Vague & chaotic?

When it comes to eating chocolates, chips and other packaged junk foods, the behaviour of 5-year-old Harshita, who belongs to an economically weaker section, is similar to that of any other child belonging to an affluent family. The basic difference between the children belonging to both sections of society is the 'affordability' of the pricey chocolates, chips, beverages or any other packaged food products that are readily available in the retail market.

It's a hard fact that most children are die-hard fans of packaged food products, and parents find themselves duty-bound to buy the same, which may prove to be a 'health hazard' for their kids after a few years of consumption of food items having high sugar and sodium (salt).

The reason behind this 'intentional ignorance' is the absence of any norm to regulate the contents of packaged food items. In India, there is no system in place to put a label or warning symbol on the front of the pack of food products – as is done in the commonly known FoPL model. Members of several consumer groups must be credited as they fought a long battle of 'mind game' with multinational companies for 'compelling' the government regulator to bring a stringent FoPL model in India. Though the battle is not yet won, the chances are very bright that the government would soon come out with an effective FoPL model.

Alarmed by the rising number of non-communicable diseases such as cancer, cardiovascular ailments, obesity, diabetes, etc. resulting from high intake of sugar and salt available in packaged food products, the apex food regulator — Food Safety Standard Authority of India (FSSAI), led by 1987 IAS batch Chief Executive Officer Arun Singhal — swung into action and organised over seven rounds of meeting with all the stakeholders, including consumer groups, industry honchos, scientists and experts after he joined the office in June 2020.

Serious efforts have been made by the FSSAI to build a consensus over the highly contentious FoPL issue by bringing all stakeholders on one platform. After their agreement during a stakeholders' meeting conducted on June 30, 2021, it was decided to take the journey of FoPL forward by tasking FSSAI to commission a survey-based study through an institution of excellence to analyse major FoPL models that are available across the globe, with the objective to identify ease of understanding and behavioural change of Indian consumers at a national level.

Now, the findings of a study conducted by IIM-Ahmedabad have suggested adopting Health Star Ratings (HSR) as the front of pack labelling model. Agreeing with the findings, the food regulator has also suggested the incorporation of HSR in the draft regulations and sought comments from stakeholders on the same.

The IIM-A, in its study, has claimed that 20,000 people belonging to different sections and communities have been surveyed and majority of them were in favour of 'star ratings' as a sign of warning for consumers before choosing a packaged food item to eat. The main cause of worry for members of consumer groups is that the IIM-A has not shared the used questionnaire pattern. They have also alleged that IIM-A works in the larger interest of the industry. No doubt, the sample size of the IIM-A survey is the largest in comparison to any other study conducted by the countries — such as Chile, Australia, New Zealand, Germany, etc — that have implemented the FoPL model.

During a stakeholders' meeting, which was held on February 15, 2022, most of the members of consumer groups opposed the HSR model of FoPL, while industry representatives, who were present in plenty, 'supported' the recommendations. The experts present in the meeting also noted that IIM-A's study recommendation is in the interest of consumers.

However, when contacted, Seema Suri, who is an associate professor at the Department of Nutrition, Institute of Home Economics, Delhi University, refused to comment on the findings of the IIM-A study, citing that she is a member of the FSSAI's scientific panel. Another expert member, Anuja Agarwala, who is a paediatrics dietician at AIIMS-New Delhi, thought it wise to stay away from the FoPL controversy.

When asked whether the industry is going ahead with HSR, Meetu Kapur, who represented the Confederation of Indian Industry (CII) at the stakeholders' meeting, said, "When the study has suggested HSR as the FoPL model and consumers understand it in a better way, we will abide by that."

Reacting to the allegations made by consumer groups that the study is biased, Kapur said, "I don't want to comment on any such matter. We respect the regulator. When the regulator has commissioned a study by an institute of great repute of our country, we will respect the findings."

To some extent, Kapur is right as the study was commissioned by the regulator after approval from all the stakeholders, and the findings should now be accepted by all.

