CONFERENCE REPORT:
GENERATION EXCESS

Contents

1) Executive summary
2) Welcome Session
3) Session I: Diet and health – the way forward
4) Session II: Nutrition labelling
5) Session III: Food marketing and advertising to children
6) Session IV: Fortified foods
7) Session V: Health and nutrition claims
8) Closing Remarks
9) Participants

Executive Summary

Delegates at the one-day ‘Generation Excess’ conference heard about the growing problem of obesity both in the developed and developing world. In some European countries, obesity rates have exceeded 30% of the population while in other regions of the world, more than 75% of the population is either obese or overweight. The growing obesity epidemic is particularly acute in children.

Many speakers stressed the importance of the World Health Organisation’s Global Strategy on Diet, Health and Physical Activity and consumer groups were urged to make their views known to their governments and be active regarding its implementation at national level.

Delegates heard about a range of initiatives to provide consumers with better information about food choice and to protect them from misleading information. Speakers from the European Commission explained plans for new labelling rules and legislation on health and diet-related claims and food fortification. The initiatives were broadly supported by consumer groups although some felt the Commission could have gone further and built in additional safeguards.

In approaching the problem of obesity many speakers stressed the importance of a multidisciplinary approach combining consumer education, better information and labelling, as well as action across a broad range of public policy areas. Medical experts stressed the importance of a preventive approach to diet-related diseases, especially in terms of cost-effectiveness.

There was a vigorous debate about the role of food advertising to children with calls for more effective regulation. An advertising industry representative called for greater co-operation with consumer groups but was largely met with scepticism about advertisers’ intentions. There were calls for increased government action across a range of fields including regulation of advertising, and food pricing and promotion policy. Several speakers made the link between poverty and obesity, and called for healthy eating to become the easier option.

Welcome Session with keynote speeches

Opening the conference, Jim Murray, European Consumers’ Organisation – BEUC, and Felix Cohen, General Director, Consumentenbond, stressed that it is necessary to focus on diet and physical activity, and that the causes of obesity are multi-faceted.

This was echoed by Paola Testori, Food Safety Director, DG Health and Consumer Protection, European Commission, who called for a multi-disciplinary approach acting on various levels. This should include nutrition and food policy, education, communication and raising awareness amongst consumers of how to choose food carefully, as well as promoting physical exercise. In short, any approach should go across the entire spectrum of public policy.

The European Commission (EC) hopes a comprehensive recommendation on diet and health will be adopted by the WHO assembly. Both diets and lifestyles must improve - over the last 20 years there has been a much bigger calorie intake and greater use of fats and more added sugar, while intake of fruit and vegetables fell. Diet is the most important determinant in cardiovascular diseases and, in the EU, obesity affects 10-20% of men and women, increasing by 40% in some countries. In the UK obesity in children was 8% in 1974 but now it was more than 22%, while in France it has gone from 3% to over 20%.

Food legislation itself wouldn’t change lifestyle but is an important contributing factor which could give the consumer the incentive to change their lifestyle. The EC recently presented a proposal to regulate health and nutritional claims on food products which, it was hoped, could influence and change marketing of food products, whilst ensuring that consumers have sufficient information.

Claims can only be made for products with a certain nutritional profile, and must be done on a scientific basis and subject to scientific evaluation. The EC is targeting nutrients which have a link to health, like saturated fats and transfatty acids, and  promoting food with a better nutritional profile. This approach to nutrition profiles will hopefully remain in the legislation, as it is an important goal for consumers.

Shaun Donnelly, Principal Deputy Assistant Secretary, Bureau of Economic and Business and Affairs, U.S. Department of State, said that the U.S. government is spending more money on the problem that at any time in history. There were one million new cases of diabetes in the U.S. at a cost to the U.S. economy of $100 billion. Sixty-one per cent of U.S. adults were now overweight or obese and the cost of dealing with it was $120 billion. Before 1991 there was only one U.S. state with an obesity rate of over 14%, but now every state except Colorado had an obesity rate of over 15%. In December 2001 the U.S. Surgeon General’s published his report on the problem and the U.S. Government met with representatives of the food industry to discuss ways of reducing fats and giving U.S. consumers healthier choices. Two fast food chains now offer healthier choices. The U.S. has devoted unprecedented amounts to research and President Bush has made a personal commitment.

