Healthy Food and. Nutrition Labelling What s happening

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1 Healthy Food and 1 Nutrition Labelling What s happening Dairy Farmers of Canada Conference Ottawa, February 5, 2015 Mary R. L Abbé, PhD Earle W. McHenry Professor and Chair, Department of Nutritional Sciences

2 2 Outline 1. Diet and Chronic disease the Global context 2. National Policies related to diet and nutrition 3. Monitoring and surveillance 4. National Dietary Guidelines are evolving 5. Nutrition labelling changes 6. Consumer Tools and Apps 7. Global initiatives where to next?

3 3 1. Diet and Risk for Obesity and Chronic Disease The Global Context driving Nutrition policy

occurred in developing countries 25,000,000 10% Deaths in 2011 20,000,000 15,000,000

4 In 2011, 13.8 million people, between age of 30-70, died from NCDs: More than 85% of these deaths occurred in developing countries 25,000,000 10% Deaths in ,000,000 15,000,000 10,000,000 Communicable, maternal, perinatal and nutritional conditions Noncommunicable diseases 5,000,000 Injuries Source: WHO, Sept 2014

9 global targets to be attained by 2025 5 3

5 9 global targets to be attained by of 6 risk factors are food and nutrition driven

6 Global accountability framework to report progress to the World Health Assembly 2015 WHA68 (2016) 2020 WHA73 (2021) 2025 WHA78 (2026) 2010 baseline Targets 2015 WHA68 (2016) 2017 WHA69 (2018) 2020 WHA73 (2021) Action Plan Source: WHO, Sept 2014

7 7 2. National Policies related to diet and nutrition

8 8 National Policies to reduce NCDs also require information on the food supply

9 9 3. Monitoring and Surveillance: Sodium and Trans levels in Canadian foods Other questions sugar, calories

WHO (2008) Global Strategy Framework to monitor and evaluate implementation Example - Pantry Breads and Rolls (2010) 41% meet 2012 target (430) 29% meet 2014 target (380) 24% exceed the 13%

10 WHO (2008) Global Strategy Framework to monitor and evaluate implementation Example - Pantry Breads and Rolls (2010) 41% meet 2012 target (430) 29% meet 2014 target (380) 24% exceed the 13% meet 2016 target maximum level of (330) 520 mg/100g 10 Avg Sodium/serving = 272 mg Avg Sodium per 100 g = 447 mg CNF level per 100 g = 532 ( 16%) N=142 breads Arcand et al, Am J Prev Med (2014)

11 11 Proportion of Cheese Meeting HC Benchmarks for Sodium in % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Dairy Prod (n=483) Natural Cheese (n=428) Proc Cheese (n=49) Exceeds All Meets 2016 Meets 2012 Meets 2010 Arcand et al, Am J Prev Med (2014)

12 12 Data Analysis: Trans Fat Arcand J, Scourboutakos MJ, Au JTC, L Abbe MR, AJCN 2014

13 13 100% 80% 60% 40% 20% 0% Baseline data: the proportion of foods meeting the trans fat limits, TFMP versus FLIP 2010 Trans Fat Monitoring Program ( ) Food Label Information Program (2010) Arcand et al, AJCN 2014

14 14 4. National Dietary Guidelines are evolving

15 15 Away from number of servings Canada's Food Guide (2007) Number of servings/food group by age/gender Directional statements and info boxes about healthy choices

16 16 To US ChooseMyPlate (May 2012) More visual approach Better approach to guide appropriate quantities Supplemental consumer apps and tools

17 To Brazil 10 Steps to a Healthy Diet (Oct 2014) Healthy Eating approach 1. Make natural or minimally processed foods the basis of your diet 2. Use oils, fats, salt, and sugar in small amounts 3.

17 17 To Brazil 10 Steps to a Healthy Diet (Oct 2014) Healthy Eating approach 1. Make natural or minimally processed foods the basis of your diet 2. Use oils, fats, salt, and sugar in small amounts 3. Limit consumption of processed foods 4. Avoid consumption of ultra-processed foods 5. Eat regularly and carefully in appropriate environments and, whenever possible, in company 6. Shop in places that offer a variety of natural or minimally processed foods 7. Develop, exercise and share cooking skills 8. Plan your time to make food and eating important in your life 9. Out of home, prefer places that serve freshly made meals 10. Be wary of food advertising and marketing

18 5. Nutrition Labelling Changes 18

19 19 Health Canada and US FDA Proposed Changes to Nutrition Labelling (2014)

20 20 Health Canada Proposed Changes A. Serving size declarations B. Reference amounts C. Daily Values D. List of core nutrients - Sodium and sugar controversy E. Format of the Nutrition Facts table

21 A. Proposed Guidelines for Serving Size 1.

21 21 A. Proposed Guidelines for Serving Size 1. Use Reference Amount and corresponding household measure, e.g. both ¾ cup (175 g) 2. Use household measure closes to the reference amount and the actual weight 3. Use a standardized household measure and corresponding actual weight

