CONFERENCE REPORT:
GENERATION EXCESS II, DECEMBER 1-2, 2005, BRUSSELS

Contents

Executive summary

Day One
1) Welcome Session
2) Session I: Where are we now?
3) Session II: The role and responsibility of industry: what's happening and what more needs to be done?
4) Session III: Key developments at the national level: creating healthy food environments
5) Session IV: The role of economic incentives and disincentives

Day Two
1) Session I: Parents Under Pressure
2) Session II: Parents Under Pressure continued
3) Session III: Nutrient profiles - their use in advertising and labelling regulation
4) Closing Remarks
5) Participants

Executive Summary

Generation Excess II built on the foundation of the first TACD Generation Excess conference held in February 2004. At that conference, much of the discussion was over the extent to which unhealthy diets caused chronic disease and obesity. The relationship between diet and health is no longer questioned and government, consumers, and industry now all agree that steps must be taken to address the problem. Accordingly, Generation Excess II focused on how to address the growing burden of diet-related disease through various public policy mechanisms, including restrictions on food marketing particularly to children, reformulation of products to lower the use of unhealthful fats, salt and added sugars, and use of economic incentives to help make the healthy choice the easy choice.

Discussions focused on the merits of self-regulation vs. mandatory regulation, giving examples of different government strategies at the national level. Examples of new government programs ranging from a law in France that requires government health notices in food advertisements to restrictions on soft drink (soda pop) sales in vending machines in California schools were discussed.

The roles of governments and industry in tackling obesity were debated. Major food companies discussed various actions they were taking to reformulate their products and change their marketing practices. Representatives of the European Commission discussed their Platform on Diet, Physical Activity and Health and representatives of the US Food and Drug Administration and Federal Trade Commission discussed policy developments in the US.

Research by academics and surveys by consumer groups shone a light on the powerful influence that the huge marketing and advertising budgets of the food industry have on the dietary choices of consumers. This is particularly true of children, who are targeted by such marketing in a variety of ways, and in whom the recent rise in obesity is most marked.

The conference also drew attention to the emergence in the US of new "stealth" and "guerilla" advertising techniques, as they are described by food marketers. Such techniques include, for example, the transmission of messages to mobile phones encouraging children to consume foods of low nutritional value. The conference also drew attention to the ‘pester power’ resulting from the many forms of recognized marketing and advertising.

In an innovative session on financial incentives and disincentives, the conference highlighted ways in which existing subsidies for, and taxes on, food could be sensibly reallocated to promote more healthy eating and reduce obesity.

A conclusion drawn by the consumer groups that organized the conference was that multinational food companies that make improvements to their products - such as adding nutritional labelling or reducing unhealthy ingredients like cholesterol-raising trans fats - should do so everywhere they operate. In practice, most companies typically respond to national or regional pressures, but fail to do so on a transatlantic basis.

Consumer groups urged that the EU and US continue to share best practice. While the conference had highlighted some positive initiatives, far more still needed to be done by government and by industry given the scale of the public health crisis. Skepticism was expressed over voluntary approaches, with a feeling by the consumer organizations that concrete and consistent action generally requires legislative solutions. They called for greater commitments by industry and government in line with a mult-factorial and multi-stakeholder approach and called for a strong lead to be taken by governments on controversial issues such as the marketing of foods high in fat, sugar and salt to children.

Full Conference Report

Day One - December 1, 2005

Welcome and introduction

Delegates at the two-day conference were welcomed by Jim Murray (Director, European Consumers’ Organisation - BEUC) and Bruce Silverglade (Co-Chair, TACD Food Working Group and Director of Legal Affairs at the Center for Science in the Public Interest).

Mr Silverglade explained that the conference would be examining one of the most pressing public health issues of our time: how to address the growing burden of chronic disease due to unhelpful diets. He remarked how far the debate has moved on since the first Generation Excess conference in early 2004. Generation Excess I debated the extent of public health problems caused by unhealthy diets, while today all sectors of civil society agree that the incidence of chronic disease due to unhealthy diets is unacceptable. Generation Excess I also debated whether diet was purely a matter of personal responsibility or whether government had a role to play in “making the healthy choice the easy choice”, while today civil society and government are working together to assist consumers in improving their diets.

Today’s challenge is not to determine if there is a problem but rather what to do about it. By way of setting the agenda for the two-day conference, Mr Silverglade listed five key questions in terms of policy choices which would become recurring themes:

• Should governments rely on self-regulation or is mandatory regulation necessary to protect public health and ensure a level competitive playing field for the food industry?
• Should public interventions be upstream (at the level of the producer) or downstream (at the level of the individual consumer)?
• Should public interventions be limited to providing consumers with information such as nutritional labeling or consumer education programmes, or should the quantity and quality of information provided by marketers be regulated to remedy the imbalance which currently exists between marketing campaigns and public health messages?
• Is government’s role limited to regulating the information flow or does it also include other regulatory mechanisms, such as controls on vending machine sales?
• At what level(s) – at the transatlantic, regional, national, state, provincial or local levels should interventions be made by governments?

Finally Mr. Silverglade mentioned that although progress has been made since the first Generation Excess conference, we are still awaiting concrete changes to take place which would advance consumer health. He expressed the hope that the conference would provide a roadmap as to what those changes are and how they can be achieved.

Session I: Where are we now?

Paola Testori Coggi (Director for Food Safety in Directorate-General Health and Consumer Protection, European Commission) pointed out that the issues on obesity and diet-related disease were similar around the world. Mrs Testori Coggi noted five Commission initiatives in the area of nutrition which merited special attention:

• EU Platform on Diet, Physical Activity And Health
• Green Paper on Nutrition
• Nutrition and Health Claims
• Revision of the legislation related to Food Labeling
• Nutrition Labeling

Mrs Testori Coggi described the (EU Platform on Diet, Physical Activity And Health), a major initiative officially launched on 15 March 2005 to provide a common forum for all interested actors at the European level in the field of diet, physical activity and health. There are currently 30 members and the Platform has received political recognition in the form of a European Council Resolution (June 2005). So far the platform has received more than 300 baseline actions from stakeholders. Within the Platform there are working groups on Healthy Lifestyles and Informing Consumer Behaviour which, while not always reaching consensus on best practices, have nevertheless provided healthy debate across all stakeholders.

The Commission intends to adopt a Green Paper on Nutrition by the end of 2005 (subsequently adopted 8 December COM(2005)0637). It describes the morbidity and mortality related to unhealthy diets and physical inactivity, as well as the related cost for health systems and the economy in general. The Green Paper on Nutrition will seek to address many issues, such as how consumers can be best enabled to make informed choices and take effective action on what they eat. It is a consultation document which should result in a Commission Communication towards the end of 2006.