However, the government should not take on the function of dictating mealtime choices. While the government’s moral and regulatory authority could be used, it’s not government action but ordinary people taking control of their lives that will should bring change. There’s no-one who doesn’t want to live a healthier lifestyle and we need to find ways of helping them do that.

Session I: Diet and health – the way forward

Pekka Puska, Director General, Finnish National Health Institute, stressed that the conference was discussing an issue of “great public health, here and globally”. Recent research on the causes of premature deaths found that six of seven top determinants of mortality related to how we eat, drink or move - diet and physical activity are therefore key determinants. In particular rapid changes in diet, declining physical activity, tobacco use, increasing urbanisation and changes in occupation have had an effect. However, prevention works and there is medical evidence to prove it. It is also the only affordable option. Hospitals are expensive and, in any case, ¾ of heart attack victims die before reaching hospital.

Eighty per cent of heart disease and 90% of type 2 diabetes could be prevented by modest changes in diet and physical activity. For example, Finland, 30 years ago, had the highest rate of cardiovascular disease in the world because of poor diet. Thanks to a campaign with strong government support, including from the media and industry, the mortality rate is now 82% less than 30 years ago. The WHO report 2002 showed that there could be substantial health gains from modest expenditures on intervention. It’s accepted that prevention is much cheaper than treatment, but the question is where to find the money. Prevention only represents a tiny proportion of government health budgets, and so we must look to the health insurance and social security budgets, which pay an enormous amount when people are sick but are not used to maintain health.

Dr Puska emphasised the role of policy support and welcomed the EU’s support for WHO Global Strategy on Diet, Health and Physical Activity. The WHO’s strategy was a roadmap for governments and other stakeholders, based on strong evidence and broad consultation. Implementation of this strategy could lead to one of the largest and most sustained improvements on public health ever seen.

Julia Unwin, Deputy Chair, UK Food Standards Agency, said of the obesity problems: “No-one is to blame but we are all responsible.” A successful approach requires the involvement of many government departments (i.e. not just the health ministry), as well as the food industry. Government levers, including information, influence, procurement, and legislation, could be activated, and we must identify the levers which produce results. In the case of procurement the UK public sector spends £1.8 billion on food so there was a lot of potential for the government to be a “very noisy and influential consumer”. Public sector catering accounted for 7% of the market, and while it’s seen as difficult to influence, it is only a handful of firms that actually dominate the market.

Taking the example of salt, there is clear evidence of the harmful effect of eating too much of it, with it being responsible for 35,000 premature deaths a year in the UK alone. The EFSA has agreed a joint strategy on salt, which is a positive step, as food is a global business. Consumers cannot do it on their own, and there is a need for the food industry to take action, as 75% of the salt we eat comes from processed food. The UK Food Standards Agency is publishing data on salt content in ready meals, bread, sausages and pizzas and running a public campaign to inform consumers about the available choices. Most people don’t know how much salt they eat and don’t know where it comes from, though they know they eat too much. But most people with high blood pressure could get better within weeks if they cut their salt intake.

Turning to the issue of children and advertising, children are bombarded with message about food from TV, celebrities and friends. A recent study by Strathclyde University concluded that promotions do have an effect on what children eat, influencing both the market size and the choices made. Now the research is available it’s time to take action, especially given the discernible shift in the attitude of the food industry, which is having to respond.”

Richard Daynard, Professor of Law, Northeastern University, Boston, (phaionline.org) said there was a limit to how much we should try and change the behaviour of consumers. While regulating consumers in undesirable, regulating business is another issue. In the U.S., however, business is deregulated leaving litigation as the principle lever to get the attention of industry. In America, people have started to think that what happened with tobacco could happen to food industry. Talk about litigation serves as a tremendous public communication regarding the obesity epidemic, previously unknown despite the Surgeon General’s report. The focus on litigation had produced a multifold increase in media articles and food companies have responded.

