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全球粮食安全与营养论坛 · FSN论坛

Re: Are there any successful policies and programmes to fight overweight and obesity?

Helen Medina
Helen MedinaUS Council for International BusinessUnited States of America

FAO Global Forum on Food Security and Nutrition
Are there any successful policies and programmes to fight overweight and obesity?
June 30, 2016
Dear Discussion Moderators,  
The U.S. Council for International Business (USCIB) appreciates the opportunity to respond to this complicated question of which policies and programmes that address overweight and obesity have been successful.
USCIB is the American affiliate of the International Chamber of Commerce (ICC), the Business and Industry Advisory Committee (BIAC) to the OECD, and the International Organisation of Employers (IOE).  As such, we work closely with intergovernmental entities, including various United Nations bodies, the Organization for Economic Cooperation and Development (OECD) and the International Labor Organization (ILO), to provide input from the business community on a variety of policy issues, including those related to health and nutrition.
All facets of society, including the private sector, have an important role to play in helping to reduce the incidence and burden of non-communicable diseases (NCDs).  This view is supported by World Health Organization (WHO) and OECD strategies recognizing that NCD solutions require a whole-of-society approach, multi-sectoral actions, and collaboration among governments, civil society and the private sector.  Given the complex and multi-factorial nature of NCDs, it is essential that all stakeholders work together to develop holistic, sustainable solutions.
The food and beverage industry’s many contributions to global efforts to prevent NCDs are guided by science-based principles that include:
- Providing a range of nutritious product choices and marketing them in ways that promote healthy lifestyles;
- Improving awareness and understanding of nutrition and energy balance; 
- Communicating clearly through labeling, packaging, websites, brochures, and in-store communications to enable consumers to make informed choices; 
- Undertaking responsible advertising practices, taking into account the special needs of children; 
- Emphasizing the importance of achieving a balance throughout life of physical activity and nutrition; and 
- Partnering with other stakeholders in these endeavors. 
The food and beverage sector has undertaken significant initiatives across all of these areas, in particular on new and reformulated products, packaging innovations, enhanced nutrition information, communications to promote healthy lifestyles, and partnerships aimed at promoting physical activity and nutrition education. There has been real progress, but the work is not done, and industry is committed to continuing its efforts and to work in collaboration with governments, civil society, and other stakeholders to achieve success.  Below are several examples of the voluntary industry efforts that have proven results.
Industry Initiatives
Healthy Weight Commitment Foundation (HWCF)
Founded in 2009, the HWCF is a partnership between industry, NGOs and educators whose aim is to reduce obesity, especially childhood obesity.  HWCF members voluntarily pledged to collectively remove trillion calories from their products (against a 2007 baseline) by the end of 2015. It focuses its efforts on families and schools and promotes ways to help people achieve a healthy weight through energy balance – calories in and calories out.
A study published in 2014 by the American Journal of Preventive Medicine and funded by the Robert Wood Johnson Foundation found that the companies had, by the end of 2012, collectively cut 6.4 trillion calories, exceeding their 2015 goal by more than 400%. Companies achieved this calorie- reduction goal by developing, introducing and selling lower-calorie options, changing recipes where possible, and lowering the content of current products or reducing portion sizes of existing single-serve products. Researchers at the Hudson Institute evaluated the impact of HWCF’s commitment to sell fewer calories by testing whether lower-calorie products sold by HWCF companies (whose members account for nearly 25% of calories consumed in the United States) grew over the five-year evaluation period and the impact of these sales on total company sales.
The study concluded that these lower-calorie products are driving sales growth and recommended these choices should continue to be pursued aggressively:
- 82% of sales growth driven by lower-calories (over four times the rate of higher-calorie products);
- Sales increase of $1.25 billion for lower-calorie products vs. less than $300 million for higher-calorie products; and
- 10 of 15 new products with sales of over $50 million+ were lower-calorie products.