A proposed Regulation on nutrition and health claims is presently under discussion in European Parliament and the Council of Ministers, with agreement hoped to be reached by the summer of 2006. Controversy is limited to provisions relating to the establishment of nutrient profiles for foods which are allowed to bear claims.

In terms of the revision of Food Labelling rules, Mrs Testori Coggi spoke of the need to strike a balance between requests for more information on a label and the need to have clear and meaningful labels. A Commission discussion paper on this topic is expected by the end of 2005.

Finally, on the subject of Nutrition Labelling, Mrs Testori Coggi noted that this was an urgent area for progress since the current legislation (91/496/EEC) is quite old and new issues - such as whether nutrition labelling should become compulsory or remain voluntary - need to be ironed out. Indeed, even if nutrition labelling was to become compulsory Mrs Testori Coggi posed the question as to which elements should be declared (salt, sugar, fat, etc.?) and where/how they should be declared (front of packet; signposting, etc.). It is hoped that a Commission Proposal will be published on this issue in 2006 but at present the discussions with EU Member States are behind schedule.

Jim Murray, on behalf of BEUC, mentioned his disappointment at the recent European Parliamentary vote on health claims.

Dr Robert Brackett (Director, Center for Food Safety and Applied Nutrition at the U.S. Food and Drug Administration) gave a U.S. perspective, describing obesity as a pervasive public health concern in the U.S., with adult obesity steadily increasing since the late 1980s. Similar trends among children have also been observed which are even more worrisome. Echoing Mr Silverglade’s opening remarks, Dr Brackett pointed out how issues of obesity and overweight were some of the most pressing public health challenges we face today. If trends continue, this would lead to a rolling back in many of the modern advances in medicine related to quality of life and life expectancy. He called on the need for everyone to work together for change and stressed that his concern was one of public health rather than appearance.

The U.S. administration is taking the issue very seriously, with a number of efforts being undertaken at different levels and with the participation of many actors from the government, industry and civil society.

Dr Brackett noted that the typical diet of an American is low in fruits, vegetables and whole-grains, while being high in saturated fats, salt and sugar. This year the FDA and U.S. Department of Agriculture jointly published the 2005 Dietary Guidelines for Americans in an effort to assist consumers in leading healthier lives through better nutrition. These Guidelines – communicated to the public at large by way of a small pamphlet called ‘Finding a Way to a Healthier You’ – are an important tool for consumers to choose a nutritious diet through achievable goals for controlling weight, building healthy bones, stronger muscles and preventing chronic diseases.

Dr Brackett also referred to the FDA’s ‘Calories Count Report’ which provides long and short-term proposals based on the scientific fact that weight control is mainly a function of caloric balance (i.e. calories in must equal calories out).

In a similar effort to that of the European Commission’s Green Paper on Nutrition, the FDA has also published an advance notice of proposals related to food labeling (such as increasing the font size for calories on labels, and improving the understanding of serving sizes).

Mary Engle (Associate Director, Division of Advertising Practices, Bureau of Consumer Protection, U.S. Federal Trade Commission) gave an overview of the U.S. Federal Trade Commission’s anti-obesity initiatives. Noting the multiple causes of obesity, Ms Engle picked up on the need for collaboration across governments, industry members, and NGOs to play a part in combating the problem.

Although the Federal Trade Commission is not a health agency, it nevertheless has a role to play, and looks at three specific areas: law enforcement, consumer and business education, and research and advocacy work.

Law enforcement: It is estimated that 70 million Americans are trying to lose weight and that consumers spend billions of dollars each year on products and services that purport to promote weight loss. Unfortunately, too many of the products advertised to consumers are more likely to reduce the bulk in consumers’ wallets than their waistlines. Therefore, over the past decade, the FTC has brought well over 100 lawsuits targeting deceptive weight loss claims for a variety of pills, potions, patches, lotions, and devices. In appropriate cases, the FTC has successfully obtained temporary restraining orders, asset freezes, strong injunctive relief, and money back to consumers.

FTC law enforcement efforts involve a significant degree of cross-border cooperation. For example, under a Trilateral Cooperation Charter agreement between the United States, Mexico, and Canada, consumer protection agencies from these countries, including the FTC, have taken nearly 730 compliance actions against companies promoting misleading weight loss schemes. These actions include prosecutions, product recalls and seizures, import refusals, and warnings.

Consumer and business education: Despite the law enforcement measures described above, bogus weight loss claims have nevertheless flourished, so the FTC also engages in business and consumer education, and enlists the media as an ally in its campaign. In an act of self-regulation the media were asked to ‘Red Flag’ advertisements with commonly found false weight loss claims, and in terms of consumer education the example of ‘teaser’ websites was given.

Research and advocacy work: A recent public workshop on “Perspectives on Marketing, Self-Regulation, and Childhood Obesity provided a forum to discuss how best to harness the power of the marketplace to improve children’s diets and activity levels. A report on the workshop will soon be made available.

Neville Rigby (Director of Policy and Public Affairs of the International Obesity Task Force) gave an overview of issues related to obesity in an international context and contrasted the experience in the U.S. with that of Europe. The IOTF, the advocacy arm of the International Association for the Study of Obesity (IASO), is part of a wider ‘Prevention Alliance’ and a founding member of the EU Platform. The IOTF produced a document for the launch of the EU Platform which covered the state of play in terms of obesity in Europe. It found that many European countries had very high levels of overweight as well as obesity.

Mr Rigby’s central message was that of the need for prevention, with a particular focus of preventing childhood obesity. He described a number of misconceptions related to obesity and made particular mention of the ‘smear campaign about obesity and BMI (the Body Mass Index) and whether it really matters’ in the U.S..

Speaking in an international context, Mr Rigby pointed out that there are different measures of obesity for different ethnic groups and noted the Chinese Vice-Minister for Health’s recent estimation that in China they have 200 million overweight and 60 million obese. He talked of a ‘global pandemic of obesity’ whereby, using BMI of greater than 30, recent studies have estimated there to be 1.5 billion overweight and obese adults over the age of 15 years old worldwide.

Mr Rigby presented numerous examples of comparative data showing a consistent upward trend in obesity in both the U.S. and Europe, with childhood obesity particularly marked. Finally, he presented estimates of the economic costs of obesity in Europe and the U.S. along with the trend that media coverage of obesity-related issues has also risen. This shows a concerted effort in raising awareness though perhaps without the required action to go with it.

Dr Colin Tukuitonga (Coordinator of the Surveillance and Population-based Prevention of Chronic Diseases at the World Health Organization) ended the session with a review of the global chronic disease burden and the WHO Strategy on Diet, Physical Activity and Health (DPAS).

Although the word ‘obesity’ tends to capture the imagination in terms of the media and political coverage, the WHO tends to talk in terms of chronic non-communicable diseases, since there is a substantial amount of people globally who have chronic diseases but who are not obese.