Much attention has been paid to cases brought against McDonalds but those cases were difficult to prove and not the most promising in the short-term. The Public Health Advocacy Institute is looking at various forms of litigation, trying to establish whether: companies had behaved badly; had behaved in a way which has increased the number of people who are overweight or obese; or had failed to do something which would have reduced the number of people who are overweight or obese. Taking the example of vending machines, he questioned the practice of marketing to schoolkids, in the case of Coke and caffeine, the marketing of a low-nutrition, mildly addictive, calorie-dense drink. There are laws against unfair or deceptive practices that would this a clear case. He also questioned the practice of Saturday-morning televisual marketing of high-calorie obesogenic products. Advertisers run the campaigns because they know they work. Selling a food as “low in fat”, but making up the calories with sugar, that’s deceptive. Selling a cereal that’s 50% sugar which provides vitamins because they were added is also deceptive. This is the kind of litigation that will be seen in the next wave. 

Philip James, Chairman, International Obesity Taskforce, and member of the FAO/WHO Committee, said that only in the last four years had obesity been highlighted as a global problem, referring to the WHO report of 2000. Obesity is no like any another disease, and it is only in the last 50 years that the human race had been exposed to this problem. In some countries, ¾ of the populations is overweight, so there is no question of picking off individuals. The WHO said in 1997 that 2-3 billion people are overweight or obese. Most of the reasons for people becoming obese have nothing to do with food, but rather with environmental or lifestyle factors. Yet the Health Ministries are one of the weakest components of government, so the question is how to influence other departments to change. Policy-makers have to think about costs and benefits, so you need to be able to provide a guarantee that obesity can be prevented. Some things might have a phenomenal effect but there is no evidence, so the International Obesity Task Force has collected evidence showing where there is an effect. collected. We’ve collected all literature you can do things where the evidence shows there’s an effect. You can prevent diabetes with dietic advice - to lose weight, limit fat, sugar and increase fruit and vegetable intake. Tackling obesity involves dietary change and physical activity. Half of Europe’s population needs to lose 10 kg, while the overweight need to lose 20 kg or cut their daily intake by 600 calories. The Trim and Fit programme in Singapore reduced obesity from 16% to 10%, but, to be effective, such campaigns need the very highest level of political backing. In Singapore’s case it had included the PM exercising on television.

Summing up, he stressed the need for a comprehensive approach. There’s no single bullet. Price is important and government has responsibility in a number of areas, including advertising, food labelling, fiscal policies, research policies and food standards.

Amalia Waxman, Project Manager, World Health Organisation Global Health Strategy, stressed the need for consumer groups to be active. WHO Member States have called WHO to develop a global strategy on diet, physical activity and health with a holistic approach based on best evidence. WHO developed the strategy through a broad process of involving stakeholders and hopes to see this approach continue when it comes to implementation of the strategy. The WHO consulted more than 80 member states, representatives of civil society, the private sector and UN agencies. In drafting the strategy more weight was being given to recommendations made by Member States. A draft was discussed in January in Geneva by the Executive Board and it was decided to have five more weeks to comment on the text, which should be ready by mid-March. Member States expressed their wish to see the strategy endorsed at World Health Assembly in May.

There have been a number of areas of controversy during the executive board. Some criticised the WHO for working on a flawed scientific basis. Some were concerned at the influence of marketing to children, while others questioned evidence for intervention or whether the WHO’s role had been too interpretative.

On personal responsibility, some delegations at the Executive Board commented that the Global Strategy focuses too much on environment and some wanted to stress freedom from government coercion.

The WHO expects to receive comments from Member States. The role of consumer groups in this process is to continue and influence demand, and the main challenge is to change demand. On information to consumers, there is a need to continue and mobilize consumer groups to improve food labelling and health claims. Consumer organizations actions influences both governments and consumers, as well as the private sector.

The speakers provoked lively debate and comments.

On the question of individual responsibility

• Dr Puska - while it existed, it was a question of how free you are to make healthier choices, and queried the level of responsibility that children have. Adults and schools had to decide for a healthier future.
• Bruce Silverglade, Center for Science in the Public Interest – American consumer groups and health organisations do not support the notion of individual which is, at worst, an excuse for governments to do nothing, which is just what the food industry wants.