22 22 Thoughts to consider Serving size and Reference Amounts Inconsistent with the principle of standardized reference amounts: Either per 100 g i.e. Europe Or per standardized serving size - US has had for > 20 years Can result in large variances example 20 g crackers (mean HC values mg sodium /100 g) Could be reported as 169 mg/17 g or 228 g/23 g serving (a 35% difference) Is there any evidence that this will be easier for consumers? Is proposed as Guidance not mandatory in the regulations is this really any improvement? FLIP Evidence (L Abbe lab - unpublished data) only 42% of packaged food products used Schedule M Reference Amounts; 23% > Schedule M Ref Amt; but 35% < Ref Amt Of those using the Ref Amt 70% were in the lower half of range

23 23 C. Daily Values Comments mostly consistent with US proposing to update RDAs EAR for Vitamin D should be consistent with approach to other nutrients?

24 24 D. Sodium and Sugar Controversy Sodium recommending changing %DV from 2400 to the UL of 2300 Large debate Consistent with FDA approach Consistent with other nutrients to limit, e.g. sat fat BUT many advocating for the AI recommended amount to bring more focus on how high sodium levels are; consumer interprets these as recommendations HOWEVER, IOM report recommended using ULs for nutrients to limit Sugar 3 changes proposed

25 25 Sugars Health Canada has Proposed 3 Approaches

26 26 Some thoughts on Added Sugar BUT Focus on added sugars due to concerns about the added sugar contribution to calorie intakes Foods high in added sugars are often those with a low nutrient density Support product reformulation with less added sugar (as was clearly demonstrated with trans labelling) Support educational messages around healthy food choices, such as those in CFG Analytically cannot distinguish in foods, but audit already frequently used Need a proper definition of added sugars Sugars that are either added during the processing of foods, or are packaged as such, and include sugars, syrups, naturally occurring sugars that are isolated from a whole food and concentrated so that sugar is the primary component, for example fruit juice concentrates, BUT LOOPHOLE for concentrated fruit juices/purees: if the fruit is listed in the product name then it is NOT a sweetener and the "no added sugar" claim can be used. (CFIA)

27 27 Proposed changes to List of Ingredients

28 28 E. Proposed Nutrition Facts table Format

29 29 Proposed new format - Comments Good Maintains the %DV on right Increased font size for Calories Heavy lines to separate nutrient to limit (top) and nutrients to encourage (below) Adding footnote to explain %DV BUT Fibre is still separated from carbs Where would n-3 fats go? Adding footnote to explain %DV is a very poor form of interpretive labelling

30 6. Consumer Tools and Aps 30

31 31 App Development - Supporting consumer knowledge and action Arcand et al, APNM (2013)

32 32 Big Life Salt Calculator - A few stats Featured on MarketPlace March 2013 Over 100,000 have done their own personal salt calculations; plus global pick-up Clinicians have requested a detailed version Salt Calculator Plus Other apps under development

33 33 7. GLOBAL OVERVIEW WHERE TO NEXT?

34 34 What was not in the recent Nutrition Labelling Proposals But happening elsewhere

35 35 What Canadians said they want (p9)

36 36 Helping Consumers identify healthy foods Interpretative Labelling Healthy Unhealthy Nordic keyhole UK FSA/Ofcom model USDA school feeding guidelines

Recent Examples of Interpretative Nutrition

Zealand) Nutrient Profiling Scoring Calculator

37 Recent Examples of Interpretative Nutrition Labelling 37 UK Traffic Light System June 2013 FSANZ - Health Star rating system approved 27 June 2014; mandatory Jan 2016 (Australia/New Zealand) Nutrient Profiling Scoring Calculator Chile Warning labels for foods high in fat, sodium or sugar

38 38 Conclusions Many food and nutrition hot topics here or on the horizon Trans, sodium, sugar, saturated fats Dietary patterns and healthy eating Nutrition labelling Technology enabled consumer support tools Interpretative nutrition labelling Menu Labelling Marketing to children Taxes on sugar sweetened beverages

39 Thank You/Questions Funding Acknowledgements

Scourboutakos, BSc Christina Wong, PhD Alyssa

Mavra Ahmed, MSc Mahsa Jessri, MSc Sheida

L Abbe, PhD Department of Nutritional Sciences Faculty

39 39 Thank You/Questions Funding Acknowledgements Research Team: JoAnne Arcand, PhD, RD Mary Scourboutakos, BSc Christina Wong, PhD Alyssa Schermel, MSc Teri Emrich, PhD, RD Chelsea Murray, MSc Mavra Ahmed, MSc Mahsa Jessri, MSc Sheida Noorhosseini, BSc Jodi Bernstein, MPH, RD Mary R. L Abbe, PhD Department of Nutritional Sciences Faculty of Medicine, University of Toronto E.W. McHenry Endowed Chair (M. L Abbe) mary.labbe@utoronto.ca

Evaluating the prevalence, nutritional quality, and marketing characteristics of nutritionally-enhanced foods in Canada

Evaluating the prevalence, nutritional quality, and marketing characteristics of nutritionally-enhanced foods in Canada by Sheida Noorhosseini A thesis submitted in conformity with the requirements for