Toss out the junk food, bring back the healthy food plate

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India, like in many other countries, is undergoing a major "nutrition transition". In what characterises rapidly changing dietary patterns, there is a significant shift away from traditional diets, which were high in fibre and comprised mostly whole foods, to more western-style diets, which are processed and high in calories. This change has coincided with rapid economic progress and urbanisation along with a surge in the consumption of packaged and processed foods (popularly called "junk foods"). These foods are nutritionally low in vitamins, minerals, fibre but are high in calories, fats, salt, sugar, and innumerable preservatives. Categorised as high in fats, salts and sugars (HFSS) foods, scientific evidence shows how junk food has been medically found to weaken the body's defences against infection, increase blood pressure, lead to a spike in blood sugar, cause weight gain, and also contribute to increased risk of cancer. Often packaged as comfort foods in India, examples of such junk or HFSS foods include cookies, cakes, chips, namkeen, instant noodles, sugary drinks, frozen meals, canned fruits, Indian sweets, and bakery products. It should come as no surprise that India is experiencing an explosion of lifestyle diseases, with unhealthy diets being one of the single largest contributing factors. To put the magnitude of the health burden into perspective, an Indian Council of Medical Research (ICMR) study published in 2023 estimates that in India the prevalence of metabolic disorders is glaringly high where 11% has diabetes, 35% is hypertensive and almost 40% are suffering from abdominal obesity.

A significant factor to consider while analysing the evolving dietary habits of Indians is the influence of aggressive advertising to promote "tasty" and "affordable" comfort foods, particularly aimed at younger consumers. According to a pan India survey conducted by the Centre for Science and Environment (CSE), 93% of children ate food that was packaged, 68% drank packaged sweetened beverages more than once a week, and 53% ate these foods at least once a day. At the same time, the ultra-processed food industry in India has expanded at a compound annual growth rate of 13.37% between 2011 and 2021. Moreover, India's food processing industry is predicted to be worth $535 billion by 2025-26.

Court's concern

Coming to the steps that have been taken to protect consumers from unhealthy foods, a ruling by the Supreme Court of India, in 2013, offers a constitutionally sound place to begin. The Court said, "We may emphasize that any food article which is hazardous or injurious to public health is a potential danger to the fundamental right to life guaranteed under Article 21 of the Constitution of India." Recognising the need to promote people's health and well-being, the Government of India has prioritised the promotion of healthy foods and an active lifestyle through its initiatives such as Eat Right India, the Fit India Movement, and Prime Minister's Overarching Scheme for Holistic Nutrition (Poshan) 2.0.

As children are more exposed to the advertising of unhealthy foods, the Food Safety and Standards Authority of India (FSSAI) released the Food Safety and Standards (Safe food and balanced diets for children in school) Regulations, 2020, restricting the sale of HFSS in school canteens/mess premises/hostel kitchens, or within 50 metres of the school campus. Recently, the National Commission for Protection of Child Rights also issued notice to a health drink giant to evaluate and withdraw all misleading advertisements, packaging and labels that brand the product as a "health drink", citing the product's high sugar content that can adversely impact the health of children.

Despite a policy intention to provide a safe food environment, there is still much work that needs to be done in ensuring effective implementation of interventions that can have an impact on the consumption of junk foods. Here are four strategies that hold the key to translating policy intention into meaningful change on the ground.

Formulate a clear definition

First, a good starting point for the government is to protect growing children from the harmful impact of junk foods. While the FSSAI has released regulations for restricting the consumption of HFSS foods, currently, there is no way to "define" or "identify" which foods fall into the category of HFSS foods. Thus, it is imperative that as the next step, the FSSAI goes ahead and "defines" what exactly constitutes HFSS foods in the Indian context which can enable better implementation of food safety regulations. Moreover, institutions such as the National Commission for Protection of Child Rights can play an instrumental role in ensuring stricter compliance of school food regulations.

Second, Front-of-Pack Labelling (FOPL) appears to be a low-hanging fruit which can enable consumers to make informed choices about what foods they choose to eat. Currently, we have access to a mathematical nutrition table in small print on the back of food packets which most of us neither notice nor comprehend. For instance, the next time you open a package of chips, are you going to sit and calculate how much salt are you consuming in a packet when the label states that there are xx micrograms of sodium per 100 grams?

As an alternative, a "warning label" that states "high in salt" on the front might make more sense, particularly if you are a hypertensive patient. The latter example is an illustration of a front of package nutrition labelling practice that draws one's attention with clear and understandable signals that can help you make an informed food choice.

The Indian Nutrition Rating (INR), where packaged food products would be given a star rating based on the overall nutritional profile of the product, is in fact included in the most recent draft of the Food Safety and Standards (Labelling & Display) Amendment Regulations, 2022. However, there are a number of concerns here. Above all, star ratings will give producers a clear escape route: they may add one or two healthy components to raise the overall star rating while still selling unhealthy foods that are dangerously high in fat, sugar, and salt. Moreover, regulations are voluntary until a period of four years from the date of final notification of the regulations.

Have subsidies for healthy foods

Third, policies can also be developed to facilitate the positive subsidies for healthy foods such as whole foods, millets, fruits and vegetables that will improve their availability, affordability, and thus greater consumption in rural and urban areas. The question for policymakers is how to make a fruit more affordable than a ₹5 high salt chips packet and ₹2 high sugar biscuits.

Fourth, in addition to the policies, a behavioural change campaign targeting children and young adults alike can play a critical role in helping youth adopt healthy dietary habits and mindful eating practices. This can include multimedia messaging on the health impacts of junk foods; campaigns building on "vocal for local" which promotes local and seasonal fruits and vegetables and traditional foods such as millets; and interactive discussions on balanced diets and tapping into social media influencers to mainstream conversations about the health risks of junk foods.

It is critical to acknowledge the urgency of switching to healthier diets and creating public demand, or, as Prime Minister Narendra Modi calls it, a "Jan Andolan" or people's movement, for healthy and nutritionally diverse diets. These efforts must be accompanied by sincere policy interventions that help Indians exercise their right to make informed food choices.

Ananya Awasthi is a public policy researcher and founder-director at Anuvaad Solutions, an accelerator for translating scientific evidence to inform policy action on India's nutrition agenda. Apoorva Kalra is a public health nutrition expert and manager at Anuvaad Solutions