Dr Tukuitonga informed the conference that 60% of all deaths are due to chronic diseases which mean the year 2005 will see the deaths of 35 million people dying from one chronic disease or another. Despite these figures there has not been the investment to match the problem. This lack of investment was echoed in his assertion that ‘when the WHO adopts a resolution the money does not come with it’.

Dr Tukuitonga described the long term intergenerational time frame for DPAS and explained how the strategy was being implemented at the international, regional and state levels. In terms of EU Member States, he highlighted the Spanish Strategy for Nutrition, Physical Activity and the Prevention of Obesity (NAOS) as a good example.

Dr Tukuitonga concluded by mentioning some of the commendable action he had seen in the private sector, especially the food and drinks industry, and also pointed out that physical activity programmes remain weak in many countries.

Discussion:

• One consumer NGO asked, given that obesity is commonly agreed to be a problem, why was it not accompanied by a corresponding budget to solve the problem. Neville Rigby suggested that there was money available but it tended to go to food companies in the guise of research. Colin Tukuitonga added that there was indeed a shortage of resources but made the general point that WHO resolutions are not necessarily connected to a budget and have value beyond money as they are used to sway public opinion. Robert Brackett mentioned that money was being spent but not necessarily in ways that consumers would notice (e.g. in terms of research).
• Questioned on why, despite an active lifestyle, the Dutch obesity levels are rising, Neville Rigby reminded delegates that it shows physical activity is not the only answer.
• One national consumer association wondered if it wouldn’t be better to concentrate on regulation instead of non-mandatory initiatives. Paola Testori Coggi mentioned that the European Commission can only spend resources in areas where it is competent. Furthermore, a complementary two-track approach (regulatory and non-mandatory) would seem to be the best way forward.
• One delegate questioned the effectiveness of self-regulation particularly in the case of the US. Robert Brackett and Mary Engel both mentioned that the legal instruments available to them as agencies were limited. In terms of advertising to children Mary Engel pointed out that free speech as enshrined in the US constitution would make it very difficult to regulate in this area.

Session II: The role and responsibility of industry - what’s happening and what more needs to be done?

Dr Kelly Brownell (Professor and Chair of the Department of Psychology at Yale University; Director of the Rudd Center for Food Policy and Obesity) argued that nutrition education in the U.S. was dominated by the food industry and gave the example that, in talks he gives, not a single person can recite the U.S. National Nutrition guidelines, while most people are able to identify certain songs or slogans associated with particular food products.

To give an idea of how dire the situation is in the U.S., he gave the statistic that 25% of all vegetables eaten in the U.S. are in the form of French Fries.

The Rudd Center for Food Policy and Obesity at Yale University intersects science with public policy in order to drive the agenda and is designed to work with, through, and sometimes against, the large institutions which in turn affect the diets of millions of people. It hopes to prevent obesity but also has a role in preventing and reducing weight stigma due to the bias against people with obesity (comparable to the stigma attached to people with AIDS and alcoholism) which tends to block social progress.

Dr Brownell argued for a change to the economic landscape in terms of food and called for enhanced accessibility of healthy food to the poor, a change to “more for less” incentives and put forward the idea of a ‘Tax & Nutrition Superfund’.

Dr Brownell also called for a reduction in soft drink consumption, a change in portion sizes and a “change to the exploitation of children which occurs through marketing”. In terms of food advertising to children, he referred to what the industry is calling “guerilla marketing”, “viral marketing” and “stealth marketing”. He argued for progress on all these fronts because “very often the comprehensive nature of obesity and its multiple causes is used as an excuse for not moving ahead aggressively on any front”.

The U.S. government’s limited ability to curb marketing to children is problematic since this leaves the issue to self-regulation by the industry “which has been a complete and utter failure”.

Dr Brownell concluded by calling for a ‘Roadmap’ which would look at the economic, social, political and biological issues related to obesity. Such a comprehensive roadmap is needed since, and quoting a colleague, ”there has never been a single demonstration in human history of the prevention of obesity short of war or famine”.

Dr Lars Ovesen (Head of the Danish Heart Foundation and representing the European Heart Network) began by saying that more 80 million children and adolescents in Europe were now obese. He gave an overview of a recent report on the Marketing of Unhealthy Foods to Children in Europe, the findings of which included the fact that most of the food marketed to children is high in fat, sugar and/or salt; that food promotion affects children's food preferences, purchase behaviour and consumption; that the use of 'pester power' is crucial and children have a major influence over parental buying decisions; and schools represent a growing marketing channel for food advertisers.

In terms of recommendations coming out of the report, Dr Ovesen called for a ban on television advertising of foods to children; the regulation of food promotion via other media, such as the internet; the restriction of promotions at the point of sale; and limits on other forms of marketing strategies of foods to children.

There has been significant change in the portion sizes of fast food over the last 20 years and a typical example is a meal which nowadays contains 825 kcal more than it did 20 years ago, which in energy terms equates to a two-hour brisk walk.

The fight against obesity will not succeed if we do not deal with the environment as well as the individual, and the prevention of obesity will require a broad-based public health program. Industry must acknowledge their responsibility within this concerted effort.

Roland Vaxelaire (Director Quality, Responsibility and Risk, Carrefour Group) explained what Carrefour is doing in the area of obesity and diet-related disease. He spoke of Carrefour’s work in the areas of recipes and food production; information to consumers; and more general forms of communication to consumers.

In terms of recipes and food production Mr Vaxelaire told delegates that Carrefour had developed a quality charter with identification of areas of improvement. On the ‘Carrefour Kids’ brands, special attention will be given to levels of sugars, in order to reduce them as much as possible.

Carrefour’s new and ‘innovative’ approach to nutrition labeling resulted from a realization that consumers did not really understand what was currently on nutrition labels. Indeed, 75% of consumers declared that they rarely or never read the nutrition labels. In order to respond to consumer expectations Carrefour has designed nutrition labels with pictures that give information about the main nutrients necessary for a balanced diet, and figures are given for what one portion gives in terms of the average daily needs of a consumer.

In terms of communication to the general consumer Mr Vaxelaire outlined Carrefour’s work on own–brand products, which focus on nutritional innovation, including the development of brochures and posters.

Finally, in an acknowledgement that more needs to be done, he said that work on reformulation of products, the development of a comparable nutritional labeling scheme (international references for Guideline Daily Amounts - GDA) and the need to invest in innovative communication tools, in order to reach all consumers, are were all under consideration.

Dick Toet (Vice-President of Foods External Affairs, Unilever) reminded delegates that health foods or foods with an added health value are not new, and gave an example of a margarine with unsaturated fat from 1960. Unilever has been following a holistic approach over the past 2 years in terms of their ‘Vitality programme’, with its four main pillars: Nutrition Enhancement Programme (which uses WHO and country diet guidelines); responsible marketing; nutrition information and education; promoting healthy diets and lifestyles.

