In view of the rising incidence of high blood pressure, diabetes, obesity among Indians, which aggravates the COVID- 19 risk among people suffering from these morbidities, health experts have called for introducing front-of-package labels (FOPL) on ultra-processed food items to check non-communicable diseases (NCDs).

Addressing a virtual media round table on “Why Getting FOPL Label Right is Critical for IndiaÂs Obesity and Diabetes EpidemicÂÂ here on Thursday, the global experts said that FOPL warning labeling would reduce disease burden and promote healthier lives by enabling consumers to identify in a quick, clear and effective way, products which are high in sugar, sodium, saturated fats, trans-fats and total fats that are responsible for the high NCD burden. The media roundtable was organized by Consumer Voice and Global Health Advocacy Incubator. 

      India is nearing a health flashpoint with 135 million obese people, the experts pointed out. Nearly 5.8 million people or 1 in 4 Indians are at a risk of dying from an NCD before they reach the age of 70. Disease burden of NCDs increased from 30% Âdisability-adjusted life years (DALYs) in 1990 to 55% in 2016, with deaths due to these conditions increasing from 37% in 1990 to 61% in 2016. Cardiovascular disease (CVD) accounts for at least 27% of NCD deaths. Untreated and uncontrolled hypertension contributes to an estimated 1.6 million deaths annually in India  57% of these deaths related to stroke and 24% related to coronary heart disease. India is also fast becoming a diabetes and cancer hotspot. This crisis is being further aggravated by the COVID-19 pandemic, as persons living with NCDs face a greater risk of becoming severely ill or dying from COVID-19.

    All of these conditions such as high blood pressure, high fasting blood sugar levels and obesity are closely linked to unhealthy diets, and an excessive intake of sugars, total fats, saturated fats, trans-fats and sodium. In turn, the excessive intake of these Ânutrients of public health concern is largely driven by the widespread availability, affordability and promotion of processed and ultra-processed food products with unhealthy nutritional profiles. Reports indicate that the COVID-19 pandemic generated a unique opportunity for the food and beverage industry to thrive in low- to middle-income countries and expand their market of unhealthy, ultra-processed foods and sugary drinks.

In 2018 the Food Safety Standards Authority India (FSSAI) had published draft regulation for FOPL which was subsequently withdrawn for further deliberation. In 2019 December, FSSAI delinked FOPL from general labelling regulations and is currently seeking consultations with civil society, industry and nutrition experts for a viable model for India.

    Dr Chandrakant Pandav, president, Indian Coalition for the Control of Iodine Deficiency Disorders (ICCIDD), warned that there is no time is to be lost as India is facing silent emergency due to very high incidence of diabetes and obesity. To check the emergency, FOPL is very important. ÂIt is clear as day that our food environment needs to change drastically if we are to reverse the health crisis and safe guard our future generations. Even as we move to fortify our food, arming people with information regarding nutrients like high concentration of salt, sugar and fats, is an equally important strategy.Â

   A strong front-of-package label is one of the most efficient tools of influencing consumer behaviour to alter dietary choices and reduce their vulnerability to NCDs, according to Dr Barry Popkin, the W. R. Kenan Junior distinguished professor of nutrition at the University of North Carolina Gillings School of Global Public Health. Sharing his experience from an investigation in multiple countries, Dr Popkin said: ÂIn our ongoing evaluations we have found that all countries which have adopted warning label system of FOPL that are easy to interpret, have succeeded in reducing consumption of the most unhealthy ultra-processed foods and beverages. As suggested by available evidence, this is one of the most effective approaches to preventing obesity and nutrition-related NCDs like diabetes and hypertension. People need to understand clearly and simply what is in the food that they are buying. Food labels have to interpret the nutrition information for consumers across age, income and literacy levels.Â

Dr Rachita Gupta of WHO SEARO shared WHO nutrient profile model applicable in Indian context.  FOPL works best when it is made mandatory and applies to all packaged products, the label is interpretative, simplistic and readily visible, guided by a strong nutrient profile model, she said.

 Underscoring the importance of enabling consumer choice, Ashim Sanyal, COO, Consumer VOICE, an NGO working in this field, talked about the difficulty of making a choice when it comes to buying food off the shelf. ÂWhile at the grocery shop or supermarket consumers faced with a variety of choices, take their decisions in a few seconds. Labels have to influence diet choices within that window of time. FSSAI has taken an important step towards making our food systems healthier by capping the content of trans- fats. It is time now to set threshold for HFSS foods and to develop a labelling system that shares that information most effectively.Â

Vandana Shah, Regional Director, Global Health Advocacy Incubator drew attention to the momentum on FOPL warning policies building across the world. ÂIndia can join the growing list of countries that are realising the potential of a strong FOPL to safeguard the lives of their people. Warning labels is a key tool in our fight against obesity and diabetes. India, with its fast growing food industry and diverse demographics, could lead the way for a regional roadmap, by picking a labelling system that best guides consumers towards the healthiest choice.Â