Need for a strong FoPL regime as a policy tool to address malnutrition in post-COVID society

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During my treatment due to COVID-19 infection in second pandemic wave, I got more conscious about the health and especially focused on nutrition (High Protein rich diet) for boosting immunity. The nutrition has helped the COVID patient for faster recovery than the normal patient getting small amount of nutritious food. During that time of pandemic people spent most of their earning on food both in rural and urban India. 

Secondly people think that packed food are more hygienic and healthier than the loose one. It increased the consumption of the packed food in India. The regular and excess consumption of foods high in fat, sugar and salt leads to obesity and is a risk factor for diabetes, high blood pressure, heart diseases and other non-communicable diseases (NCDs).

Silent killer- Non-Communicable Diseases (NCDs) are the major cause of morbidity and mortality in India. As we know, be it fresh preparations or pre-packaged food, excess consumption of food that is high in fat, salt or sugar (HFSS) are often the major risk factors for Obesity and NCDs.

Noncommunicable diseases (NCDs) are a group of diseases that affect individuals over an extended period of time causing socio-economic burden to the nation. The major NCDs share four behavioral risk factors- unhealthy diet, lack of physical activity, and use of tobacco and alcohol. Factors contributing to the rise of NCDs also include ageing, rapid unplanned urbanization and globalization.

In 2008, NCDs accounted for 5.2 million deaths in India. A rising trend in the burden of NCDs is expected in the years ahead.

Non-communicable diseases (NCDs) are medical conditions or diseases that are not caused by infectious agents. These are chronic diseases of long duration, and generally with slow progression and are the result of a combination of genetic, physiological, environmental and behavioural factors.

NCDs are one of the major challenges for public health in 21st century, not only in terms of human sufferings they cause but also the harm/burden they inflict on the socioeconomic development of the country. NCDs kill approximately 41 million people (71% of global deaths) worldwide each year, including 14 million people who die too young between the ages of 30 and 70. The majority of premature NCD deaths are preventable. According to World Health Organization (WHO) projections, the total annual number of deaths from NCDs will increase to 55 million by 2030, if timely interventions are not done for prevention and control of NCDs. NCDs are rapidly increasing globally and reached epidemic proportions in many countries, largely due to globalization, industrialization, and rapid urbanization with demographic and lifestyle changes.

Epidemiological transition ratios of the states of India, 1990 and 2016

India is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCD) surpassing the burden of communicable diseases like water-borne or vector-borne diseases, TB, HIV, etc. In India, nearly 5.8 million people (WHO report, 2015) die from NCDs (heart and lung diseases, stroke, cancer and diabetes) every year or in other words 1 in 4 Indians has a risk of dying from an NCD before they reach the age of 70. The NCDs like Cardiovascular diseases, Cancer, Chronic Respiratory Diseases, Diabetes and other NCDs are estimated to account for around 60% of all deaths, thus making them the leading causes of death. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke, hypertension and diabetes are also projected to increase over the years.

In a reportIndia: Health of the Nation’s States” by Ministry of Health and Family Welfare (MOHFW), Government of India (GOI), it is found that there is increase in the contribution of NCDs from 30% of the total disease burden- ‘disability-adjusted life years’ (DALYs) in 1990 to 55% in 2016 and also an increase in proportion of deaths due to NCDs (among all deaths) from 37% in 1990 to 61% in 2016. This shows a rapid epidemiological transition with a shift in disease burden to NCDs.

To address the rising prevalence of NCDs in India, The Food Safety Standards Authority of India (FSSAI) is actively considering a regulation for front of package labels (FoPL) for all packaged foods. There will be no better time to bring FoPL regulation in the country when COVID pandemic has brought public health including children’s health and well-being at the centre stage of the public discourse and catch the imagination of every Indian. Increasing obesity and high prevalence of NCDs among children and young population is the second pandemic the country is staring at.

During the second wave of the pandemic outbreak people got more conscious about the health and especially focused on nutrition (High Protein rich diet) for boosting their immunity. The nutrition has helped the COVID patients for faster recovery than the normal patient getting small amount of nutritious food. During both the waves of the pandemic people spent most of their earning on food both in rural and urban India.  Secondly people think that packed food are more hygienic and healthier than the loose one. It increased the consumption of the packed food in India. India became the third largest country to consume packaged food especially by children and adolescents.

Hunger and malnutrition in all its forms – undernutrition, including wasting and stunting, micronutrient deficiencies, overweight, and obesity – are major challenges that countries face and are a potential result of food insecurity and unhealthy diets along with many other factors and causes.  Undernourished women are more likely to have low-birth-weight babies who are at an increased risk of becoming malnourished as children – and into adulthood – as well as overweight or obese as adults. Maternal obesity poses short- and long-term risks for maternal and child health and wellbeing including poor cognition and increased risk of neurodevelopment disorders early in life, and an increased susceptibility to overweight in school-age and pre-school age children and obesity and non-communicable diseases (NCDs) in adult life. These diseases may lead to early death and increased morbidity and disability which require higher spending on health care, and place significant burdens on national health care systems and economies.

Malnutrition in all its forms is associated with various forms of ill health and increased mortality. Undernutrition is a major cause of death among children under the age of five years, and a source of increased susceptibility to infectious diseases and NCDs in adulthood. Overweight and obesity represent major and increasing risk factors globally for diet-related NCDs such as some forms of cancer, cardiovascular disease, chronic respiratory diseases and diabetes.

World Health Organization (WHO) states that the Front of Pack Labelling (FoPL) is a crucial policy tool for nations to provide healthier food options for citizens, and provides guiding principles and framework manual on FoPL for various regions, including the Nutrient Profile Model (NPM) for the South Asia region.

NPMs define whether a food product has excessive levels of sugar, salt and fats and state what the threshold is for each nutrient of concern. NPMs can either follow a regional WHO format or be a global best practice decided by experts free from industry influence and any kind of conflicts of interest in the country, based on the country’s nutrition guidelines/diet.

We need to create an enabling environment in shaping public discourse including government deliberation on Nutrient Profile Model and Front of Packet Labelling (FoPL) regulation. We are looking to ensure following principle in FoPL regulation in the country which helps India leapfrogging in protecting children’s health as well as support and promote healthy food products manufactured and marketed by the Food processing Industry.

(a) Front of Package Labelling should be empowering consumer with accurate information in the most lucid way and make consumer aware of food products that are high in fat, sugar and salt content.

(b) Comprise an underpinning nutrient profile model that limit high consumption of salt, sugar and fat through package food, thereby help in supporting healthy life for the public including children and young population.

A science based effective FoPL regulation shouldn’t be seen against development of a vibrant food processing industry. PVCHR firmly believes that food processing industry is an important, in-fact critical cog in the wheel needed for strong economic growth of the country. The food processing industry is very important for a nation’s economy by creating employment opportunities, generating more foreign reserve and supporting farmer’s income. We believe that FoPL will significantly help the food processing industry in the country as market or demand shift toward healthy food, this will be a unique opportunity created in India which will help leapfrogging Indian food processing industry and attract more foreign investment.

Dr. Lenin Raghuvanshi is CEO of PVCHR

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