Nearly all of the Unilever food product range has been assessed against the benchmarks set by the guidelines in the Nutrition Enhancement Programme. This means that, in 2005 and 2006, reformulation changes will remove 15,000 tons of trans fats, 10,000 tons of saturated fats, 2,000 tons of sodium and 10,000 tons of sugars from their portfolio. However, there is a limit as to what can be done. For example, only so much salt can be taken out from a traditionally savoury product, such as soup, without affecting the taste, and these reductions need to be gradual otherwise consumers “simply won’t eat it anymore”.

Regarding Unilever’s commitment to responsible marketing presentations of foods must be accurate, science-based and there should be no direct marketing communications to children under the age of six.

Concerning nutrition information and education Unilever’s activities include their support for a revision of EU labelling regulations. Whether labelling turned out to be voluntary or mandatory is not their greatest concern. Rather, Mr Toet called for agreed benchmarks as well as a certain degree of flexibility so that nutrition labelling is not taken out of context. He urged some consolidation of the many EU regulations related to labelling requirements so that labels can be more comprehensible for consumers. He also expressed concern about the different signposting models which have been launched – common criteria need to be agreed.

Mr Toet called for a constructive dialogue with consumer organisations and civil society aiming at real improvements of products, diets and information in an environment where there should be no discrimination of specific food categories in any system. Finally, as part of the company’s work in promoting healthy diets and lifestyles, Mr Toet listed numerous activities mainly at the national and European level such as their sponsorship of the Flora London Marathon and the Heart Health Programme across Europe.

Mark H. Berlind (Executive Vice President, Global Corporate Affairs, Kraft Foods) ended the session with a presentation on Kraft’s Health and Wellness Agenda, and making it clear that Kraft believe they do have responsibility in the area of diet and nutrition and it is not just question of consumer responsibility: “there is a lot of shared responsibility here”. Mr Berlind mentioned that the area of product nutrition was where they can make the biggest difference. He expressed the hope that interests of the public health community and industry can intersect since “we see a tremendous business opportunity in tapping into the interests that consumers have in better nutrition”, and thus an opportunity for a ‘win-win’ situation.

Mr Berlind gave numerous examples of efforts Kraft are making in terms of improved nutritional quality of products across their range (such as a 30% reduction in salt from their ‘Dairylea’ products in the UK). However, echoing Mr Toet’s remarks he said these nutritional improvements had to be made step by step and it was not feasibly to move some ingredients entirely from a given product. The safety aspects in terms of food preservation are also a consideration.

In terms of consumer information and nutritional labelling he mentioned many of the similar issues referred to by Mr Vaxelaire from Carrefour. Particular mention was made in terms of their on-pack information, signposting and ‘Sensible Solution’ Profiles (for more on this see Joanna Scott’s presentation on Nutrient profiles – Day 2, Session 3). The ‘Sensible Solution’ flag had been introduced in the U.S. but not yet in the EU, due to the ongoing discussions related legislation on Health Claims in the EU.

Voluntary restraints that Kraft has placed on itself in terms of marketing practices include a commitment not to advertise on TV, radio or print when these mediums primarily reach children under the age of 6, and future plans to shift advertising primarily reaching children aged 6-11 to Sensible Solution Nourishing products. Finally, in terms of advocacy and dialogue, Mr Berlind mentioned participation in the EU-wide ‘Shape Up’ programme.

Discussion:

• When questioned on whether he was heartened by the discussions, Dr Brownell expressed his satisfaction with what industry seemed to be doing but added that it was the progressive companies which tend to represented at these conferences and that the ‘laggards’ need to be punished. He also made the point that if a consumer perceives a ‘better-for-you food’ as a ‘good-for-you food’ and consequently eats more of the product overall then there may be problems.
• One delegate wondered about the problem with Kraft’s assertion that people were willing to pay a premium on healthier foods when obesity tends to affect the poorer sections of society. Mr Berlind responded that access to fruits and vegetables and the problems with subsidies related to these foods was more of an issue on a macro level.

The debate ended with the panellists giving their ‘key messages’:

Dr Brownell called for ‘science based’ solutions.

Dr Ovesen called for cooperation and shared responsibility.

Mr Berlind wanted people to be aware that eating is also a pleasure and people will eat what they like. Policies need to find a balance between foods being appealing as well as healthy.

Mr Vaxelaire reinforced the message of cooperation and wanted a shift from the blame game.

Mr Toet mentioned what his company is doing internally in terms of science but also reinforced Mark Berlind’s point that food is also about pleasure and there must be room for such products.

Session III: Key developments at the national level: creating healthy food environments

Rosemary Hignett (Head of Nutrition Division, UK Food Standards Agency) began this session by explaining how her agency and other UK departments are trying to improve the dietary health of the population. She noted how diet related and lifestyle issues are ‘galloping up the political agenda’. Calling for a multi-factoral and integrated approach to improving dietary health, Ms Hignett focused on the issues of reformulation, food labeling and the work which is taking place in schools.

Reformulation forces a change in what people eat; labeling changes the information that people have; and work in schools helps to bring about a cultural change in people’s knowledge of, and reaction to, food.

Ms Hignett talked about the efforts that have been made in the UK regarding reformulation of food in partnership with the food industry and gave the specific example of salt reduction. This approach needs to be slow in order to “reeducate people’s taste buds”.

Ms Hignett then discussed food labeling and more specifically that of ‘signposting’. Following consumer research carried out in June 2005, the FSA found that 96% of consumers believe that a signposting scheme would help them make healthier choices. However, the research also made it clear that consumers wanted one simplified scheme of easy-to-use information. This means that the numerous signposting schemes being developed by different businesses may suit the businesses themselves but do not help the consumers. The FSA found that a ‘multiple traffic light’ scheme is the most popular and informative signposting scheme.

The work being done in schools is a crucial area because it is here that the “consumers of the future” are educated. Work is being carried out in three main areas: dinners and lunch boxes; snacks and drinks; and lessons which include innovative learning materials for pupils.

Dr Michel Chauliac (French Ministry of Health) described what is happening with regard to the development of a French policy on nutrition. In order to create a favorable environment for nutrition policy, the French government introduced a National Nutrition and Health Programme (PNNS) in 2001 with specific objectives related to food and physical activity in order to improve health.

Overseeing the PNNS is a Comité Stratégique pour la coordination et le suivi du PNNS with representatives from all stakeholders. The PNNS has the overall aim of trying to encourage individuals to make health choices using guidelines and media campaigns, and it includes activities at all levels of society.

Another key action has been the attempt to improve the nutritional quality of food. Activities include providing food with an enriched nutritional quality for homeless people as well as looking at quantities of salt in key foods such as bread, soup and meat.

In terms of legislation related to nutrition in France, Dr Chauliac made particular mention of the recent law for a total ban on vending machines in schools, as well as the law which would either require marketers to include a health message in their advertisements or pay a 1.5% tax on the cost of the advertisement.