In terms of government action

• Professor James – it’s possible to make a difference with pricing policy e.g. EU’s Common Agricultural Policy on butter and margarine. In both the EU and the U.S. there have been government policies that promoted unhealthy foods, fats, oils, sugars.
• Shaun Donnelly - government has the ultimate ability to use more forceful actions, such as taxes, but these are seen as tactics of last resort in the U.S. where there is strong aversion to government regulation. There would have to be compelling science and a clear consensus before the U.S. talks about a more draconian approach introducing legislation, especially on taxation.

One delegate asked if there been studies on relation of income and professional activity to obesity

• Professor James - when you come out of poverty the rich people are obese, with the post-war generation in Germany being a good example. But there has been a reversal and in most societies it’s easier to buy foods which are unhealthy. Obesity is now a disease of poverty
• Rhoda Karpatkin,, President Emeritus, the US Consumers’ Union, welcomed Professor James’ comments about the link with poverty. The U.S. is particularly vulnerable, with over 40 million of its citizens having no health insurance. Not only more susceptible, they have less access to medical treatment. Labelling will not reach this section of the population.

Many delegates pointed out that the food industry was keen to introduce healthier products but were afraid of losing market share

• Olivier Andrault, Centre Consommation, Logement et Cadre de Vie - it is important to realise that the European food industry is not a bloc and there are various approaches to food production.
• Some reflected that if companies reduced the amount of sugar marketers will say their products are less interesting, so a government-led approach to reducing fat or sugar is needed.
• Amalia Waxman - some big US companies had started to introduce changes and this could help push others in industry to make these changes.
• Professor James - the food industry in the EU and the U.S. was fairly low-tech compared to other sectors of industry. The proportion of turnover spent on R&D is small compared to other industries and mostly focused on marketing low-salt, low-sugar products. They need to be stimulated to make them more innovative.

Session II: Nutrition labelling

Michelle Limoli, U.S. Food and Drug Administration, spoke about the U.S. nutritional labelling system, which arose out of the 1990 Nutrition Labelling and Education Act. The system is based on scientific research and studies with focus groups into what type of labelling can be understood by consumers. Mandatory labelling is based on current public health recommendations and should be seen as a tool, not as the single answer, and some consumer education was still needed.

A key feature of the system is the reference to a standardised serving size. Labels list the calorie and fat content, as well as nutrients whose intake should be limited. Other nutrients are listed in terms of a percentage of daily value based on a diet of 2000 calories.  Three nutrients are listed: fats, sugars and proteins. The labels provide a quick guide to daily value: 5% or less is low, 20% or more is high. The system aims to point out the best options available and allow consumers to compare claims and make dietary trade-offs. It is necessary to adjust as the science changes; for example, serving sizes may need to be adjusted to take account of the fact that average portions are now larger. Further research is also needed to find out how consumers are using labels and whether they’re useful.

Basil Mathioudakis, DG Health and Consumer Protection, European Commission, talked about proposals for revising the EU’s food labelling rules. Currently, nutrition labelling is voluntary and compulsory only when nutrition claims are made about nutrients like fats, proteins, energy, carbohydrates. The EC would like mandatory labelling and believes that the majority of member states would be in favour of this, provided information given is short and relevant. European industry is not opposed outright but some groups, including small businesses, are concerned that this will impose a heavy burden on them.

In terms of which nutrients to list, the EC looked at WHO recommendations on non-communicable diseases and decided on 6 elements: energy / calories, fats, saturated fats, carbohydrates, salt, and sodium. There are also calls for adding other elements, but the EC felt that providing information regarding protein and fibre should be voluntary. Industry thinks six is too many and they would like energy, carbohydrates, fat and protein. There would have to be some derogations to deal with concerns of small businesses as well as for products like tea, coffee, spices. The proposal should be tabled before the end of this Commission’s mandate and probably before the end of the summer. It would then have to be approved by the Council of Ministers and the European Parliament.

