Chilean food supply sees substantial decreases in sugar, sodium, and saturated fat after front-of-package warning labels required on “high in” foods and drinks

A new study published this week in BMC Medicine examining changes in Chile’s packaged food supply under the country’s mandatory front-of-package warning label law finds sweeping product reformulation to contain less sugar, sodium, saturated fat, and calories. The amount of foods and drinks in Chilean stores that would need “high in” nutrient warning labels dropped from 71% before the law in 2015–2016 to 53% after the law’s third and most strict phase went into effect in 2020.

While the proportion of “high in” products and content of concerning nutrients decreased across all food and beverage categories, researchers saw the greatest reductions in sodium in savory foods and sugars in sweet foods and beverages. Changes in products’ saturated fat content were smaller; however, researchers did find a 20+ percentage point decrease in the proportion of nuts, snacks, and savory spreads requiring warning labels for high saturated fat content. They also found a greater than 20 percentage point drop in savory baked products, breakfast cereals, and savory spreads requiring “high in calories” warning labels.

Food categories with greatest changes in “high in” nutrient or calorie content before and after Chile’s labeling law

“We know that before this law, there were almost no significant nutritional improvements in the packaged food supply,” said the study’s first author Natalia Rebolledo, PhD, assistant professor of nutrition at the University of Chile’s Institute of Nutrition and Food Technology. “We also know that voluntary labeling policies have produced minimal changes in product formulation. This study underscores how much more effective a mandatory warning label regulation can be.”

This study highlights one of several ways that front-of-package warning labels work to improve population nutrition: by encouraging the food industry to offer healthier products. Companies wishing to avoid adding warning labels to their packages have an incentive to reduce sugar, sodium, saturated fat, and calorie density in their products. Indeed, this study found that product changes increased as the regulation’s nutritional thresholds tightened with each phase.

Additionally, warning labels nudge consumers towards healthier options or portion sizes as they’re shopping or making food choices at home, and in Chile, the labels are also linked to companion policies that restrict marketing to children and ban sales or promotion in schools for any product with a warning label.

To track changes in the food supply, researchers at the University of Chile photographed thousands of packaged food and beverage products from supermarkets in Santiago, Chile every year from 2015 and 2020. They worked with researchers at the University of North Carolina at Chapel Hill to record nutrition facts panel information for these products, then analyzed how their nutritional profiles changed as the three increasingly strict phases of the Chilean labeling law came into effect.

This study is the latest in a series of policy evaluations showing improvements in the nutritional quality of Chilean’s food purchases, changes in social norms and knowledge around foods and drinks with warning labels, and significant drops in children’s exposure to harmful food marketing. Chile now serves as a model for countries aiming to combat high and rising rates of obesity and other nutrition-related diseases by improving the food environment.

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This research was supported by Bloomberg Philanthropies at part of the Food Policy Program, with additional support from INTA-UNC, INFORMAS, the International Development Research Centre (IDRC), and the ANID/Fondo Nacional de Desarrollo Científico y Tecnológico-FONDECYT Postdoctorado.

STUDY 1 AUTHORS

Natalia Rebolledo
Pedro Ferrer-Rosende
Marcela Reyes
Lindsey Smith Taillie
Camila Corvalán

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Read more in BMC Medicine

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MORE RESEARCH FROM CHILE:

Chileans bought less sugar, salt, saturated fat, and calories at the grocery store after trailblazing warning label law, with high compliance from the food industry Read more…

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Products changed, but not prices, under Chile’s Law of Food Labeling and Advertising Read more…

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Children in Chile saw 73% fewer TV ads for unhealthy foods and drinks following trailblazing marketing restrictions Read more…

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After Chile’s labeling and marketing law, drink purchases contained less sugar and more non-nutritive sweeteners, but overall sweetness stayed the same Read more…

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Study finds no negative economic impact from Chilean food labeling and advertising law Read more…

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Despite extensive product reformulation after Chile began requiring warning labels on the front of less-healthy food and drink packages, Chilean consumers saw no significant change in food and beverage prices associated with the policy in the first year and a half. This was the main finding of a new study from researchers at Universidad Adolfo Ibáñez, Universidad de Chile, and the University of North Carolina at Chapel Hill that examined price changes after the Law of Food Labeling and Advertising took effect in 2016.