Matthew Marsom (Manager, Policy and Planning Unit for the Cancer Prevention and Nutrition Section of the California Department of Health Services) explained the key policy developments in US State of California to create healthy food environments.

He began with some statistics and informed the conference that in 2003 well over half of California adults were overweight or obese, up by more than 10% since the early 1990s, with these rates as much as 10% higher among low-income individuals. Obesity amongst California’s school student population increased by 6% between 2001 and 2004. In California, obesity has its greatest impact on low-income families and certain communities. Data from 2004 suggests that among children and adolescents, overweight and obesity is more common in African American and Latino young people, and for adults, highest among African American and Mexican American women, and American-Indian males. It appears that rates may be rising even more sharply for Latino and African-American youth.

The conference was also told of the less well-known problem of California’s high level of food insecurity. The University of California, Los Angeles, reported in May that more than 2.9 million low-income Californians in 2003 experienced periods during the year when they could not afford to put food on the table or had to forego other basic needs in order to do so.

In terms of action on these problems, Mr Marsom noted that obesity was a key priority for the administration, which announced a new Obesity Prevention Initiative in the State budget, and is sponsoring legislation before the State Legislature to improve children’s’ diet and physical activity.

Mr Marsom also explained that while advertising and marketing is under Federal jurisdiction and protected by the Constitution, Governor Schwarzenegger’s vision statement does include as one of its ten steps that only healthy foods and beverages will be marketed to children ages 12 and under.

Earlier this year, the California Department of Health Services issued its own policy statement to Reduce Obesity and Overweight. Key strategies include: improving community design; limiting children’s TV viewing time; limiting calorie intake; increasing initiation and duration of breastfeeding and the availability of fruits and vegetables; and decreasing food insecurity.

Mr Marsom also referred to other activities such as the California Nutrition Network for Healthy, Active Families and the work being done by local communities to improve access to healthy food.

As Mr Marsom pointed out, “California has an unhealthy environment, where short-sighted planning and community design means that many of those who are most at risk live in ‘Food Deserts’, surrounded by liquor and convenience stores selling junk food, but with little or no access to affordable healthy food.”

“In terms of physical activity poor community design and urban planning means that many neighborhoods lack the sidewalks and bike paths to encourage walking and cycling, or safe play areas for children to be active. Our communities have been designed for cars, not for people, and we have engineered physical activity out of our lives.”

To conclude, Mr Marsom looked to the future and informed the conference that California was likely to see discussion of legislation on physical activity and school PE, and informed delegates of an initiative which would raise tobacco taxes in California by an additional $1.50, with some of the funds going to support nutrition, physical activity and obesity prevention interventions.

Dr. Annamária Somhegyi (Senior Counselor, Hungarian Ministry of Health) outlined Hungary’s National Public Health Program which was launched in 2001 and supported by all political parties.

As far as the health sector is concerned there have been a number of activities, including making GPs better aware of the need for more physical activity and ensuring that, as well as prescribing any necessary medicine, they also give advice for an adequate diet and pattern of physical activity.

There is also a National Strategy for Healthy Diet and Physical Activity (2004-2005) but it has unfortunately not yet started due to a lack of resources. They are also trying to improve general access to dietitians and experts in sport medicine.

Outside the health sector, there have been attempts to promote healthy diets and physical activity in, for example, the National Strategy for Sport (2004). Dr Somhegyi also pointed to the need for better inter-sectorial cooperation not only at the national level but at the EU level too.

Sissel Lyberg Beckmann (Deputy Director General and Head of Section for Nutrition and Food Safety, Department of Public Health, Ministry of Health and Care Services, Norway) concluded the session with a presentation on nutrition policy and activities in Norway.

The main aims of Norway’s strategy are more years of healthy life for the population as a whole and a reduction in health disparities between social classes, ethnic groups and sexes.

Most of Ms Beckmann’s presentation related to the work being done in Norway’s schools and kindergartens in terms of diet. Norway has National Guidelines in this area which prescribe that schools ought to offer fruit and vegetables, low-fat diary products, sandwiches and water while they should not offer soft drinks, crisps / chips and sweets. There is also a School Fruit Programme in Norway to which 78,000 pupils have so far signed up at 1,340 schools. Finally, and building on the need for cross-sectorial action and an integrated approach, Norway has launched a project on physical activity and meals in schools (2004-2006), which is a joint initiative between the Ministries of Health & Care Services, Education and Research.

Discussion:

• Asked why the FSA decided to concentrate initially on salt, Ms Hignett said that the issues related to salt are less complex than those related to fat or sugar and so it was decided to choose the simpler option at the outset. Mr Chauliac added that France also began its work with salt because it has implications which were wider than just obesity.
• Asked to elaborate on the advertising to children in California, Mr Marsom simply said that it was only a vision statement at present, but the importance of the statement was nevertheless important since it came from a Governor who has a particular experience with the media.

Session IV: The role of economic incentives and disincentives

Kicking off this session on the role of economic incentives and disincentives the moderator, Bill Jeffrey (Center for Science in the Public Interest, Canada) pointed out that tax has been applied to food in many ways but not necessarily with health issues in mind.

Dr Simone A. French (Professor, Division of Epidemiology & Community Health, University of Minnesota) presented some experimental data which she and colleagues have generated over the last ten years on pricing strategies to promote healthy food choices in work sites and schools. She expressed the hope that such data would be used to inform policy development.

Broadly speaking, the debate over obesity and diet has not considered the economic aspects of environmental influences on food choice. Spending on food, as a percentage of one’s disposable income, has fallen over the years. Although the price of food has risen gradually over the last 20 years, the price of sweetened foods has risen more slowly than the price of fruits and vegetables. Echoing other speakers, Dr French demonstrated how the size of a portion has increased and added that the larger the quantity the cheaper the price per unit.

In the context of a school setting she posed the question of whether subsidization is a key to success. By way of an example she showed that this was possible since price reductions in school cafeterias of both fruit and vegetables resulted in a marked increase in sales.

Jørgen Dejgård Jensen (Senior Researcher at the Food and Resource Economic Institute at the Royal Veterinary and Agricultural University of Copenhagen) pointed out that economic instruments give producers, consumers and others incentives to behave in a particular way but these are hardly ever used in relation to diet or food despite their success in several other areas, such as environmental regulation, tobacco and alcohol.

However, the tax on sugar in Denmark between 1976 and 1989 gradually turned around consumption and eventually reduced its use by 25%. But since then, sugar consumption has risen again.

Mr Jensen therefore argued that economic instruments do work, if measures are targeted properly. Suggested measures included targeting particular foods such as fruit and vegetables; a tax on particular nutrients such as saturated fats; or a subsidy for physical activity.

He also put forward the more controversial possibility of a ‘weight or lifestyle tax or subsidy’. This could be on an individual’s weight or BMI or a user fee on public health care when ill-health is caused by unhealthy lifestyle or excess weight.