Bengt Ingerstam, Swedish Consumer Forum, Konsument-Forum, explained the Swedish keyhole system which aims to inform consumers about better food choices. Introduced in 1999, 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. So products containing up to 41% fat can be labelled, such as Becel margarine, by producer described as a healthy mixture of fat! Products involved include, milk, yoghurt, bread, biscuits, flour, breakfast cereals, fat spreads, meat and cured meats. It is under discussion to include sugar and salt.  The scheme will be revised in 2004. 

Bruce Silverglade - nutrition labelling is one part of a comprehensive approach to tackling obesity and diet-related problems. Obesity is aggravated by food adverts, agricultural subsidies and other factors, which cannot be resolved by labelling.

Session III: Food marketing and advertising to children

Sue Dibb, UK National Consumers’ Council, spoke about the Hastings review on the effects of advertising on children, commissioned by the UK Food Standards Agency. It found that the majority of TV advertising is for sweets, soft drinks, confectionery, savoury snacks and fast foods. 95% of adverts are for less healthy food. The review provided sufficient evidence that food promotion can and does influence children in their preferences, purchasing behaviour and consumption, especially at both brand and category level. The findings may underestimate effects because the study only focused on TV advertising and only looked at direct effects, not indirect effects of parents and peer groups for example. Full research can be viewed at food.gov.uk.

Stephan Loerke, World Federation of Advertisers, explained that the advertising industry is asking how it can be part of the solution. The WFA’s mission statement is to “defend the freedom to advertise responsibly”. The advertising industry realises the gravity of the threat of obesity, although may not agree with consumer groups on the solutions, including the role of advertising. There was need for dialogue, and there may be common ground. WFA welcomes the WHO strategy’s call for collaboration between different actors. A large number of factors are responsible for obesity, and simply blaming advertising ignores the complexity of the subject. While food advertising plays a role in food choices there is not a direct link between advertising and obesity.

Referring to TACD’s call for a review of marketing guidelines, especially on restrictions of high calorie, energy dense foods, he pointed out that Coca-Cola had removed all branding from its vending machines in the UK and was reviewing product choice in the machines themselves. Nestlé has released communications principles, McDonalds has added salad choices and fruit to its menus, and Kraft has announced the end of in-school marketing. These companies are setting a trend.

WFA has been working on raising awareness and strengthening self-regulation codes, believing that a legal framework is an essential basis for effective self-regulation, and calling for a carrot and stick approach. However, not all advertising self-regulation systems are working to the same standards and WFA is involved in the process of ensuring that they work, and setting others up in accession countries. Media literacy campaigns are also important, such as the Media Start programme in the UK that is based on a Canadian system which 98% of teachers said they would re-use. There are plans to launch similar schemes in other EU countries. There is also a need for more public advertising campaigns which can be very effective, as road safety campaigns had been.

Andre Allard, Legal Counsel, Quebec Office for Consumer Protection, expounded on Quebec’s ban on advertising to children, which has been in place since 1978. The legislation was motivated by consumer protection concerns and not specific health or obesity issues. In 1978 the Quebec government was reviewing legislation on consumer protection as the U.S. Federal Trade Commission was carrying out an investigation. The FTC study concluded that children were very susceptible under the age of 7 and from 7 -12. In 1981 the FTC published its report supporting that the only effective remedy would be a ban on all advertisements oriented towards young children but did not recommend to proceed with this remedy.

Key criteria for deciding which adverts to ban: the nature and intended purpose of the products, the way in which the advert is presented, and the time and place in which it is shown. The decision was challenged in the Supreme Court which ruled that, although it was a restriction of commercial freedom of expression, the problem was a major concern  the ban was therefore reasonable. The Office for Consumer Protection advises companies on how to comply with the law.

Asked if the ban was effective, Mr Allard said that they hadn’t measured the impact. Quebec has one of the lowest obesity rates in Canada but it’s difficult to say whether this the ban has had a direct impact, and it is one of many measures that can be taken.

Marianne Abyhammer, Deputy Ombudsman, Swedish Consumer Agency, said that Sweden and Norway were the only European countries which have bans on advertising to children. The Swedish ban dates back to 1991 when commercial TV was introduced and it was felt that children should be protected from commercial pressures. The ban applies to all TV advertising of all products (not just food) aimed at catching attention of children under 12. Also no advertising at all is allowed immediately before, during or immediately after children’s programmes.