HWCF has also created a families and schools programme. The Together Counts™ campaign promotes energy balance, the advantages of family meals and physical activity and the website, designed in partnership with Discovery Education, which provides free, downloadable resources for families, teachers and children for Pre-K through elementary school. Today, more than 19 million children are engaged with the curriculum. This successful U.S. programme is also being implemented in Australia, under the auspices of the Healthier Australia Commitment, an industry-led initiative in partnership with NGOs, to help reduce the incidence of chronic preventable diseases and improve the nutritional quality of the Australian diet.
Facts Up Front (FUF)
Facts Up Front (FUF) is a voluntary initiative created in 2011 by the Washington, DC-based Grocery Manufacturers Association (GMA) and the Food Marketing Institute (FMI).  FUF (see example below) is a simple and easy-to-use labeling system that displays key nutrition facts on the front of food and beverage packages – displaying the calories, saturated fat, sodium and sugar in each serving.   
Almost 90 percent of U.S. grocery sales by GMA members use FUF.  GMA members have made significant investments to develop the FUF consumer website (, consumer research, and stakeholder outreach including media campaigns and ongoing consumer education efforts.  To continue to improve consumer understanding, GMA and FMI are extending the reach of consumer education efforts through key partnerships with groups such as Share our Strength.  Share Our Strength’s Cooking Matters program, in support of its goal of “No Kid Hungry,” will feature FUF in training materials for teaching basic nutrition, shopping, and cooking skills to individuals in low-income areas. 
A recent study was published in September 2015 in the Journal of Consumer Affairs that reflects the FUF communications campaign evaluation survey. The publication provides further support that FUF icons are visible, easy to understand, and helpful to the consumer.
Additionally, two important articles on front-of-pack nutrition labeling were published in respected journals in spring 2014.  The first article, published in the Journal of the Academy of Nutrition and Dietetics (JAND), is based on consumer research GMA commissioned the International Food Information Council Foundation to conduct in 2010 to examine consumer comprehension, ease of understanding, and interpretation of nutrition information in the uniformly formatted, voluntary front-of-package labeling system that was under consideration by GMA and FMI.  The research and subsequent JAND article finds that robust front-of-package labeling can significantly improve consumers’ ability to identify and understand a food’s nutrition information, and allows consumers to make informed choices about their purchases.  Several articles in respected journals (see footnote references in attached document) have found that fact-based front-of-package labeling like FUF significantly improves consumers’ ability to identify and understand nutrition information and make informed choices about their purchase. 


Product Innovation
Other examples of efforts of leading U.S. food and beverage companies’ efforts to reformulate and innovate products, provide clear nutrition labeling and consumer information, advertise responsibly, enhance workplace wellness and partner with stakeholders in healthy eating and active living programs have been documented by GMA. In 2014, GMA published cumulative results (2002-2013) of these efforts by 69 member companies representing about $245 billion in annual U.S. sales (roughly half of U.S. food and beverage sales).  Highlights include:
o 94% of companies reported nutritional improvements in over 30,000 products and sizes, with reductions in saturated fat, trans-fat, calories, sugar and carbohydrates and sodium;
o 81% of companies reported providing enhanced front-of-pack labeling information; and
o 77% of companies reported sponsorship of national and local initiatives to improve nutrition education and encourage regular physical activity, spending over $300 million in these expenditures between 2002 and 2013.
A separate study two years ago by GMA demonstrated a 16% reduction in sodium in member company products purchased between 2008 and 2013, with decreases appearing in those food categories that contributed the most to sodium intakes in the U.S..
Children’s Food and Beverage Advertising Initiative (CFBAI)
With regards to advertising, US companies have voluntarily taken concrete steps to help drive changes in the marketplace and improve the types of products advertised to children. In 2006, the U.S. Council of Better Business Bureaus (BBB) and leading U.S. food and beverage advertisers created the Children’s Food & Beverage Advertising Initiative (CFBAI) to respond to calls to action from the U.S. Federal Trade Commission (FTC), the U.S. Department of Health & Human Services (HHS)5 and the Institute of Medicine (IOM) for industry self-regulation and for food companies to do more to address food advertising to children because of the rise in childhood obesity. 