Jane Landon (Associate Director, National Heart Forum, UK) then built on one of the elements of Mr Jensen’s presentation with her talk on ‘The ‘fat tax’: economic incentives to reduce obesity?’, which demonstrated some of the UK Institute for Fiscal Studies’ (IFS) modelling in the area. In terms of policy levers to improve public health, Ms Landon observed that the mention of food taxes often provokes an ‘allergic reaction’ in the public that can be a barrier to productive discussion and analysis in some quarters.

In terms of the UK’s burden of healthcare food-related ill health was estimated to cost the UK €8.7bn per year, which far outweighed the health costs related to alcohol and tobacco (each estimated at €2.5bn).

Delegates were reminded that taxes related to food (such as VAT) do exist but none of them could be described as specific fat taxes. The IFS’s modelling of a fat tax came up with the following conclusions:

• Nutrient purchase varies little between rich and poor households
• Poorer people pay relatively more tax (poorest = 0.7% of income; richest = 0.1% of income)
• A fat tax would be regressive
• This would likely hold true for any tax on food

Ms Landon concluded with a brief explanation of the drawbacks of the model but nevertheless argued that there could be lessons such as the fact that pricing policies using both taxes and subsidies could influence both consumer and producer. The IFS Briefing Note (49) is available at www.ifs.org.uk

Dr Jeff Strnad (Professor of Law at Stanford University) looked at U.S. with regard to the pros and cons of food taxes and subsidies, and compared the experience with other taxes, such as those related to alcohol and tobacco.

The potential tax magnitude of a ‘fat tax’ is estimated to be very high. For example, such taxes would need to draw in costs related to obesity of between $60-90bn per year. Furthermore, if the tax aimed at creating parity with alternative healthy foods such as fruit and vegetables then a large tax of around five times the retail price of foods like cookies, chips/crisps, and soda would need to be levied.

Dr Strnad also described the potential of a tax which would be levied on consumers in terms of what their future healthcare costs would be due to eating unhealthy foods. Using this as a starting point he stated his preference for an insurance-based tax system but made clear the government’s key role if such a system was created.

Discussion:

• Asked about what she considered the most promising economic incentives to be, Dr French felt that subsidisation of healthy foods as well as better guidelines in terms of the Federal Food Stamp Programme and School Meals should be looked at. She also mentioned the problems related to sugar subsidies in the U.S.
• Asked whether subsidies on healthy foods would be progressive, Ms Landon said it was worth exploring further. Dr Strnad made the general point that the more instruments you have, the better the policy would be. He also pointed out that the producer response to these issues would probably be very strong.
• Questioned on ‘small taxes’, Dr Strnad said that politically smaller taxes would be a good option since they are politically easier to pass. Bill Jeffrey said that it was, nevertheless, important to be ambitious.

Day Two - December 2, 2005

Session I: Parents Under Pressure

Jim Murray (Director, European Consumers’ Organisation – BEUC) kicked off the morning session with a presentation on what his organisation sees as the unacceptable pressure placed on parents through the promotion of foods to children.

The consumption of less sugar, salt and fat is the priority of consumer advocates and where possible they would work with industry to achieve this. Mr Murray cited two studies – one by BEUC and one by Which?, with the study by Which? portraying a real sense of struggle by parents in the face of food promotion to children.

The BEUC study looked at five countries and questioned participants on their knowledge of nutritional information. In terms of nutritional claims the study found that in Germany 70% of people trusted claims on products while claims were trusted least in Denmark (33%) perhaps due to restrictions on claims in Denmark. Taken together Mr Murray argued that claims on food products provide a bad basis on which to decide what food parents should buy for their children.

Mr Murray ended his presentation with some of BEUC’s conclusions and recommendations with the central idea that the commercial presentation and marketing of food to and for children is one of the contributing factors to the current crisis of diet, nutrition and obesity in Europe, and presumably the U.S., and merits a regulatory response as part of a broader programme to tackle current problems.

Luisa Villa (Public Affairs Officer, Altroconsumo) gave a presentation of the findings of a campaign and survey carried out the Italian consumer organization, Altroconsumo. The survey, as part of a wider campaign entitled ‘A Plateful of Health’, monitored the degree of food advertisements broadcast each day aimed at children in Italy. The focus was on children because they are less likely to distinguish between advertisements and other programmes, and because they are easily conditioned.

Among the quantitative findings of the survey was the fact that food advertising accounted for 26% of all adverts aimed at children. The types of food advertised varied, with fruit and vegetables receiving the lowest amount of advertisements.

Among the qualitative findings of the survey was the use of the mother figure as a common vehicle to sell foods to children, the use of nutritional claims, cartoon characters, free gifts and celebrities. Very worrisome was the finding that some alcoholic drinks were advertised during TV viewing times when children are the predominant viewers.

Olivier Andrault (Agriculture and Food Officer, Union Fédérale des Consommateurs - Que Choisir) gave the French consumer perspective, which complemented Michel Chauliac’s presentation from the view of the French Ministry of Health.

As well as mentioning the National Nutrition and Health Programme (PNNS) and the recent law for a total ban on vending machines in schools, Mr Andrault elaborated on the work being done in terms of nutrition labeling and food advertising in France.

Sue Davies (Chief Policy Adviser at Which?, UK, and EU Co-chair of the TACD Food Working Group) elaborated on the findings of the Which? surveys of parents and young adults (one in 2003, the other in 2004) mentioned earlier by Jim Murray:

• Around three quarters of respondents agreed that advertising and promotions make it difficult for parents to insist that their children eat healthier foods (2003)
• 74% believed that there is far too much advertising of junk food (2003)
• 8 in 10 said that there should be more advertising of healthy foods (2003)
• 70% felt that there should be no advertising of junk foods during children’s viewing times (2003)
• Over three-quarters believed that the use of cartoon characters on packs of foods high in fat, sugar and salt make it difficult for parents to say no to their children (2004)
• 8 in 10 believe that celebrities and sports personalities should promote healthy food to children (2004)

Ms Davies mentioned other forms of marketing to children, the most recent of which are the internet and SMS text messages, and echoed some of Dr Brownell’s concerns about ‘guerilla marketing’. Endorsements are another area of concern and one of numerous examples given was the Shrek 2 ‘Mud and Worms’ breakfast cereal Nestlé had produced which contained 36.6g sugar per 100g.

The UK government was looking at both broadcast and non-broadcast marketing. She emphasized that action was needed on numerous at the EU level (revision of the Television Without Frontiers Directive and the EU Platform) and at the national level (a review of current voluntary codes, with the possibility of regulation in 2007). Which? wants to see the marketing of foods, high in fat, sugar and salt to children stopped. She stressed that failure to tackle this area would undermine other positive initiative such as the work on improving school meals.

