Make the effort to meet health targets - the World Health Organization (WHO)

When you look at healthy eating trends across the world, a conflicted picture starts to emerge. On the one hand, we have more information than ever regarding what it takes to live a healthy life. The clean eating movement is booming, particularly among the wealthy and educated, and, even outside this demographic, most people in developed nations know the fundamentals of a nutritious diet.

In fact, the consumer backlash against sugar, salt and artificial ingredients is gathering momentum. This is placing the food business under pressure. “There’s probably more change today than at any time in my history in the industry,” said Kellogg chief John Bryant in a recent statement to investors.

On the other hand, chronic health conditions are surging and obesity continues to rise. According to the World Health Organization (WHO), the worldwide prevalence of obesity has more than doubled since 1980, and there are now more people globally classed as obese than underweight. No longer associated with affluence, being overweight and obesity are growing fast in lower-income nations too.

Meet WHO targets

In October 2016, Dr Margaret Chan, director general of the World Health Organization, framed the issue in no uncertain terms. Speaking at the 47th meeting of the National Academy of Medicine, she called obesity and diabetes “a slow-motion disaster”, adding that adiposity-related diseases will place an enormous burden on the healthcare system in the future.

While the causality is undoubtedly complex – Chan blamed international trade policies, agricultural subsidies, heavy advertising and politically powerful lobbies, to name a few factors – she did not let the food industry off the hook.

“The food industry resists interference from a health agency like WHO, and it has the power to do so,” she said.

Of course, if food manufacturers are partially culpable, that means they also have the power to exert change. For health-conscious manufacturers, there are clear guidelines that can be followed to help them improve consumers’ diets.

Below, we run through what WHO recommends and how the industry might help nudge consumers towards meeting these targets.

Sugar

WHO recommends that people limit their intake of free sugars to less than 10% of their total energy intake, and to less than 5% for further benefits. This equates to around 50 and 25g respectively in an average 2,000kcal daily diet.

The term ‘free sugars’ requires clarifying. WHO says it refers to “all sugars added to foods or drinks by the manufacturer, cook or consumer, as well as sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”. It does not, however, include the sugars found in fresh fruit and vegetables, or those present in milk.

“We have solid evidence that keeping intake of free sugars to less than 10% of total energy intake reduces the risk of being overweight, obesity and tooth decay,” said Dr Francesco Branca, director of WHO’s Department of Nutrition for Health and Development, when the updated guideline was announced in March 2015.

Unfortunately, in many parts of the world, average consumption far exceeds the 10% limit. It sits at around 16–17% of average intake in Spain and the UK, and a staggering 25% among Portuguese children.

WHO has suggested that one way to redress the situation might be a sugar tax, which could be applied to sugar-sweetened beverages. According to its ‘Commission on Ending Childhood Obesity’ (2014), this tax should raise prices by at least 20% in order to be effective. So far, a tax of this nature has been applied in France, Hungary, Mexico, Norway and various parts of the US, and the UK plans to implement its own sugary drinks tax in April 2018.

The UK has also released a set of voluntary technical guidelines that aim to cut sugar in nine major food categories by 20% between 2017 and 2020. If manufacturers are to meet this target, they will need to invest heavily in product reformulation.

A number of brands, of course, have already made efforts to reduce the amount of sugar in their products, substituting it with artificial sweeteners, bulking agents, nutritive sweetening agents like honey and ‘natural’ sweeteners like stevia. While this comes in part from governmental pressures, it is also driven by the consumer: a backlash against sugar is described as the top food industry trend in Mintel’s 2017 report.

Salt

WHO says that salt intake should be kept to under 5g a day (around a teaspoon), which helps prevent hypertension, and reduces the risk of heart disease and stroke in the adult population. It estimates that as many as 2.5 million deaths could be prevented every year if global salt consumption were cut to this level. In consequence, WHO member states have agreed to reduce their population’s salt intake by 30% by 2025.

At present, most people globally consume around 9–12g of salt a day, around double the recommended intake. Although some of this will be added at the table, a major culprit is processed foods (such as ready-meals, processed meats and cheese). More than 75% of the salt we eat is estimated to come from packaged and pre-prepared foods.

This means manufacturers are strongly responsible for helping consumers reduce their intake, and should consider product reformulation wherever possible. This might occur through use of low-sodium salt replacements (such as those made with potassium chloride), or simply with natural seasonings like herbs and spices.  

