The Lancet, Volume 382, Issue 9890, Pages 385 - 386, 3 August 2013
doi:10.1016/S0140-6736(13)61657-8 (click here for original posting)
Latin American countries crack down on junk food
While several Latin American nations have introduced healthy food laws to try to combat childhood obesity, implementation has proved trickier. Barbara Fraser reports from Lima, Peru.
Sergio Escalante got a shock at lunchtime on the first day of school this year. His school's food kiosk no longer offered the usual fare—potato crisps, cookies, sweets, soft drinks, and sandwiches dripping with creamy sauces.
“He came home and said there was nothing to eat”, his mother, Miriam González, a nurse, recalled with a chuckle. “They were selling fruit and chicken sandwiches without mayonnaise—to him, that meant ‘nothing to eat’.”
The food concession was lining up with Peru's new healthy food law, which aims to tackle the country's rising obesity rate by getting children onto a healthier diet.
Peru's law is the latest in a series of efforts by Latin American countries to tackle a public health problem that has accompanied the economic boom of the past two decades—more overweight kids and an increase in non-communicable diseases such as diabetes and cardiovascular problems.
But although several countries have passed laws, implementing regulations have lagged, and some public health experts are calling for international measures—such as the ones used to tackle cigarette sales—to counter what they say is powerful lobbying by the food and advertising industries.
Peru's law immediately drew criticism from legislators, advertisers, and even the Catholic archbishop of Lima, who said that shaping children's dietary habits was a job for parents, not the government.
But the entire country will benefit if the government can head off future health problems by reducing children's consumption of salty, sugary, and high-fat processed foods, according to Luis Fernando Leanes, who heads the Pan American Health Organization (PAHO) office in Peru.
“Being able to decrease children's exposure to these foods will mean more hospital beds free in the future to care for people with other illnesses”, he said on July 9 at a conference in Lima on public policy for promoting healthy foods.
Peru, Chile, Colombia, Costa Rica, and Brazil are among the Latin American countries with healthy food legislation. Uruguay's Senate recently approved a law and Ecuador is considering one. The Latin American Parliament, an inter-governmental group, is drafting non-binding recommendations for countries that are considering legislation.
In Latin America, efforts to redirect children's food choices have taken several approaches. Most have focused on controlling the food offered and advertised in schools. Some countries have added labelling regulations, while others have tried limiting advertising, especially on television.
In 2011, PAHO issued a series of recommendations on the regulation of marketing of food to children, in the wake of a series of studies showing that television channels in some countries bombarded children with more than a dozen ads per hour for foods high in salt, fat, and sugar.
The Peruvian law, signed by the president in May, calls for nutrition education in schools; information campaigns by the education and health ministries; a system for monitoring nutrition, overweight, and obesity among children and adolescents; healthy food in school kiosks or cafeterias; more physical activity; and controls on advertising aimed at children and adolescents younger than 16 years.
The law prohibits advertising that encourages “immoderate consumption” of food and non-alcoholic beverages that contain trans fats or high levels of sugar, salt, and saturated fat; shows “inappropriate portions”; appeals to children's naiveté or emotions; claims products are natural when they really are not; or uses testimony from real people or fictitious characters whom the children might admire. It also forbids adverts that suggest that a parent is “more intelligent or more generous” if he or she purchases a particular product.
Studies have shown the power of advertising. In São Paulo, Brazil, 85% of parents said advertising influenced their children's demands, and three-quarters said prizes or free food were strong incentives, according to a 2010 study commissioned by the Alana Institute, a Brazilian non-profit organisation that advocates for children's rights.
The Peruvian law will not take effect until implementing regulations, being drafted by a multi-agency commission, are approved. Those regulations will flesh out the details and ultimately determine how strong the law will be.
Chile passed a healthy foods law after a 5-year effort by consumer organisations, academics, and some sympathetic legislators, but the deadline for publishing the implementation regulations passed on July 6, said Cecilia Castillo, a paediatrician who works with a consumer group. “We're afraid the law may just die”, she says. “The regulations have been difficult because of pressure from large companies.”
Industry lobbying led Congress to remove some provisions before the law was approved in 2012, including a “traffic light” symbol on packages, indicating how healthy a food item is; banning the sale of junk food within a certain radius of schools, like a rule that applies to cigarettes; and a prohibition on the distribution of infant formula.
The law does require nutrition labelling and ingredient lists on packages of prepared food and calls for the Health Ministry to identify foods that are high in calories or salt and set per-portion limits on fats, sugars, and salt. Those foods cannot be advertised to children younger than 14 years, and advertisers cannot use toys, stickers, or other enticements.
Castillo called the law “the best legislation possible” but said there was little public participation in the drafting of the regulations, and the law's supporters do not know how strong they will be.
In Chile, as in Peru, food and advertising industry representatives argued that the industry could regulate itself with codes of conduct. The problem with such codes, which exist worldwide, is that “none of them is particularly strong”, says Corinna Hawkes, head of policy and public affairs for the London-based World Cancer Research Fund International. “What works are clear objectives and clear criteria” for substantially reducing children's exposure to advertising.
Countries should begin by gathering their own data about advertising that targets children and set clear standards for types of food, age groups, communication channels, marketing techniques, and labelling requirements, she says. They must also devise ways to monitor the rules they put in place.
Industry representatives must also play a part, not in drafting the rules, but in negotiations about how they will be implemented, said Ekaterine Karageorgiadis, a lawyer with the Alana Institute in Brazil. The institute, which also raises awareness about nutrition, has taken some food companies to court under consumer defence laws.
In Costa Rica, industry lawyers appealed to the country's Constitutional Court to overturn a law promoted by the Education Ministry, which limited the kinds of food available in schools. “People told us not to take on the big food industry” because of its political and economic clout, says Education Minister Leonardo Garnier. “And the pressure was strong, but both the public and the media played a role in support of the regulations.”
That backing, he said, stemmed from a growing realisation of the seriousness of obesity-related public health problems. When colleagues in Mexico warned Garnier that industry representatives would lobby for setting maximum levels of sugar and fats in a way that would allow them to sell the same product in a smaller package, Costa Rican officials based their calculations on energy density instead. “We were insistent that it wasn't a matter of package size”, Garnier said.
The court upheld the law and manufacturers began to adapt. A few months after the law took effect, one company invited Garnier to a press conference, which he attended with some trepidation. To his surprise, the company—which had had only five acceptable products when the law took effect—was launching 20 more products that complied with the new standards.
To ensure that the law is implemented properly, Education Ministry staff members are training school principals and food vendors, he said. Controlling advertising to children, which is not addressed in Costa Rica's law, may be a task for the future.
Brazil took a different approach to promoting healthy food in schools, not only setting nutrition standards, but also requiring that schools purchase locally grown or manufactured products, supporting small farmers and stimulating the local economy, according to Fabio Gomes, a nutritionist at the Health Ministry's National Cancer Institute.
Unlike Europe or the USA, where processed foods make up more than half the diet, about two-thirds of the average Brazilian diet still consists of traditional, unprocessed foods, he said. The Brazilian law reinforces that, requiring that 70% of the food served to children in school meal programmes be unprocessed—rice, beans, meat, fish, fruits, or vegetables—and 30% be locally sourced.
Health experts and children's rights advocates in Brazil have tried to win controls on advertising, but so far the efforts have been unsuccessful. “As neighbouring countries approve [regulation of advertising], it gives us hope that one day one of those measures will be approved here”, says Gomes.
For the complete Lancet Series on Maternal and Child Nutrition see http://www.thelancet.com/series/maternal-and-child-nutrition