Assessment is very complicated, and depends on representation in the advert; for instance, is there a child, a cartoon character, or a child’s voice in it? Other factors include whether it is shown during the daytime when kids are watching, or close to a family programme, and whether the product is aimed at children. In court cases judges have put the emphasis on products and markets rather than representation. The legislation was challenged in the DeAgostini case in the European Court of Justice, but was cleared, as long as it was not imposed on TV from other countries. 

Is it working? The ban is relatively easy to circumvent ban but Sweden doesn’t have advertising targeting children, and therefore less commercial pressure on children who watch Swedish TV. It has also had a preventive effect on design of commercials. Satellite channels have agreed to some extent to remove adverts on programmes broadcast to children. Nevertheless, obesity in children is almost as high in Sweden as in other countries showing that marketing legislation cannot deal with lack of responsibility from advertisers.

In the ensuing discussion, the role of self-regulation in the advertising industry featured very strongly.

• Bill Jeffrey, CSPI Canada, consumer groups have difficulty with self-regulation because they believe that genuinely ethical standards should not allow advertising of soft drinks and cereals like Fruit Loops to children
.
• Stephan Loerke – the advertising industry sees self-regulation as a way of implementing legislative provisions. Asked whether the WFA would work on a code of conduct regarding the advertising of unhealthy products, Mr Loerke said that self-regulation codes were required for companies to take into account responsible WFA could agree self-regulation codes in the first half of this year.
• Charlie Powell, Sustain - self-regulation is wholly unrealistic and will never work. Consumer groups would find it very difficult to work together with advertisers if it meant allowing advertising of fatty, sugary, salty foods. There is no appreciation in self-regulation codes of the cumulative effects of consumption of these foods. Self-regulation was wholly unrealistic.
• Stephan Loerke - the discussions were on focusing on only one aspect of the debate. The ban in Sweden hasn’t affected obesity rates and stopping commercial communications elsewhere would not solve the problem.

Session IV: Fortified foods

Michelle Limoli, U.S. Food and Drug Administration, explained the US approach to food fortification, defined as addition of a food, food constituent or food supplement. The U.S. has mandatory fortification for such things as folates in bread, pasta, etc. For discretionary fortification there are only guidelines and fortifying snack foods is not allowed. Discretionary fortification is driven by marketing and is very prevalent in the US. Many items are fortified to 100% of daily recommended limits. There are questions about what happens if you eat several times the daily limit. In 2002 the Food and Drug Administration (FDA) and U.S. Department of Agriculture requested guidelines on fortified foods from the National Academy of Science. The outcome was that there should be a scientific justification based on documented health needs. There were safety issues to be taken into account, she pointed out, as excessive consumption of some substances may be harmful, e.g. excessive intake of magnesium may cause diarrohea, excessive amounts of Vitamin A may harm the liver, etc.

Basil Mathioudakis, DG Health and Consumer Protection, European Commission, explained that in November the Commission had proposed a regulation on addition of vitamins, mineral and other substances to foods. The Regulation defines the purpose for which fortification can be allowed, such as restoration of vitamins and mineral lost in the production process, or the production of substitute foods. Following Codex Alimentarius guidelines, additives would be allowed when there is a deficiency and when there is a potential to improve nutrition because of dietary habits. The proposal has restrictions on foods to which vitamins and minerals can be added. Evolving science must be taken into account, such as scientific discussion on the role of folic acid in health. The proposal was not very controversial and will hopefully remain that way, despite a ruling by a UK court in favour of consumer groups which refers the Food Supplement Directive to the European Court of Justice.

The proposal is linked to another proposal on health and nutritional claims. It depends on whether the Council and European Parliament retain Article 4, which was under pressure of being removed. The criteria being proposed are similar to the Directive on Food Supplements. Perhaps Europe is ahead of the U.S. because of its intention to limit the amount of minerals and vitamins you can add. There are two main criteria: upper safe levels, as established by scientific data, and the amount of nutrients that are got from other sources. For foods to which vitamins and minerals have been added statements should be correct in provisions of claims regulation. That’s how a link is made to the claims legislation. Products also have to be notified.