After Chile began mandating warning labels on products high in calorie density or added sugars, salt, or saturated fat, some food and beverage manufacturers changed the nutritional composition of their products to avoid the label requirement. These reformulations could have led to changes in product prices in two ways, according to first author Guillermo Paraje, professor of economics at the Universidad Adolfo Ibáñez in Chile: “Reformulation could have increased firms’ costs, leading to higher prices if companies passed on the cost to consumers. Additionally, consumers may have been attracted to reformulated products without warning labels, increasing their demand and hence, their prices.”

Researchers compared prices of products with and without warning labels to a control group of products that remained unregulated (did not require warning labels) throughout the study period. They used pricing information from a large database containing prices for packaged food purchases from over 2,500 households from January 2014 to December 2017 (before and after the labeling law took effect). A team of trained nutritionists reviewed and categories all the purchased products by regulation status, i.e., whether they would be required to carry one or more warning labels. Researchers then analyzed changes before and after the law began in both levels and trends of absolute prices using the Laspeyres Price Index.

They found no significant change in prices of labeled products relative to unlabeled products. Rather, prices for both product groups continued to follow their pre-regulatory trends or changed in similar ways following the law. Researchers also compared these price changes within different “shopping baskets” or preferred foods and drinks for different socio-economic groups, and similarly found no significant differences in price changes.

“A common argument we hear from industry is that regulations like this are too costly and hurt consumers and the economy,” said senior author Barry Popkin, W. R. Kenan Jr. Distinguished Professor of Nutrition at UNC-Chapel Hill. “We see here that Chile’s law did not lead to more expensive prices on healthier options, and we’ve seen in previous studies that there was no impact on employment or wages.”

This study adds to a growing body of evidence on the impacts of Chile’s Law of Food Labeling and Advertising, which in addition to requiring front-of-package warning labels also restricts marketing for unhealthy foods and bans their sale or promotion in schools. For example, previous research has found that the policy package was associated with decreased calories, sugar, sodium and saturated fat purchased from regulated foods and drinks as well as significant drops in children’s exposure to TV advertising for regulated products. More long-term evaluations of the fully implemented regulation are expected in the coming year.

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This research was funded by Bloomberg Philanthropies.

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In a study of Colombia’s packaged foods and beverages, researchers in the Global Food Research Program at UNC-Chapel Hill found that, though the country is exploring similar food policies to those of neighboring countries Peru and Chile, Colombia’s top-selling packaged foods have seen little change in the way they are formulated.

In “Reformulation of Packaged Foods and Beverages in the Colombian Food Supply,” published Oct. 24 in Nutrients, authors examined nutritional information of top-selling products among processed/ultra-processed foods and beverages from the largest supermarket chains in Bogota, Colombia, between 2016 and 2018. While calories in beverages declined sharply, calories in food products remained relatively stable.

“Our paper highlights that, in the absence of mandatory policy regulations, very little is changing, at least among food products. Nutrition policies in neighboring countries like Peru do not seem to have an effect on the Colombian food supply, so if Colombian policymakers are concerned about the consumption of nutrients of concern like sugar, saturated fat and sodium, they will likely need to take action at the national level,” says lead author Caitlin Lowery, a doctoral student in nutrition at the UNC Gillings School of Global Public Health.

Other Gillings School authors include Barry Popkin, PhD, W. R. Kenan Jr. Distinguished Professor of nutrition, and Lindsey Smith Taillie, PhD, assistant professor of nutrition. Mercedes Mora-Plazas, MSc, of the National University of Colombia, and Luis Fernando Gómez, MD, MPH, of Pontifical Xavierian University, are also co-authors.

As part of national obesity-prevention efforts, both Chile and Peru have enacted taxes on sugar-sweetened beverages (SSB) and marketing regulations such as mandatory front-of package warning labels for products high in nutrients of concern. Though Colombia has not yet passed such policies as these neighboring countries, it shares many of the same food suppliers with those nations. Researchers sought to find whether there might be spillover effects from other countries’ policies or whether the ongoing legislative debate in Colombia might drive manufacturer reformation.

The one area where researchers saw change was in beverage formulation, with reductions in the sugar content of beverages and increase in the use of non-nutritive sweeteners. One reason is a self-regulation pledge made by several of the dominant beverage manufacturers, which Lowery says is a strategy that has been used in other contexts to avoid more restrictive government regulation.

“It may be easier for beverage companies to reformulate products from a technical perspective, as you don’t have the same concerns around product consistency or other properties that you might have with foods, and it may be that companies are more concerned about the possibility of a successful SSB tax, since that could have a more direct effect on revenue, as compared to labels or other policies.”

The study highlights the need for comprehensive policies that include mandatory regulations and laws to make substantial changes in the quantities of nutrients of concern among food products in Colombia.

