“Healthy” or “unhealthy”?

Products high in sugar or saturated fat, for example, can be classified as “unhealthy”. Products low in sugar or saturated fat but high levels of fibers, for example, can be classified as “healthy”.

So-called nutrient profiling is “the science of classifying or ranking foods according to their nutritional composition for reasons related to preventing disease and promoting health”. In this regard, the contents of saturated fats, salt or sugar play a role. With the assistance of such models,  products high in sugar or saturated fat, for example, can be classified as “unhealthy”. Products low in sugar or saturated fat but high levels of fibers, for example, can be classified as “healthy”.

In the battle against the increase in obesity and chronic illnesses, such as type 2 diabetes, nutrient profiles are of central importance. The differentiation between healthy and unhealthy foods is necessary to, for example, restrict certain product advertising aimed at children or to develop health-oriented food taxes. In addition, a few countries have introduced voluntary labelling models that distinguish healthy products especially.

"Healthy" and "unhealthy foods"? Is there such a thing?

The food lobby never tires of maintaining that there is no such thing as healthy or unhealthy food: only healthy or unhealthy eating habits. The message behind it is “a calorie is a calorie: it only depends on the amount”. The truth is “a calorie is not equal to a calorie”! There is a very great difference in whether we cover our calorie needs with vegetables, fruits and whole-grain products or with French fries, ice-cream, fried sausages, chocolate, cherry cream cake and cola. Why? Because the negative nutritional characteristics (for example: many trans fats, a lot of sugar, little dietary fibres, few vitamins) outweigh the positive (calcium in ice-cream, flavonols in chocolate, vitamins in the cherries of the cake) in the latter products just named. If all foods were equally balanced or unbalanced, then dietary habits consisting only of cake, fried sausages and cola would lead to the best of health instead of to an increased risk in cardiac disease. Yet, they usually do not. In short: there are indeed "unhealthy" foods. These are namely those foods that we should not eat great amounts of. Yet, which ones? Is a cereal or a yoghurt containing 15 per cent sugar still healthy or is it "too much" sugar? Nutrition profile models exist to answer exactly these questions. 

Nutritional profiles as a precondition for health advertising

An important instrument to protect consumers from being misled is to regulate health-related advertising for foods. This is the purpose of the so-called Health Claims Regulation in the EU. Originally, the Regulation was intended to prevent that "health claims" (such as: "for your immune system") or "nutrition claims" (for example: "contains Vitamin C") mask the unhealthy nutritional composition of a product (for example: a high sugar content). For this purpose, nutrient profiles were to be introduced by January 2009 according to the Regulation. Any products not fulfilling these nutrient profiles were to be excluded from advertising with health claim messages. However, the EU failed to introduce these nutrient profiles until today, more than seven years after the deadline. That is why currently, the conceivably most unhealthy products - cola, energy drinks or confectionary products - can be advertised with health claims as soon as vitamins are added industrially. Under the pressure of the food lobby, the EU is even considering totally scrapping the profiles from the Regulation. This needs to be prevented!

Nutrient profiles to restrict advertising directed at children

Advertising directed at children using comic characters, adding free toys or prize draws count as an important influence in learning unbalanced eating habits early. During the last few years, convincing proof was presented that food advertising directed at children influences their preferences, purchasing habits and also eating patterns.  In the battle against obesity in children, WHO thus sees the restriction of marketing communication towards children as inevitable.  Numerous countries, among them Chile, the UK, Ireland, Mexico and South Korea, have started to restrict advertising with comic characters, free toys or prize draws for products high in fat, sugar or salt. These countries have been using their own respective nutrient profile models that differ in their methodology.