Dónal Walshe, Secretary General, EURO COOP, said there’s a need for harmonisation of fortified food rules at EU- level. He welcomed the EC proposals on food fortification as Europe had seen the growth of an unregulated market in fortified foods which claim to be healthier. EURO COOP is concerned that rules on use of fortification should only be possible where there is a benefit for the consumer, and a clear public heath impact assessment.  Ethical concerns arise because consumers are facing a situation where sugary, salty, fatty products are being fortified and marketed as healthier. EURO COOP is not against the concept of fortification which can bring real benefits, however it should ideally only be allowed for population groups whose intakes are lower than recommended daily allowances. Foodstuffs which do not have the necessary nutrient profile should not be allowed to be fortified. The EC should adopt nutrient profiles and also look at longer-term intakes. EURO COOP supports the EC on maximum and minimum limits as otherwise there could be excessive use, but says the measure should go further. Fortification is not needed when consumers have a healthy diet.

On labelling, EuroCoop believes that consumers should have access to information in order to guarantee freedom of choice. Nutrition labelling should appear on all foods and labels should state recommended daily allowances. There should be a warning on labels on maximum intake levels. There are good arguments for statements that this food is not an alternative for balanced diets. 

• Sue Dibb - could manufacturers be prevented from adding vitamins to the name of products. Under the proposed legislation? Basil Mathioudakis - established brand names such as Diet Coke and Weightwatchers cannot be touched, but in the future new rules will be taken into account when names are registered to determine if it makes a health claim.

• Richard Daynard - do the authorities agree it’s misleading when manufacturers want to add 100% of daily requirements in order to sell products as health food?
• Michelle Limoli - this was under consideration by FDA because it’s seen as a serious problem.

• Rasmus Kjedahl, Danish Consumer Council - the fortified foods proposal is problematic because it does not include nutritional profiles. A lot of unhealthy foods could be fortified and would fool parents into thinking they were eating healthy food. Paola Testori - fortification proposal didn’t include nutritional profiles but she argued that to have it in the claims proposal was enough. When the food industry fortifies food it is to make claims so by regulating claims it regulates fortification. All claims would have to respect nutritional profiles.

Session V: Health and nutrition claims

J Howard Beales III, Director, Bureau of Consumer Protection, U.S. Federal Trade Commission, said that improving consumer understanding of what we eat is an important goal. The Federal Trade Commission (FTC) has jurisdiction over food advertising while the FDA has authority over food labels.

A 1989 study into Kelloggs’ All-Bran campaign found that healthcare claims had a positive effect on fibre consumption and consumer knowledge, and that those gains were largest among most disadvantaged groups. In 1990 the Nutrition Labelling Education Act (NLEA) was passed and has been effective. The percentage of advertisements with health claims fell, and ads referring to fat and oil feel from 45% to zero after the NLEA.

Decline in health information has prompted concern that consumers have a right to truthful health claims. It is crucial that consumers understand limitations of evidence as well as the facts. Claims can be modified as science changes. Obesity is a growing concern and policy-makers are considering a range of options to encourage greater competition between firms. The FTC is looking at whether government regulations have produced a decline in information, and thought that the FDA should review the calorie serving. The FDA should allow greater flexibility on reduced calorie claims, and should allow health claims which link reducing calorie intake to lower prevalence of certain diseases.

Patrick Deboyser, DG Health and Consumer Protection, European Commission, spoke about the proposed rules on health and nutrition claims. Since the proposal was first mentioned in the White Paper on food safety in 2001 it has developed in two ways. Originally, the Commission had not wanted to discuss disease-related claims, but industry and consumer groups asked for the existing ban on references to disease in labelling and advertising to be relaxed. The Commission also introduced Article 4, would indicate levels of fat, saturated fats and transfats, sugars or sodium that would act as disqualifying criteria. There’s been controversy about this article which came late in the Commission proposal, and European Parliamentarians have said that the concept is not very clear.