"One cannot predict the impact of its implementation without even testing the FoPL model. What has failed in Australia does not mean that it would also not prove effective in India. The demography and consumer base of India is very different from any other country. The consumer groups should accept the findings of IIM-A and allow the HSR model to be rolled out," a health ministry official said, adding that they wanted it to happen at the earliest, and now it's the consumer groups who are creating roadblocks and delaying the rollout of FoPL.

Contrary to the Health Ministry official, Ashim Sanyal, who represents Consumer Voice, said that the IIM-A study is being manipulated to protect the industry's interest which is least

bothered about the health of children or any other group. "The key objective of the food industry, which is owned by multinational companies, is to make profit at any cost. The IIM-A study is in favour of the industry, as the suggested HSR model for FoPL is not going to serve the purpose," Sanyal said.

"Instead of creating awareness among consumers, the star rating would create confusion. They may perceive stars as a sign of quality. Also, chances are very high that food manufacturing companies would engage in unethical practices to improve the star ratings of their products," he said.

On making it voluntary for four years, Sanyal said, "Considering the disease burden related to the consumption of highly processed foods, FoPL cannot be left to the food industry which is profit-oriented and has no obligation towards public health mandate. All existing evidence has shown that voluntary FoPL does not come to pass."

If HSR is used, there is a potential for creating misconception by the industry as the HSR ratings may be improved by adding even one or two positive nutrients, which does not offset the potential for adverse effects of the product, Sanyal said, adding that FoPL warning system should be made mandatory to reduce the overall consumption of food items high in salt, sugar and fat.

He also demanded that the WHO thresholds for FoPL should not be diluted and it should be free from any mention of positive nutrients. "Images should be used rather than numbers on packaged food to enable

interpretation by persons with poor literacy. The FoPL should be immediately applied to new food products and stickers should be used on products already on the shelves," he said.

Notably, Chile, Peru, Mexico, Israel and Uruguay already have FoPL nutrition warning systems in practice, while Brazil, Columbia and Canada are likely to enforce it in 2022.

Advocating for a strong and effective FoPL model, noted consumer rights activist Pushpa Girimaji said that there should be some pictorial depiction. "As most of the consumers don't know much about high sugar and salt contents available in a packaged food, they consume an excessive amount of sugar and salt that makes them vulnerable to several non-communicable diseases," she said, adding that multiple-traffic light is very easy to understand, while star ratings will be more difficult to understand.

"The star rating will create confusion among consumers. It will be difficult for the consumers to find whether one is good or five is better. The FoPL model needs to be simple and easy to understand. The star ratings will not serve the purpose unless it is not accompanied by a comprehensive awareness drive," she opined.

Demanding statutory warning on the front of the pack, Ashwani Mahajan — the national co-convener of Swadeshi Jagaran Manch – said, "The HSR model of FoPL will not work. The FSSAI should formulate a policy to make it must for all food packets to have warning messages like 'eating high sugar and salt is injurious to health'. The warning message will be more effective in controlling the high intake of sugar and salt."

Raising a doubt that star rating may become a tool of marketing for the food industry, Central Government Health Scheme Employees' national president Vikas Jain said that the parameters for star rating should be completely scientific as the food companies may misuse the rating mechanism for their benefits. Jain also suggested that FSSAI should make the rating process transparent by putting the data in the public domain.

Away from the FoPL slugfest between consumer groups and the food industry, shopkeepers and parents have expressed their satisfaction over the FSSAI's initiative to turn FoPL into a reality.

"As of now, there is no warning label on any food products. I buy chocolates or chips as per the taste of my children, even without knowing how harmful it will be for my kids. If there will be a warning label on the front of the pack, it will help mothers like me to choose food products on the basis of ratings," said Soni Koli, a mother of three kids.

When asked, will it be easy to understand star ratings, she said, "Yes, it will be. I'm not much educated, still I know that eating packaged food is not good for the health. If there will be "one star" on a packet of chips or chocolates, I would look for food items having more stars."

