Europe Must Act to Nip Obesity in the Bud, but the Devil’s in the Details

Europe Must Act to Nip Obesity in the Bud, but the Devil’s in the Details

If Europe was still in doubt that it needs to curb its rising obesity rates, the coronavirus pandemic has put renewed emphasis on the deadly consequences of excess weight. Obesity is starting to emerge as a major aggravating factor for COVID-19. A staggering 83% of coronavirus patients in French intensive care units were overweight or obese. It’s a trend that’s been borne out in other European countries: 73% of British ICU patients were overweight, while these heavier coronavirus patients were less likely to recover after their stint in the hospital.

It’s unclear whether this comorbidity can be chalked up to obesity in and of itself, or whether overweight patients are suffering more severe complications from COVID-19 because they are more likely to have other health problems, such as hypertension or diabetes. Researchers have suggested that, once the situation with the pandemic stabilises, added pressure should be put on the food industry to manufacture healthier products.

Their call doesn’t seem to have fallen on deaf ears. On April 14th, almost 40 civil society organisations published an open letter urging the European Commission not to delay the publication of the EU’s Farm to Fork strategy. The organisations argued that the pandemic makes it even more critical to ensure that European consumers have broader access to healthy, environmentally sustainable food.

If most European policymakers and public health experts are confident that fighting obesity needs to be a priority, there’s less consensus on what tools should be deployed in the battle. A particularly thorny issue is how to modify food labels to showcase the nutritional information which could help consumers make healthier choices.

It’s clear that current nutritional labels aren’t working for most shoppers. Research has shown that consumers find the plethora of information available on a typical label confusing, and struggle to interpret vague phrasing like “reduced sodium”. In one study, for example, people consistently overestimated the nutritional value of foods described as “high fibre” on their packaging.

The EU is working towards adopting a front of package (FOP) labelling scheme which would present nutritional information in a more simplified manner. Crafting FOP labels which are easy to read and yet give consumers a picture of the nutritional value of their food which is accurate enough to help them make healthy choices, however, has proven tricky.

France has managed to convince several other countries to adopt its Nutri-Score system, which distills a range of elements—from the calories in 100 g or 100 mL of any given food, to the quantity of fibre or sugar—into a single “grade”, ranging from A to E. These letter scores are also colour coded, to drive home the consumer’s impression that an “A” or “B” product (shaded in green) are healthy choices, while an orange “D” or red “E” seems to signal an unhealthy food.

Politicians such as German Food and Agriculture Minister Julia Klöckner are hoping that the fear of getting a “bad grade” under the Nutri-Score system will push companies to lower the amount of sugar and salt in their products. It’s not clear how likely this is, however. Nutri-Score’s categories are so broad that it’s difficult to achieve a change in score, meaning that manufacturers have little incentive to roll out healthier versions of their products.

What’s more, merely having less sugar or less salt doesn’t necessarily make a food healthy. The very simplicity that Nutri-Score’s advocates have cheered is one of its fatal flaws. The overly reductive approach has led to surreal scenarios where a meal made up of schnitzel, French fries and a diet soda—not what public health officials would consider a healthy choice—gets stamped with a light green “B”.

Meanwhile, the choice to calculate scores based on quantity of ingredients per 100g or 100 ml works fine for products actually consumed in those quantities. For foodstuffs like olive oil, however, the system’s critics argue its shortcomings are on full display. Extra-virgin olive oil earns an orange D because of its fat content per 100 ml, despite the fact that olive oil is virtually never used in such large quantities.

The olive oil issue points to a wider concern which has thrown a wrench in some MEPs’ efforts to promote Nutri-Score as an EU-wide scheme. Nutri-Score’s formula has been accused of unfairly penalising the Mediterranean diet, which has repeatedly been lauded as one of the best ways to curb obesity.

Alarmed at the possibility that overly reductionist systems like Nutri-Score could steer consumers away from traditional products like olive oil and Parma ham, Italy has proposed an alternative system, Nutrinform. The scheme replaces Nutri-Score’s coloured letter grades with a battery icon similar to those showing how much electronic devices have been charged.

Instead of Nutri-Score’s single assessment, which is supposed to represent all the nutritional elements in a product, the Italian labels include five “batteries”: one for calories, one each for saturated and unsaturated fats, one for sugar, and one for salt. By looking at how “charged” each battery is, consumers can see how a product fits into the overall balance of their diet.

For many products, the battery system and Nutri-Score present a radically different picture to consumers. Prosciutto di Parma, for example, gets a red E under the Nutri-Score scheme because of the salt used to cure the ham. The battery system, meanwhile, shows that while the product’s salt levels are indeed elevated relative to other nutrients, each serving of prosciutto only represents 20.5% of recommended daily intake—and low levels of other elements, such as 0% of sugar.

In many ways, the FOP labelling debate mirrors broader issues facing European policymakers determined to tackle obesity. Just as a single-minded focus on sugar or salt content fails to capture the nutritional value of foodstuffs, there’s no simple, one-size-fits-all solution to the problem of obesity. Rather, it requires a holistic approach, addressing diet, exercise, and psychological factors. What’s clear is that Europe needs to decide upon the elements which make up that holistic approach and put them into place as soon as the current health crisis is under control.

Image credit: Van Dung Nguyen/Pixabay

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