There is less resistance to the notion of nutrition profiles, although Germany is opposed and some Member States have reserved positions. Article 11 on health claims is also controversial. The EC thinks some claims should be banned even if they can be substantiated, such as on slimming products. Consumers are disappointed with such products because they don’t relate to conditions in which you lose weight. There are special categories for energy control, but even for meal replacements it is not possible to make claims about how you lose weight. These products are not true meal replacements. Products which can’t make claims will not be kept off the market, but just prevented from making claims. The presence of additional vitamins and minerals can only be claimed if the product also complies with health and nutritional claim proposals.

• Richard Daynard - do EC and U.S. consider claims as deceptive to consumers? Is the FTC going to investigate these health claims?
• Bruce Silverglade - are there any cease-and-desist orders to food advertisers?
• Mr Beales - until now, the FTC has concentrated on dietary supplements and a joint enforcement campaign with FDA.
• Mr Deboyser - on specific claims, products could be sold as medicines, such as mineral waters sold in Germany through pharmacies. The European Commission is proposing that, in the case of disease-reduction claims, a dossier must be submitted to the EFSA for verification.

Closing remarks

Summing up, Sue Davies, UK Consumers’ Association, and EU co-chair of TACD’s Food Working Group, said it was clear that a critical point had been reached in terms of the impact of diet on health as had been highlighted by Pekka Puska. However it was also clear that something could be done about it. Philip James had highlighted the complexities of the issue and how we needed to adopt a multi-disciplinary approach involving a range of ministries and stakeholders. Government and industry have important roles enabling consumers to more easily make healthy choices. Approaches among the many needed had been highlighted including the role of labelling, controls over claims and fortification and the marketing of foods to children (who need particular protection) as well as the threat of litigation in the US. Consumer organisations have an important role to play and many are working on these issues at national level. It would also be a TACD priority and the conference would help formulate more detailed positions and strategies. Amalia Waxman had highlighted the importance of the next few weeks for the WHO's Global Strategy on diet and physical activity both in terms of lobbying, but also consumer organisations' role in influencing consumer demand as well as governments and industry practices.

Bruce Silverglade, Center for Science in the Public Interest and U.S. co-chair of TACD’s Food Working Group, said:

• Combating obesity has become an essential public health measure – it is a time bomb waiting to explode, especially among children.  Governments must act now, on the basis of available evidence, to take steps to protect our health.

• Obesity is not merely a matter of individual responsibility.  We must look at the total food environment – the pervasiveness of junk food advertising, the inadequacy of food labelling, food availability such as the prevalence of low nutrition foods in easy to access vending machines, food pricing, school food programs, and the lack of adequate mass educational campaigns.  The personal responsibility approach has been tried by the Bush administration in the United Sates and has failed miserably – the U.S. has one of the highest obesity rates in the world.   

• Some aspects of the hostile food environment are actually created by government.  Commodity advertising and promotion programs in the U.S. for the beef and pork industries, and pressure by American dairy farmers to require schools to offer full-fat milk in lunch programs are good examples.  Government policies have been part of the problem and now must be part of the solution. 

• Self-regulation is inefficient and ineffective.  It is nice that McDonald’s is now offering salads, but as the draft World Health Organization (WHO) Global Strategy on Diet, Physical Activity, and Health report notes, fast food chains must reduce the fat, salt and sugar content of their regular line of menu items.  Similarly, it is great that Coca-Cola has agreed to remove branding messages from its vending machines in schools in the UK, but why has the company not agreed to take this action in the U.S.?  Perhaps it is because Coke realized that the government of the UK is serious about regulation while the U.S. government is not.

• No one measure by itself, whether it is a ban on food advertising directed at kids, or a requirement for nutrition labelling, will end the obesity epidemic.  Such measures must be part of a comprehensive public health strategy dealing with the overall food environment that leads to unhealthy eating.

• While food and tobacco are different, we have learned from the tobacco regulation experience that there are a number of successful public policy approaches than can be taken to change public attitudes and decrease the consumption of unhealthy products.  We should support final approval of the WHO’s draft Global Strategy on Diet, Physical Activity, and Health which can serve a blueprint for such measures.

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