According to 2015 figures, 75 countries have a salt-reduction strategy in place. This may include consumer education campaigns, labelling efforts, legislative action and industry engagement, often in conjunction. South Africa, for instance, is currently phasing in legislation, while the US and UK have implemented voluntary targets.

Beyond cutting sodium (the relevant mineral in salt), WHO recommends that consumers also need to increase their potassium intake to at least 3.5g a day. Potassium, which can help counteract the effects of sodium on blood pressure, is found predominantly in fresh fruit and vegetables, and could be highlighted on food labels as consumer awareness increases. Some nutritionists have argued for mandatory potassium labeling, dubbing it “a very important public health concern”.

Fruit and vegetables

The well-known ‘five-a-day’ rule is based on long-standing WHO advice; namely, that people should consume at least 400g (five portions) of fruit and vegetables a day, excluding starchy vegetables like potatoes. WHO says this helps to reduce the risk of non-communicable diseases like diabetes and heart disease, as well as promoting an adequate intake of dietary fibre.

In February, a study by Imperial College London revealed that people should really be eating ten portions a day for optimum health, although nutritionists have slammed this recommendation as unrealistic. There is certainly a long way to go: NHS figures from 2015 suggest that just one in four adults are reaching the five-a-day target, with a similar proportion managing fewer than three.

Many countries have implemented five-a-day campaigns or similar. In Australia, people are advised to ‘go for 2 & 5’ (meaning two servings of fruit and five of vegetables a day), while Canada has run a campaign called ‘Fruits and Veggies – Mix it up!’. 

Because public awareness of ‘five a day’ is high, manufacturers may benefit from including the number of fruit and vegetable portions on their food labels. However, the consumer group Which? has called for the five-a-day logo to be banned on products that also contain high levels of salt, sugar and saturated fat.

Red and processed meat

In October 2015, a WHO advisory board made headlines around the world when it classified processed meat as carcinogenic. Red meat too was classed as ‘probably carcinogenic’ based on less conclusive evidence. More specifically, WHO’s analysis suggests that every 50g portion of processed meat eaten daily increases the risk of colorectal cancer by 18%, and that the figure for red meat may be similar.

This risk increase is relatively low, meaning WHO’s advice to governments was less than hard-hitting: “Governments may decide to include this new information on the cancer hazards of processed meat in the context of other health risks and benefits in updating dietary recommendations,” it said. However, the story caused a splash in the media and meat producers braced themselves for the impact, with the North American meat industry terming the report a “dramatic and alarmist overreach”.

Whatever the impacts on the processed meat sector, the report certainly spelled good news for manufacturers of alternative proteins. Consumer distrust for meat products is growing, with the number of vegans in in the UK nearly quadrupling between 2006 and 2016. As a result, demand for plant-based ingredients, such as algae and pea proteins, is climbing fast. 

Fat

WHO says that total fat intake should not exceed 30% of total energy intake, equating to around 67g a day in a 2,000kcal daily diet. Breaking this down further, it suggests people shift their fat consumption away from saturated to unsaturated fats, and towards eliminating trans fats altogether.

Many countries have made strides at cutting trans fats from the national diet. In the US, manufacturers have until June 2018 to remove all partially hydrogenated oils from their products, while six European countries have already taken the plunge. Various other nations, like the UK, rely on voluntary targets – a move that critics have argued does not go far enough. In 2015, the Guardian reported that an outright ban would save 7,200 lives by 2020.

Certain countries also have strategies in place for reducing saturated-fat consumption.

In 2013, the UK introduced its Saturated Fat Reduction Pledge responsibility deal, which was expected to remove over one and a half swimming pools worth of saturated fat from the nation’s diet. Participating manufacturers included Nestlé, which pledged to remove 3,800t of saturated fat from its Kit Kat bars over the next year.

For manufacturers looking to cut saturated fat from their products, it may come down to a mix of savvy ingredient swaps and the use of emulsion technologies.   

How does WHO help?

In 2013, WHO member states agreed to nine global voluntary targets for preventing and controlling non-communicable diseases. These include a 25% relative reduction in premature mortality from those diseases by 2025.

Although WHO has no direct means of influencing the food industry, it does encourage governments to reduce incentives for the food industry to continue or increase production of processed foods with saturated fats and free sugars, and promotes reformulation of food products to reduce the contents of salt, fats (saturated fats and trans fats) and free sugars.

The food industry is likely to see more pushes of this kind in future, as the burden of chronic disease continues and the complex strands of causality are teased out. For food manufacturers, subject to governmental pressures and rising consumer awareness, making their products more nutritious may ultimately be in their own commercial interests.