Discussion:

In the debate following this session Will Gilroy from the World Federation of Advertisers made the point that only a very small minority of the advertising community were in denial about the effects of advertising on children. He also stated that there were no plans to press for the increase of ad-minutage (the amount of minutes of advertising allowed per hour) because this would lead to ‘media clutter’.

Session II: Parents Under Pressure Continued

Professor Gerard Hastings (Director of the Institute for Social Marketing and Centre for Tobacco Control based at Stirling University) presented the findings and conclusions of his FSA-commissioned Systematic Review of Research on the Effects of Food Promotion to Children (2002-2003).

The main findings were that: the advertised diet contrasts strongly with the recommended diet; there is sufficient evidence to show that food promotion has an effect on children, particularly their food preferences and purchase behaviour (including ‘pester power’); and that the evidence is likely to understate the effects.

Professor Hastings made the point that “there is an effect and what we should be doing is building on that knowledge, not questioning it or arguing about it anymore”. The report can be found here.

Emmanuel Joly (Administrator in the Audiovisual Policy Unit of the Directorate-General for Education and Culture, European Commission) made particular mention of the issues related to TV advertising and marketing techniques.

In terms of TV advertising, food advertising to children could not banned or regulated at an EU level since this does not yet occur at the national level. Such measures are therefore unlikely to be included in the TV without Frontiers Directive.

In terms of marketing techniques, the problem is better addressed through the EU Unfair Commercial Practices Directive. On the case of product placement, it is not clear that all EU Member States feel this is problematic (the case of Austria was given, as well as the point that in France and other countries product placement is permitted in cinemas).

Mary Engle (Associate Director, Division of Advertising Practices, Bureau of Consumer Protection, U.S. Federal Trade Commission) talked about the public workshop on food marketing and childhood obesity held by the U.S. Federal Trade Commission and the U.S. Department of Health and Human Services in July 2005.

The FTC is in the process of drafting a report based on the information presented in connection with the workshop where the main issues covered were how food is marketed to children, food industry best practices, media best practices, food marketing to minority children, and self-regulation.

Ms Engle stated that the U.S. government departments involved intended to seize upon the momentum from the workshop and to continue the dialogue on how industry can move forward on the issue of childhood obesity. The government agencies are in the process of determining what steps they will recommend that industry take to help decrease childhood obesity. The report will be available here.

Sabine Nafziger (Senior Manager for Consumer Information, Diet and Health Issues at the Confederation of the Food and Drink Industries of the EU – CIAA) ended the session with an industry perspective on the issue of ‘parents under pressure’. Picking up on a previous point, Ms Nafziger began by saying that CIAA represents the parts of the food and drink industry that is not in denial. However, she did add that she wanted to put advertising and marketing into context.

On the specific point of pressure on parents, Ms Nafziger mentioned today’s urban environment having less and less opportunities for “natural physical activity”; the fact that many leisure time activities are static for children (e.g. computer games), as well as exposure of children to commercial communications. The extent to which commercial communications influence children is unclear, so it is not clear how much action should be taken in this area – action must be proportional.

The industry is working closely with government officials to strengthen co-regulatory codes for advertising and marketing. It is also strengthening and expanding the remit of advertising co-regulation across the EU 25 by implementing the International Chamber of Commerce (ICC) Global Framework for Responsible Food and Beverage Communications into national co-regulatory code provisions and by implementing Marketing Communications Guidelines which go beyond the ICC Framework.

Finally, industry is proposing to set up a Healthy Lifestyles advertising campaign in the framework of the EU Platform commitments for 2006. However, partnership with other members of the EU Platform is needed for this to materialise.

Discussion:

• Professor Hastings’ talk prompted one consumer organisation to challenge the World Federation of Advertisers to endorse the Hastings review. The review was not endorsed and the WFA talked instead in terms of the need for proportionality.
• Questioned on conflicting messages which appear to be coming out of the Commission (such as economic interests versus health interests), Mr Joly said that if there is no clear message coming from EU member states then it would be disproportionate for the Commission to work towards a ban on advertising of food to children.

Session III: Nutrient profiles – their use in advertising and labelling regulation

Dr Mike Rayner (Director, British Heart Foundation Health Promotion Research Group, based at the Department of Public Health, University of Oxford) began this session with a presentation on the development of nutrient profiles in the UK as well as some general principles surrounding the issue of nutrient profiles. Dr Rayner’s group was tasked with exploring options for definitions for use by the UK Food Standards Agency in relation to food promotion and children’s diets.

There is no one universal nutrient profiling system which could be used since different nutrient profile models might be better or worse in a given situation.

Dr Rayner described the issue over food category specific versus across the board criteria as the ‘million dollar question’ since this is the major way in which nutrient profiling models differ. Healthier/less healthy choices within categories versus healthier/less healthy choices per se will inform which type of model you wish to use. Dr Rayner’s Group opted for healthier/less healthy choices per se with their model due to problems in defining categories of food.

Dr Rayner then presented the two models which his Group has come up with. The first, ‘SSCg3d’, used 8 different nutrients while the second model, ‘WXY’, used three nutrients. Both models yielded similar results and classified foods as ‘healthier’, ‘intermediate’ or ‘less healthy’. Dr Rayner also informed the conference that a new model was due to be published in the week of 5 December 2005 with slight modifications.

Dr Anita Laser Reuterswärd (Swedish National Food Administration) then gave a talk presenting the Swedish ‘keyhole system’ which is known as a ‘threshold’ model and pre-dates the concept of ‘nutrient profiling’. It aims to inform consumers about better food choices.

Introduced in 1989, a small green keyhole symbol is put on the front of food packaging to indicate better choice of food in terms of fat and fibre content. It aims to label low-fat, fibre-rich products and give a better choice within different groups of food products. The ‘keyhole system’ was revised in 1992, 2004 and also in 2005. The criteria for the keyhole system are being tightened up all the time and it is a simple positive tool for helping people to make healthier choices.

Joanna Scott.(Director, Corporate & Government Affairs, Kraft Foods) confirmed that Kraft Foods supports the principle of nutrition profiling as a means of differentiating foods. Kraft has developed nutrition profile criteria based on the principles of the threshold model, and a signposting scheme based on food category. As Mark Berlind referred to on Day 1 of the conference, these are known as Kraft’s Sensible Solution nutrition criteria and are calculated on a per serving basis for each different category of food and beverage.

A product can qualify in one of two ways: either by providing beneficial nutrients such as fibre, wholegrain, or calcium, at meaningful levels, while staying within specific limits on calories, fat, sodium or sugar; or by meeting specifications for “reduced”, “low” or “free” in calories, fat, saturated fat, sodium or sugar.

Dr Robert Brackett (Director, Center for Food Safety and Applied Nutrition at the U.S. Food and Drug Administration) talked about the 1990 Nutrition Labeling and Education Act (NLEA) which is a statutory instrument and was established to clear up consumer confusion over labels. The system is based on scientific research and studies with focus groups into what type of labeling can be understood by consumers.