Lowery notes that “passing these policies is an uphill battle. The food and beverage industry has put a lot of effort into fighting these policies.”

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A new study from researchers at UNC-Chapel Hill published today (July 29, 2020) in the Journal of the Academy of Nutrition and Dietetics examined household purchases between 2002 and 2018 and found a decline in products that contained caloric sweeteners (CS) like sugar and high fructose corn syrup, as well as an increase of products that contained NNS, which adds sweetness to products without adding calories.

“With excessive sugar consumption linked to chronic cardiometabolic diseases, sugar reduction has become an important public health strategy. This has resulted in greater innovation by the food industry and increased use of NNS in our food supply,” says lead investigator Barry Popkin, PhD, W.R. Kenan Jr. Distinguished Professor in the Department of Nutrition at the UNC Gillings Global School of Public Health.

“Types and amounts of non-nutritive sweeteners purchased by US households: A comparison of 2002 and 2018 Nielsen Homescan purchases,” is co-authored by Gillings School and Carolina Population Center (CPC) faculty Shu Wen Ng, PhD, associate professor, and Elizabeth K. Dunford, PhD, assistant professor, as well as CPC Director of Research Programming Services Donna R. Miles, PhD.

The analysis used a nationally representative dataset on household purchases at the barcode level (Nielsen Homescan) in 2002 and 2018 linked with Nutrition Facts Panel (NFP) data and ingredient information using commercial nutrition databases that are updated regularly to capture reformulations. The study found a decline in prevalence of products containing aspartame and saccharin, but a steep increase in those with sucralose (from 38.7 percent to 71.0 percent) and reb-A (from 0.1 percent to 25.9 percent).

Beverages accounted for most of products purchased containing NNS only or combined with CS. Compared to households without children, households with children are buying more packaged beverages and foods products that contain NNS. While this aligns with the public health objectives, it also raised other concerns about exposure to NNS, as their long-term health effects are still unknown.

“Considering further improvements to the nutrition facts label to include the amounts of NNS when present in products can allow monitoring of our exposure to these additives so that we can better assess their potential harms or benefits on health” says Ng.

Some observational studies have linked NNS consumption to increased body weight, type 2 diabetes, and other adverse cardiometabolic outcomes, while others have found the opposite effect, particularly when controlled for diet to focus on the impact of NNS. Results from randomized controlled trials and meta-analyses have not demonstrated any relationship between NNS and increased consumption of sweet foods. It is unclear whether the inconsistency of the findings is due to studies typically categorizing all NNS together, rather than examining differences in the effect of specific types of NNS on outcomes.

The study also showed that non-Hispanic whites purchased almost double the volume of products containing NNS compared to Hispanics and non-Hispanic Blacks throughout the study period. However, non-Hispanic Black households showed a 42 percent increase in the proportion of households purchasing beverage products containing both CS and NNS between 2002 and 2018, indicating that purchasing behavior may be changing for this race-ethnic group.

“There is a need to be able to track our exposure to specific types of sweeteners in order to properly understand their health implications,” says Dunford. “The change to the food supply that our study documents reinforces the need to develop and maintain the data systems to monitor what companies are putting in their foods. This work can help complement new and emerging clinical evidence about the different cardiometabolic and health effects of each NNS type.”

The authors are all part of the Global Food Research Program at UNC, a team that collaborates with partners across the globe to carefully evaluate food and nutrition policies and help to develop in-depth, longitudinal research on large-scale obesity prevention efforts.

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In new research published in PLOS Medicine, researchers from the University of North Carolina at Chapel Hill and the University of Chile found there were important decreases in the levels of sugar and sodium in packaged foods and beverages within just one year of a 2016 Chilean law requiring front-of-package warning labels on unhealthy foods, showing that these kinds of regulations can lead to concrete nutritional improvements of such popular products.

“Changes in the amount of nutrient of packaged foods and beverages after the initial implementation of the Chilean Law of Food Labeling and Advertising: a nonexperimental prospective study,” was published in PLOS Medicine July 28, 2020. This is the first study to evaluate the impact of any such regulation on key disease-linked nutrients, such as sugars, sodium, saturated fats and excessive calories, in packaged foods.

UNC Gillings School of Global Public Health’s Barry Popkin, PhD, W. R. Kenan Jr. Distinguished Professor, and Lindsey Smith Taillie, PhD, assistant professor of nutrition, are both co-authors on the paper and part of the Global Food Research Program (GFRP) at UNC.

