Stop says the red light, go says the green
By Vashni Benjamin
In a move to curb the increasing number of health problems related to nutrition, the Ministry of Health announced last week that all solid foods must henceforth be labelled with a colour-coded system, starting from 1 April.
The system introduced in 2016 to indicate sugar content in all fizzy drinks, juices, and cordials will be extended to solid food, partially-solid food, and liquid food, but this time indicating the amount of salt, sugar, and fat content. The system will follow the “traffic light” coding system with red indicating high content, orange indicating moderate content, and green indicating a healthy amount of salt, sugar, and fat in each serving.
The decision was made after consultation with many food experts and nutritionists from the WHO. The main concern behind the decision was the alarming growth rate in incidence of NCDs (Non-Communicable Diseases – cardiovascular diseases, cancers, respiratory disorders, and diabetes) within the country, with more children being vulnerable to them than ever before.
The WHO identifies NCDs as one of the biggest threats to health in 2019, with the 2030 WHO agenda labelling it the biggest challenge to sustainable development.
Apart from metabolic factors naturally present in the body, physical inactivity and an unhealthy diet are unsurprisingly the biggest contributing factors to this issue (with regards to nutrition). With the newly imposed system, the Ministry of Health hopes that people will take into consideration the nutritional value of the food they consume.
How effective will it be?
A study conducted in the US by the Massachusetts General Hospital showed a significant change in the buying habits of its consumers over a period of six months thanks to the traffic light colour-coding system.
While there is no statistical proof of whether the colour-coding system used on the fizzy drinks made any difference in Sri Lanka, many consumers have admitted that the indication of sugar content has in fact influenced the way they select their beverages, although some said that it would be hard to give up their favourites despite knowing that they were unhealthy.
Michelle, the mother of a preschooler, believes it’s an excellent idea as the simplification of the label would make it easier to teach kids, from a young age, about what’s healthy and what isn’t, in terms of basic nutrition.
Benjamin, on the other hand, a diabetic patient himself, while admitting it was a good concept, was doubtful of its feasibility. He shared: “If the manufacturers and authorities follow the regulations to the T, then it will have an impact. There is a chance that the packaging may indicate something as having low sugar content, but often has other alternative sweeteners that may end up being worse for one’s health.
“As for whether it will help Sri Lankans’ health situations would depend on the extent of the awareness created. For example, people in the urban areas will know what to look for on the packaging but will that same awareness be present in the more rural areas?”
Hayati, who thinks the system’s biggest success will be in creating passive guilt in the minds of the consumers, said that when it comes to picking favourites, she would opt for alternatives with lower sugar and salt content as long as they tasted the same.
This helped us realise that in order to really achieve the full benefits of this system, there should ideally be healthier alternatives in the market that offer consumers the same taste and quality.
Though nutritional information has long been displayed in a little chart on all food packaging, limited knowledge of its composition has meant that not many consumers are aware of the nutritional value of what they’re eating, even if they are aware of the ingredients.
Therefore, we spoke to Dr. Dheena Sadik, certified nutritionist and dietician, to find out to what extent this newly-imposed system may affect the Sri Lankan buyer’s choice.
Q. How much importance would you place on reading the labels on food before making purchases and why?
Knowing how to read food labels is important, not only if you have health conditions such as diabetes mellitus, high cholesterol, high or low blood pressure, or obesity where you need to follow a special diet, but it’s important for all individuals.
It isn’t sufficient to check only the expiry dates, as in addition to that, one needs to also understand the levels of added sugar, salt, macro (proteins, carbohydrates, fats), and micro (vitamins and minerals) nutrient content in the foods they eat.
It also makes it easier to compare similar foods to see which are healthier. The more practice you get reading food labels, the better you become in using them as a tool to plan your healthy, balanced diet.
However, individuals must also be cautious when reading food labels as sometimes they can be misleading, from the advertising perspective.
For example, “sugar free” products usually include alternate sweeteners high in calorie numbers, “diet” doesn’t necessarily mean all the nutrients are balanced, and food labelled “fat-free” food could be high in artificial additives and sweeteners in order to be more palatable to consumers.
Q. How exactly would the colour-coding system affect the way people buy and consume solid food?
It will make consumers more aware of their food, qualitatively. Culturally, we tend to spend time with family and friends enjoying sweet foods and beverages. As such, in that context, becoming more aware of the colour-coding system would mean a social shift in the way we consume food.
I have seen this shift already with several patients becoming more aware of their sugar consumption, in their daily cups of tea, for example, which is definitely a positive shift.
Q. What is the general situation regarding health and nutrition in Sri Lanka that might have prompted this decision, and how effective will this system be in curbing these problems?
With increased urbanisation leading to the lack of time to prepare home-cooked meals, we are seeing a rise in both the sedentary lifestyle and consumption of processed foods.
Despite increased awareness in nutrition among the Sri Lankan public, there is an alarming rise in obesity and NCDs in the last few decades.