Most packaged foods have a Nutrition Facts label which is supposed to help consumers find out how many calories and nutrients are present in a serving of food. To use the label effectively, it is important to check serving size, servings per container, and calories. The Nutrition Facts label also provides Daily Values for nutrients, which help consumers determine how a serving of food fits into a typical 2000-calorie diet.

Dr Brackett also referred to nutrient content claims. For example, ‘healthy’ is an implied nutrient content claim, characterizing a food that has ‘healthy’ levels of total fat, saturated fat, cholesterol and sodium. To be labeled as ‘healthy’, a food must therefore meet the definition of ‘low’ for fat and saturated fat, and neither cholesterol nor sodium may be present at a level exceeding certain disclosure levels. It must also contain 10% of the daily value for at least 1 of 6 specific nutrients.

Dr Brackett described the health claims which refer to a relationship between a food, food component, or dietary supplement ingredient, and reducing risk of a disease or health-related condition. Certain regulations apply to such claims.

Finally Dr Brackett reiterated the importance of the US Dietary Guidelines as complementing these other instruments in order to create a meaningful framework to assist consumers in constructing healthy diets. At some point the FDA may consider signposting but it is difficult for these signposts to be applicable to all people - such as a young child, athlete or pregnant woman across the board.

Discussion:

• Questioned on the subject of consumer research and evaluation of labeling, Dr Brackett said that a lot more needed to be done. Joanna Scott mentioned that the ‘Sensible Solution’ labels had only just been launched so there had not been any evaluation yet, although a lot of market research was carried out for the initial design of the concept.
• Asked about sales related to ‘keyhole’ products, Dr Reuterswärd mentioned that some product ranges such as cheese had seen sales increases of around 15%.

Closing Session: Where do we go from here?

Dr Pilar Rodriguez Iglesias, (European Food Safety Authority) gave a presentation on the work of EFSA, explaining that the Authority performs risk assessment (science), but that risk management (policy) is performed by the European Commission, from which EFSA is independent. EFSA provides scientific advice and scientific and technical support on human nutrition and, at the request of the Commission, assistance concerning communication on nutritional issues within the framework of the Community health programme. Current and future areas of work include the development of dietary guidelines, novel foods, dietetic foods, dietary intakes for European population, and health claims.

The other members of the panel gave reflections on the conference, and on where we should go now:

Dr Robert Brackett (Director of the U.S. FDA’s Center for Food Safety and Applied Nutrition) warned of the importance to consider the unintended consequences of any policy actions. For instance, draconian changes to taxes or to advertising regulations may have consequences that had not been considered, so it is important to look at the global picture and consider all effects before change is made. He said how important it is for TACD to continue to provide politically-neutral solutions to ensure lasting change to the culture of consumption.

Michael Hübel (Head of Unit on Health Determinants, EC DG Health and Consumer Protection) announced that the European Commission’s Green Paper on Nutrition and Physical Activity will launch broad consultation to see what, in this mulit-factoral and multi-sectoral problem, can be done and which sectors need to be involved, and an Action Plan will be published by the end of 2006. The starting point is concern for public health, and the social and economic costs linked to this. One particular concern, which has been considered as part of the UK Presidency, is that of obesity seeming to be concentrated in poorer communities. The problems cannot be solved by regulation alone and, through its Platform, the EC will work proactively with the food industry, medical professions, consumer and public health experts to get commitments to work on these issues. The initial phase of the Platform has been difficult as the participants get comfortable with each other, but the work is starting to bear fruit, and also encourages initiatives at the national level in the EU. The Platform will think outside of Europe too, so the May 11-12 Joint Platform with the U.S. will benefit from experiences on the U.S. side and start a transatlantic dialogue on these issues.

Sabine Nafziger (Confederation of the Food and Drinks Industries of the EU, CIAA) explained that the food and drink industries want to be part of the solution to these problems, and have made commitments in the framework of the Platform. It would be unfair to judge industry before it has had a chance to carry out its commitments to the Platform. CIAA is very active in three areas – physical activity, advertising and marketing, and consumer information and education. Information is the key to empowering consumers to make informed choices, but they need to be educated to understand this information.

Bruce Silverglade (Center for Science in the Public Interest) responded that the reasons why we make unhealthy choices are not due solely to a lack of consumer information and education. Instead, he suggested that healthy foods could be made more accessible and more affordable and that processed foods could be reformulated. He noted that allowing billions of dollars of advertising to undermine whatever public health messages that do exist does hinders efforts to change the culture of food consumption. With regard to the debate over mandatory regulation vs. self-regulation, real progress has been made (e.g. restrictions on school vending machines in France and California, ban on trans fatty acids in Denmark) when mandatory legislation has been adopted. Mr. Silverglade also said it is also time to start talking about tax reform of food; it is not a question of a new “fat tax”, but rather of reforming existing taxes so that they are more rational from a public health and nutritional standpoint. While CSPI is not enthusiastic about self-regulation, it is willing to talk with industry about how government can help facilitate food reformulation, and about how changes in the tax structure could provide incentives to industry to use healthier ingredients.

Jim Murray (BEUC) asked how much evidence, with regards to the effect of food marketing to children, needs to be put forward before someone stops saying that there is not a problem. A ban on the advertising of tobacco is seen as a crucial part of the strategy to deal with a public health problem, and the same is the case for food marketing. The surest way of reaching our goal of competitiveness would be to abolish obesity in Europe, which is a huge economic, as well as social and public health, cost. It is therefore regrettable that the EC is about to announce that there will be more advertising of unhealthy foods to children, through the revision of the directive “Television Without Frontiers” Directive. It is worth noting that the World Federation of Advertisers, that presumably represents advertisers in the US as well, is in favour of restrictions in advertising to prevent clutter, and opposed to the use of product placement in advertising to children. Regarding self-regulation, BEUC would accept a voluntary agreement from industry not to promote junk food, but they do not believe it will happen, and that is why they are pushing for mandatory regulation.

Discussion:

• Matthew Marsom (California Department of Health Services), urged everyone to consider the question of food access, and enabling those in the poorest communities, where obesity seems to be concentrated, to have healthy food.
• Bill Jeffrey highlighted positive unintended consequences in food policy, such as the decline in the amount saturated fat in Danish food when trans-fatty acids were banned, as vegetable oils introduced instead. Also, when there were moves in Canada to remove partially hydrogenated oils, an unintended consequence was the increase of fibre and unsaturated fats in muffins.
• Jens Henriksson, (Swedish Consumers Association) asked whether the high level of calories and energy in alcohol means that alcohol consumption has a role in the obesity debate? Michael Hübel responded that the EC is doing an alcohol strategy concerning the harm of alcohol, and is very aware of links with energy intake. However, it would not mix it into the debate on nutrition.

Participants List