In the past 30 years, heavily processed packaged foods and beverages have become increasingly available and popular all over the globe, with high levels of sugar, sodium and saturated fats – nutrients that have been linked to a higher risk of chronic conditions, such as obesity and heart disease. To confront this increasingly poor health outlook in Chile, the nation’s government implemented in 2016 a four-phase law to place warning labels on foods high in these harmful nutrients and prevent them from being marketed to children.

Researchers collected nutrient content information from more than 4,000 packaged foods and beverages available in supermarkets and candy stores in the Chilean capital Santiago before the implementation of the law and one year later.

They found significant reductions of sugar and sodium in products that had been previously high in those nutrients: most carbonated and noncarbonated sugar-sweetened beverages, milks and milk-based drinks, breakfast cereals, sweet and savory spreads, sweet baked products, cheeses, ready-to-eat meats, sausages and soups. The prevalence of products for sale with warning labels that were high in sugar decreased from 80% to 60% and such products that had been high in sodium decreased from 74% to 27%. Few products reduced saturated fats.

Not only do these findings show that the industry can reformulate the sugar and sodium in their products in response to these laws, says Popkin, it shows they have the capacity to do it quickly.

“We are seeing that these laws are working as some manufacturers begin to decrease the level of harmful nutrients in products consumed by the Chilean population, a trend which will have a positive impact on their health,” says Popkin.

With Chilean partners, researchers from GFRP, a project of the Carolina Population Center, have been evaluating the various impacts of this law at each of its phases. While previous research has shown that food reformulation is a cost-effective way to prevent non-communicable diseases that are linked to poor diet, such as heart disease and obesity, there has been little evidence to show how policies promote food reformulation without mandatory regulations and policies.

“Without rigorous and independent evaluation of these policies, we can’t know if they work, and academics, media and policymakers will not have access to information they can trust,” says Popkin. “Already Israel, Peru and Mexico have replicated the Chilean warning label law and many other countries are considering it. This publication will only accelerate this trend.”

These are findings that can be translated all over the globe as other countries facing similar issues with access to healthy foods and high burdens of disease work to improve or implement laws that can protect the health of their populations, says Taillie.

“These results are relevant not only to Chile, but all over the world. Other countries are discussing the different policies that can help them improve quality of life for their citizens and confront the obesity epidemic, and we think these findings will help them tremendously,” says Taillie.

Contacts:

Barry Popkin, PhD

popkin@unc.edu

919-619-1428

Lindsey Smith Taillie, PhD

taillie@unc.edu

312-342-9783

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Sodium reduction initiatives from industry and government have led companies to slash salt, he said, and a consumer revolt against sweetened foods and beverages has encouraged sugar cuts. As for saturated fats, he said, there is some evidence to suggest that manufacturers have used them to replace their more dangerous cousin, trans fats.

Forthcoming research from his team has also found that some foods that typically contain more saturated fats, such as savory snacks, have become more popular with consumers. The report notes that whole-milk yogurt, for instance — which contains more saturated fat — has seen a resurgence.

“They are independent trends,” he said — although he expects them to interact in the real world.

Read more from the Washington Post here.

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Sodium purchased by U.S. households from store-bought packaged foods and beverages dropped by 18% in the 15 years studied by the team. Details from the study were featured in several publications, including the Washington Times and Reuters, who quoted Dr. Poti:

“Households are getting less sodium form the grocery store, but I think it’s important to know sodium in packaged foods is still way too high,” said lead author Jennifer Poti, of the Department of Nutrition at the University of North Carolina at Chapel Hill. “So we have a long way to go.”

Read a UNC press release here, or find the full journal article here.

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It just might be the dawn of a new era in American eating. Two-thirds of us are now more likely to go for foods marketed as lower-calorie and “better-for-you,” and that means we’re finally eating fewer calories.

As we’ve reported, 16 companies, including General Mills, Kraft and Nestle, have removed 6.4 trillion calories from the marketplace. The calorie cuts — tracked by the Healthy Weight Commitment Foundation — are part of a nationwide effort to tackle the obesity epidemic.

And a new paper published in the American Journal of Preventive Medicine finds that as a results of company’s trimming calories, Americans are cutting back on salty snacks and sugary treats.

“We found that families with children cut 101 calories per day [per person] in their purchases,” researcher Barry Popkin of the University of North Carolina, Chapel Hill, tells us.

Read the articles referenced in the NPR piece, published in AJPM here (calories sold) and here (calories purchased). Access to the accompanying commentaries is available here.

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