Almost 80% of all deaths in developing countries are due to NCDs and Sri Lanka is no exception. According to the WHO: “In Sri Lanka, NCDs cause more than three-quarter of all deaths and nearly one in five people die prematurely from NCDs. In October, 2015, the United Nations Interagency Task Force on NCDs conducted a mission to Sri Lanka and concluded that the epidemic of NCDs has now become a serious economic as well as public health issue in Sri Lanka and is fuelled by tobacco use, unhealthy diet, harmful use of alcohol, and physical inactivity. More than one-third of adult males in the country are tobacco users. One out of three people have raised blood pressure, and a third of women are overweight. Consumption of salt is two to three times higher than recommended.”
One of the common causes amongst many NCDs is unhealthy eating habits, and therefore, becoming more aware of sugar (salt and fat) consumption through the labels will indeed be a positive move at both, individual and social levels.
Q. Is there such a thing as a recommended daily intake of sugar, salt, and fat?
The recommended daily intake of nutrients depends on many factors such as gender, age, height, diseases, pregnancy and lactation, and the individual’s level of physical activity.
A sedentary individual of a certain age and height, for example, would need a lesser caloric intake than an athlete or individual engaging in physical labour (such as manual workers).
Sugar has no nutritive value and purely contains calories and hence must be obtained from natural sources such as fruits, sugar cane, and vegetables as much as possible.
The recommended intake of salt in Sri Lanka is one teaspoon per day for adults.
The recommended intake of fats highly depends on the individual’s dietary history and physical activity levels.
Q. People who live a more health-conscious lifestyle are more conscious of their daily intake of sugar, fat, and calories. Would you encourage this behaviour in regular consumers as well? If so, why?
Anyone who would like to live a long and healthy life should be health conscious; it’s not a luxury reserved only for athletes or professions in the fitness industry.
It may seem a cumbersome task to keep track of your food quality, quantity, and timing, however, it is a skill that can be learned and implemented by anyone interested in preventing diseases.
So, I would encourage everyone to develop serious interest and take responsibility in what they eat and also incorporate regular exercise – regardless of age and history in fitness.
Q. Do you have any suggestions on how food labelling can be more effective in promoting a healthier lifestyle?
We still have a long way to go in Sri Lanka when it comes to food labelling. It’s undoubtedly a positive movement, but we are still in its infancy phase.
For example, a consumer could be misled to think a diet soda with a green or yellow label is healthier than a fruit juice with a red label, when in reality, as far as nutrients go, it’s the other way around, despite the contradicting levels of sugar in both products.
Hence, it becomes very essential for all food companies to regulate their products by having them closely monitored by qualified food scientists, nutritionists, and dieticians.
Q. Apart from being more conscious of what we buy, are there any other food habits Sri Lankans should change in order to combat the growing problem of NCDs?
Indeed. It’s none other than eating more home-cooked food and minimising the consumption of processed food. Even if it’s a simple meal, the nutritional benefits of the former almost always outweigh those of processed fast food consumed.
Be conscious of your portion sizes and minimise eating junk food as much as possible. Also, don’t forget to stay hydrated.
Get to know your nutrition facts label
This is a sample nutritional information label. They may vary from product to product.
Thanks to the tricks of marketing, many people skim through the label, read the amount of calories, and simply make their purchase. However, there other aspects that you need to pay attention to.
· The first thing is the serving size and the number of servings in the container. Though the calories may read 170 on the label, that is in fact only for one serving and since the container contains 6 servings, the total number of calories would in fact be 1,020.
· The Daily Value percentage you see on the side is a value that indicates how much the particular ingredient contributes to your daily diet. The diet generally used for reference is a 2,000-calorie diet. Therefore, if you were to consume one serving, the fats would take up 10% of the recommended intake in a 2,000-calorie diet. However, if you were to consume the entirety of this package, you would be consuming close to 60% of the recommended intake from this food product alone.
· In the fats section, the element to pay attention to is “Trans Fats”. While the saturated fat and other unlisted fats may not be harmful, trans fat is the primary cause of cardiovascular and cholesterol-related diseases.
· Calculating how much sodium you will be taking in is important as well, keeping in mind that the recommended daily intake is only one teaspoon (5.69 g).
· With carbohydrates, the dietary fibre is good for you in moderate amounts but it’s the sugars you will need to watch out for. Additionally, any carbohydrates not listed (apart from the dietary fibre) will also operate similarly to the sugars and therefore you need to be aware of the gap in the dietary fibre and sugar listed and the unlisted carbohydrates.
· Eating a good amount of protein is recommended and it is best to rely on fruits and veggies for your calcium and vitamin intake.
Dr. Dheena Sadik, MBBS
Dietetics and Applied Nutrition (University of Colombo)
Certified Dietician and Health Fitness Specialist
Skin Clinic, Bambalapitiya