globally, according to figures from the World Health Organisation (WHO), almost 18 million people die each year as a result of cardiovascular disease – nearly a third (32%) of all deaths. According to the US Centers for Disease Control, one person every 36 seconds dies from cardiovascular disease in the US alone. It is fair to say trans fats are not responsible for all those deaths, but globally the WHO estimates that intake of trans fats accounts for approximately 500,000 premature deaths from coronary heart disease each year.

“Trans fats are unsaturated fats with a specific molecular shape – a trans arrangement of the two hydrogen atoms either side of a carbon double-bond – that has been shown to cause significant risk for cardiovascular disease,” explains James Stevenson, senior research fellow and member of the Consultative Group on International Agricultural Research (CGIAR) Standing Panel on Impact Assessment. It is true to say that some trans fats are produced naturally and can make it into our diet, but Stevenson asserts artificial ones were prevalent in Western diets by the end of the past century.

Stevenson discussed in great detail their development over the past century or so. An expert in the field, he was particularly good at describing what trans fats were in terms many of us would understand. According to Stevenson, Procter & Gamble was the first company to develop artificial products and labelled it “a miraculous new product, a completely new consumer category superior to, and healthier than, animal-sourced fats such as butter or lard”. It was a campaign, he adds, that was hugely successful in the 1910s and 1920s, influencing how food was prepared in the US and beyond.

Although concerns relating to the impact they had on human health were raised some 50 or so years later, it was not until the late 1980s and early 1990s that any genuine attention was paid to them.

“It was not until the field of nutritional epidemiology had developed – based on careful data collection from the same subjects over an extended period of time – that researchers were really able to tease out patterns of excess mortality and morbidity associated with components of diets,” Steveson says. Thanks to this, the following years saw growing pressure for changes to our diets, first in Europe and then the US.

A policy toolkit to tackle trans fats

Understanding of the dangers of trans fats is even further advanced today, but they still play a part in people’s daily dietary intake; a truth that is becoming harder to fathom and accept, particularly given the data spoken of earlier.

“Simply put, cardiovascular diseases are the leading cause of global mortality, so the stakes are really high,” he adds. “Trans fats are a double-whammy for cardiovascular disease risk because they raise levels of LDL cholesterol – the ‘bad’ form of cholesterol – and lower the ‘good’ HDL cholesterol.”

So, how can the industry get away from their use? That is a very complex question requiring a multifaceted response. The WHO, however, believes it has one that even has its own mnemonic – REPLACE.

REPLACE is a package the WHO says comprises an overarching technical document that provides a rationale and framework for an integrated approach to the elimination of trans fats. Put simply, the organisation says it contains six elements:

  • Review dietary sources of industrially produced trans fats and the landscape for policy change.
  • Promote the replacement of industrially produced trans fats with healthier fats and oils.
  • Legislate or enact regulatory actions to eliminate industrially produced trans fats.
  • Assess and monitor trans fat content in the food supply and changes in trans fat consumption in the population.
  • Create awareness of the negative health impact of trans fats among policymakers, producers, suppliers and the public.
  • Enforce compliance with policies and regulations.

The guidance is available online for policymakers, industry or anyone else who is interested. It provides resources that can be used to formulate policy and industry-wide plans to help cut and then eliminate the use of trans fats from products, kitchens and ultimately our diets.

Educating the public while finding alternatives

One of the challenges is to promote healthier decision-making, which is not easily done in a population that largely does not understand the correlation between trans fats and ill health. This, however, is where Stevenson’s vision can help.

Speaking of partial hydrogenation, the process of producing trans fats, he says: “This hydrogenation can be continued all the way to complete saturation, resulting in a solid fat that has a really hard, soap-like consistency. It is, therefore, no coincidence that some of the first experiments to commercially hydrogenate oils were carried out by soap makers.”


The proportion of all deaths recorded globally related to cardiovascular disease and illness.


The idea that partially hydrogenated oils can resemble soap evokes an image reminiscent of the anti-smoking campaign on UK television screens in the early 2000s, which tried to portray the impact smoking has on the cardiovascular system and arteries. The promotion – which included fat dripping from the end of cigarettes people were smoking – was widely applauded by health groups.

“I hope that a trend of increasing consumer awareness will continue, which pressures governments to introduce mandatory limits on trans fat contents of foods.”

James Stevenson

According to Stevenson, partially hydrogenated, soap-like fats play different functional roles across different food products. For example, they can be used to prolong shelf life, act as deep-frying oils or as a fat in baked goods. “Finding a suitable trans-fat- free substitute will depend on the role that partially hydrogenated oil plays,” Stevenson says.

There are, however, replacements in development, with palm oil and inter-esterified fats as two examples, but they come with their own issues.

“The cultivation of oil palm causes extensive loss of biodiversity-rich rainforest ecosystems and palm oil is dense in saturated fat. Inter-esterified fats have unknown health impacts. It’s one that health researchers are just starting to keep an eye on,” Stevenson explains.

Time to force trans fats out?

Thankfully, food manufacturers and retailers have done a lot to help reduce the levels of trans fats either contained in their foods or used as part of the cooking process. International regulators, like the US FDA, have regulated to help reduce their usage and educate the public on the dangers.

Echoing Stevenson, the American Heart Association (AHA) says that, before 1990, very little was known about how trans fats could harm people’s health. It adds that the FDA has since instituted labelling regulations for trans fats and consumption has decreased in the US in recent decades.

“Read the nutrition facts panel on foods you buy at the store and, when eating out, ask what kind of oil foods are cooked in. Replace the trans fats in your diet with monounsaturated or polyunsaturated fats,” the AHA advises.

While this is widely known and understood within the food and beverage industry, raising that awareness among the general population has now become the challenge – one the WHO is attempting to take on.

“In 2013, Dr Shauna Downs of Rutgers University led a study of the scientific evidence on the impact of policy action to reduce trans fat consumption. They found that a range of different policy approaches reduces trans fats in foods but that bans are ‘likely to be the most effective, economical, and equitable approach’,” Stevenson says. “Simply put, it is hard for consumers to interrogate the content of foods, or different labelling schemes, in order to make healthy choices.”

While he accepts that promoting healthier fats and oils is a “laudable component” of the WHO’s REPLACE package, promoting regulatory actions that limit trans fats to very low levels consistent with lower cardiovascular disease risk is also critical.

“I hope that a trend of increasing consumer awareness will continue, which pressures governments to introduce mandatory limits on trans fat contents of foods,” he concludes.

With regulators continuing to focus on the use of trans fats in products and their preparation, and the industry adopting positions that aims to cut them too, the next frontier has to be in the kitchens and dining tables of homes and businesses the world over. The question now is, can policy and reformulation do that or is more still needed? REPLACE might be just the beginning.