Can warning labels help to guide consumers and counter obesity?

By early June, just days before Colombia’s deadline for companies to start putting labels on food and drinks so that consumers can easily identify products with excess sodium or sugar, saturated or trans fats, or artificial sweeteners, grocery store shelves were already full of packages with the warnings in the shape of black-and-white octagons. And Carolina Piñeros, the executive director of Red PaPaz, part of the coalition of civil society groups that had been pressing for the labels, was jubilant. Piñeros told Devex that early research had found, “people are already taking into account the labeling in order to define what to buy,” she said. The first labels had actually started to appear soon after Colombia’s administration issued a resolution in December 2022 clarifying a law adopted months before requiring the warnings. Now with the labels becoming mandatory and more widespread, she hopes they might encourage a broader shift in Colombian purchasing habits toward healthier options. “This is a good example of something coming from the global south that is gaining traction everywhere.” --— Isabel Barbosa, associate director with the health and human rights initiative at O’Neill Institute, Georgetown University In a country where overweight and obesity are on the rise, alongside the noncommunicable diseases they can help cause, such as diabetes, Piñeros said that “people want to know what to eat and what is better for them.” She believes the front of package labels, known as FOPLs, will “make it easy for people to understand. It’s not a silver bullet” for solving the overweight and obesity crisis, “but it’s a starting point.” Colombia is now the 16th country to at least be in the process of mandating some kind of FOPL, according to the Global Food Research Program at the University of North Carolina. And the United States is expected to introduce its own warning label proposal in a matter of weeks. Ten of the 16 countries require mandatory warnings about problems such as excess sodium or trans fats. The World Health Organization touts the labels as “an important policy tool for countries to help consumers to make healthier food choices,” and researchers have credited FOPLs with pushing food producers to reduce their sugar and salt content, which could lead to long-term health benefits. At the same time, the food and beverage industry, which has worked to slow the introduction of FOPLs everywhere they have sprung up, is still pushing for concrete evidence that the labels can actually help reduce overweight and obesity. That has not dampened the enthusiasm Isabel Barbosa, an associate director with the health and human rights initiative at Georgetown University’s O’Neill Institute, has for the intervention as part of a broader suite of projects to reduce obesity and NCDs. “This is a good example of something coming from the global south that is gaining traction everywhere,” she said. FOPLs first emerged in the late 1980s, but mandatory labeling with warnings about specific nutrients, such as excess sodium, only started to be implemented in recent years — and primarily in Latin America. Eight of the 10 countries that require FOPLs with nutrient details are in Latin America, beginning with Chile, where FOPLs went into effect in 2016. Barbosa attributes this, in part, to the region having “very mature civil society when it comes to NCDs. There are a lot of organizations doing incredible work in this regard.” In Chile, the decision to turn to FOPLs only followed “two decades of unsuccessful efforts to decrease obesity rates in the country,” Camila Corvalán, an expert in nutrition at the University of Chile, told Devex. Obesity in men had climbed from 17% in 2000 to nearly 25% in 2016. In women, obesity rates had risen from nearly 24% to almost 31% in the same period. Corvalán blames, in part, a rapidly developing economy that ushered in a shift in diets, including the introduction of ultra-processed foods. Academics and politicians there sought to make the decision to select healthier foods “easier for people and to really push for the transformation of the food environment, rather than just focusing on the behavior of people,” she said. Detailed information about the product’s content often found on the back of the package was seen as too complicated to quickly interpret and was easily ignored by consumers. That ultimately led them to FOPLs, which quickly transmit basic information. They introduced the warnings alongside taxes on sugary drinks and limitations on advertisements for the foods that bore the FOPLs. Politicians also improved health and nutrition standards for school lunches. The immediate result was that people bought fewer of the products with warning labels. But consumers weren’t the only ones to react to the FOPLs. Manufacturers, who didn’t want their products branded with FOPLs, reduced sugar and sodium in their products. But only after they spent years fighting the introduction of the labels in the first place. They argued publicly that the FOPLs would hurt businesses and lobbied behind the scenes to shift the standards for what received a label. They also tried to weigh in on what the labels looked like. In Chile, and elsewhere across Latin America, experts have often settled on black-and-white octagons, mimicking the shape of a stop sign. The industry has asked instead for circles or to use colors, which proponents of FOPLs worry might end up blending into packaging. In Europe and elsewhere, countries have developed stoplight or numbering approaches, which offer more detail on the relative healthiness of foods and beverages. “It’s not only that governments need to act. … But if they don’t act, they’re infringing on their obligations.” --— Isabel Barbosa Ultimately, Covalán said, the design may vary, but the FOPL should be “something simple that would give the consumer the idea to stop, that this is not something good.” On an international stage, industry representatives and allied governments have argued that the FOPLs are a violation of regional trade agreements and international trade regulations, Juan Carballo, a senior legal adviser on the Global Health Advocacy Incubator’s food policy program, told Devex. While these attacks have not necessarily tanked any FOPL legislation, he said they have succeeded in slowing their introduction. In places such as Mexico, corporations have also taken to the courts, challenging the constitutionality of requiring FOPLs by arguing, among other things, that the warnings undermine their right to free expression. Barbosa said that any country that is looking to introduce FOPLs must prepare itself for industry pushback, even as she specifically urged countries to take their own rights-based approach to introducing the labels. Where constitutions spell out a right to health, for instance, advocates can make the argument that the government is actually obligated to introduce the FOPLs. “It’s not only that governments need to act,” she said, “but if they don’t act, they’re infringing on their obligations.” Still, the industry and some experts continue to attack the FOPLs, including pointing out the fact that eight years after labels were introduced in Chile alongside other interventions, the country appears to have made little progress in its battle against overweight and obesity. Several industry groups did not respond to requests for comment or were not available, but Baylen Linnekin, an adjunct law professor at George Mason University Law School has written that, “the best thing supporters … appear able to say about the Chilean law’s impact to date is that consumers there ‘understand the regulations very well.’” Experts caution that it will take time to show substantial results, even in combination with other efforts. They also emphasize that FOPLs alone are unlikely to have the kind of transformative impact that is needed to dramatically reduce the rates of obesity and NCDs. In Colombia, for instance, the government has also introduced taxes on sugary drinks and one of the first levies on ultra-processed foods, which overlaps with many of the foods that now bear the warning labels. “One single policy will not really achieve the goal,” Corvalán said. “We need to implement a set of policies.” The delay in results has not kept countries from across the global south from looking to Chile and elsewhere in Latin America for guidance on their own FOPL policies, Corvalán said, as part of a broader package of interventions. With overweight and obesity on the rise across low- and middle-income countries, governments are desperate for interventions that will help reduce those rates. How they choose to address it will depend on context, but in instances where the rising rates seem to be linked to easier access to affordable ultra-processed foods, Corvalán said it makes sense to think about FOPLs as a starting point for raising awareness of that connection among consumers. “The ideal is a package of actions, but which ones and how to do it really depends on the context,” she said. “In our case, it makes a lot of sense to prioritize labeling because there was a push from the consumers to better understand what they are eating. Other countries, where people know much more, taxes might be better.” More than a dozen countries across sub-Saharan Africa, Central America, and South Asia are currently developing FOPL policies, according to the Global Food Research Program. Barbosa said the proponents of FOPLs in Latin America are ready to share their experiences. “We can leverage these experiences in Latin America to guide discussions happening in other parts of the world,” she said.