Early in 2015, the WHO Regional Office for Europe (WHO Europe) published a nutrient profile model to restrict children’s marketing, which can be used for a harmonised EU approach. Accordingly, for example, breakfast cereals with a sugar content of more than 15 per cent are considered unbalanced as do yoghurts with a sugar content of more than 10 per cent. Other categories, such as confectionary products or sweet beverages in general count as unbalanced and therefore should no longer be advertised to children.  The model is considered reasonable allowing only the healthiest processed products to fulfil all the criteria.

The food industry's own nutrient model is totally different. In line with the voluntary commitment "EU Pledge", the worldwide leading food companies (among them: Coca-Cola, Ferrero, Nestlé, Kellogg and PepsiCo) have committed themselves to marketing foods and beverages responsibly to children. For this purpose, the nutrient profile model developed by the industry evaluated breakfast cereals containing up to 30 per cent sugar or fatty salty chips as "balanced".  In comparison to the WHO model, the industry criteria are considered lax. 

Nutrient profiles as the basis for food taxes and fees

Besides marketing restrictions, fiscal instruments also play a central role in the prevention of non-communicable diseases.  On the one hand, fiscal conditions can be developed to motivate manufacturers of processed foods to change their recipes. On the other hand, potential tax increases on the final purchasing prices would as a rule result in a lower demand for taxed products. Potential price reductions based on, for example, subsidies could increase the demand for certain food groups. For these fiscal instruments, the following is valid: nutrient profiles are the prerequisite for introduction. 

Most government agencies that understand food taxes as a part of their prevention policies focus their efforts on sugar sweetened beverages. During the past years, among others, Belgium, Chile, Finland, Hungary, Mexico, Portugal, France, Philadelphia (USA), Berkeley (USA), the UK and Ireland have introduced special fees or taxes for sweet beverages or have passed resolutions for their future introduction.  The reason for the focus is that the most significant evidence of positive health effects is provided by a special tax on beverages.  In this case, a "simple" nutrient profile model (based on food groups) also reduces the administrative barriers. According to WHO, a regulation, however, would have the greatest effect if the amount of tax was based on the sugar content in the beverage. This way, the manufacturers would be stimulated to "reformulate" their products. However, WHO mainly recommends this approach to countries with a developed tax system. According to the WHO, public support would be higher in addition if the resulting income were tied to health programmes. 

In the opinion of foodwatch, the most convincing model up to now for a special tax on beverages was presented by the UK at the beginning of 2016. It describes what WHO considers the "gold standard". In the UK, manufacturers must pay taxes for beverages sweetened with sugar based on different levels of sugar content starting in 2018. For beverages containing 5.1 to 8 grams of sugar per 100 millilitres, the manufacturers must pay 18 pence for each litre filled; for beverages containing more than 8 grams of sugar per 100 millilitres, 24 pence must be paid. Initially, the manufacturers have, however, been given two years to reduce the sugar content in their beverages if they want to bypass or reduce the tax. The main goal of the regulation is to create an impetus to improve the recipes. Tesco, the largest food retailer in the country, has already announced plans to reduce the sugar content in their own brand beverages by 50 per cent.  The British treasury estimates income to approx. GBP 1.5 billion during the first three years. This income, however, is not planned to flow into the general national budget: it is to be completely invested in prevention programmes. The volume of sports classes for children is to be doubled and the so-called breakfast clubs are to be expanded where healthy school food is provided.

Conclusions: Nutrient profiles are essential in the fight against excess weight and chronic diseases. Without differentiating between "healthy" and "unhealthy" foods, numerous important instruments cannot be implemented. The specific criteria can - if a model is weakly designed - considerably water down supportive regulations and even render them ineffective as the example EU Pledge shows. From foodwatch's point of view, nutrient profile models must therefore adhere to strict criteria and respectively only distinguish the healthiest products. In regard to marketing restrictions as well as binding labelling regulations, an EU-wide harmonised approach is necessary due to the EU common market. To restrict advertising aimed at children, WHO Regional Office for Europe has presented a highly suitable model. From the point of foodwatch, this model could also be applied to restrict health-related advertising for foods.