Anjana, who works at an Anganwadi centre in Delhi, said that be it a star rating or multiple traffic lights, parents are interested in decoding the warning message. "Even illiterate parents are more concerned about the health of their children. It's the need of the hour to have a warning label on food packets."

As the FSSAI is ready to go ahead with the HSR model of FoPL, the consumer groups, under the umbrella of Nutrition Advocacy in Public Interest-India, have written a letter to Prime Minister Narendra Modi and expressed their concerns over FSSAI's decision to include HSR in the draft regulation.

"The HSR could be misleading and controversial as it leads to providing more stars to food items that don't deserve to be called healthy or are explicitly unhealthy. HSR is creating 'health halos' while warning-based systems could be more easily understood. The HSR modelling, therefore, is fundamentally flawed," the letter read.

Consumer groups have also highlighted the conflict of interest within the panel. Referring to the case of Seema Puri, who is a member of 'scientific panel' on labelling, claims/advertisement and functional foods, the consumer groups claimed that she has been associated with several food-related companies — like GSK Healthcare, Danone and PepsiCo India — as a consultant on research, strategy, and new product launches.

It has also been claimed by consumer groups that K Madhvan Nair, who is a member of FSSAI's scientific panel on fortification and the scientific committee, is also the chair of the labelling panel. Further, Nair is a member of the International Scientific Committee of CHOICES International Foundation, which is primarily funded by the food industry.

Views expressed are personal

In a nutshell, all have to respect consumers' feedback

Why FoPL?

It has been found in every country that FoPL brings behavioural changes among consumers and promotes healthier food eating habits. So, FSSAI is also making efforts to bring FoPL into the country. Earlier, a regulation was brought in, but no consensus was reached as it was assumed that there were no sufficient consultations conducted over the issue. So, we started comprehensive consultation with all stakeholders and seven rounds of consultations have already been done.

Taking all on board

During the sixth stakeholders' meeting, all agreed to consider 'total sugars' and no added sugar, total fat instead of saturated fat and the term 'salt' to be used on FoPL for ease of understanding. It was also decided to limit the category to two – food and beverages.

Why fresh study?

When we went through different studies on FoPL conducted in several other countries, we found lots of disparities. There are 10-11 countries where FoPL is mandatory while FoPL is voluntary in most of the countries. On comparing both the systems, we found that mandatory FoPL has more effective results than a voluntary one. The comparison with other countries is not valid.

So, all stakeholders agreed on conducting a survey by a reputed institute. IIM-Ahmedabad and IIM-Hyderabad showed their interest. IIM-H refused to do the survey, while IIM-A agreed to take it forward. We gave just two mandates – find out the effectiveness of one among five FoPLs which also has the potential to change consumer behaviour. There was no interference from our side. The IIM-A study found that multiple traffic lighting systems are more effective in changing consumer behaviour while Health Star Rating is easy to understand.

Bone of contention

During the last consultation, consumer groups opposed the recommendations of the IIM-A study. The study was conducted after their approval and now they are refusing to accept its findings, which will not be acceptable. When over 20,000 consumers have directly given their feedback, then there is no point in asking about the preferences of consumers from anybody else.

The industry was in favour of the monochrome GDA FoPL model and consumer groups were in support of warning labels, but the IIM-A study has recommended HSR. So, all should now accept the HSR model.

Controversy over points for star

The weightage design of point scores would be finalised in such a way that a few positive points would not overshadow the negative points. Adding some positive nutrients to food products having one rating would not improve its rating to four. A robust point weightage system is on the anvil to avoid masking negative points.

The rollout plan

It's just a start. After bringing out the draft notification, public comments will be sought and after vetting out and incorporating all the suggestions, it will be sent to the government for approval. Once approved, the HSR model of FoPL will be implemented. As regulations are dynamic in nature, the effectiveness of the FoPL model will also be reviewed after implementation and necessary changes will be made.