CFBAI’s goal is to be part of a multi-faceted solution to the complex problem of childhood obesity by using advertising to help promote healthier dietary choices and lifestyles among children under age 12. Under CFBAI’s Core Principles  participants commit that in advertising primarily directed to children under age 12 (“child-directed advertising”) they will depict only healthier or better-for-you foods. The participants agree to CFBAI oversight and to be held accountable for failure to comply with their commitments. CFBAI extensively monitors covered media for compliance and requires participants to submit detailed self-assessments annually. Each year CFBAI publishes a compliance and progress report.  It has found outstanding compliance every year. The problems that CFBAI has detected or that participants have self-reported have been quickly remedied. 
Since December 31, 2013, participants may advertise only foods that meet CFBAI’s category-specific uniform nutrition criteria in advertising primarily directed to children under age 12. CFBAI’s uniform nutrition criteria replaced and are stronger than previously used company-specific nutrition criteria.
In 2014, the BBB analyzed television ads aired in children’s programming, a repeat of analyses conducted in 2009, 2010, 2012 and 2013.  Of the 1,274 ads analyzed, 23% were for food and beverages. In 2014, ninety percent of the ads were for foods containing fruit, vegetables, non/low-fat dairy, whole grains, or at least a “good” source of what the 2010 Dietary Guidelines for Americans call “nutrients of concern” because they are not consumed in sufficient amounts (calcium, fiber, potassium and vitamin D) up from 83% in 2013 – confirming an upward trend based on past analyses.
Industry Partnerships to address Childhood Obesity
With more than 20 years of experience and a rigorous scientific evaluation, the EPODE (Together Let’s Prevent Childhood Obesity) methodology developed in France has been recognized by the international scientific community as innovative in tackling the problem of childhood obesity. EPODE's methodology is based on community based interventions (CBIs) aimed at changing the environment and behaviors of children, families and local stakeholders with the ultimate goal of promoting healthy lifestyles in families in a sustainable manner. EPODE comprises four critical components: political commitment, public and private partnerships, community-based actions, and evaluation. Peer-reviewed studies indicate that this multi-stakeholder approach has already shown encouraging results in preventing childhood obesity in France and Belgium and has reduced the socioeconomic gap in obesity prevalence in France.
The methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases. The Epode European Network (EEN) and the EPODE International Network (EIN) have been created to support the worldwide implementation of CBIs. The major partners in the EEN program include four committees, each one headed by one of four major European Universities (Amsterdam, Gent, Lille, Saragoza), and four private partners, including USCIB members: The Coca-Cola Company and Nestlé. These international networks allow the sharing of experience and best practices for the continuous improvement of the programs. By 2012, CBIs inspired by the EPODE methodology had been implemented in 17 countries. The South Australian and Mexican Health Ministers adopted the methodology to conceptualize and implement their “National plan on nutrition and Physical activity (Obesity Prevention and Active Lifestyle program and 5 Pasos strategy, respectively).
Public-Private Partnerships Responding to Global Health NCD Challenges
The ITU and WHO, the UN information and communication technologies (ICTs) and health agencies, have come together in a groundbreaking new partnership, Be He@lthy, Be Mobile, to focus on the use of mobile technology to improve NCDs prevention and treatment. This initiative aims to contribute to global and national efforts to save lives, minimize illness and disability, and reduce the social and economic burden due to NCDs. The initiative will harness the best mobile technology available and make it accessible for all countries to fight NCDs.
A number of countries are already using mobile technology to deliver health promotion messages on the NCD risk factors, to survey the epidemic, to persuade users to change unhealthy behaviors and to help countries implement national laws on NCDs. These successful pilots will be used as templates, scaled-up and customized to each country’s need. MHealth operational projects will be set up in participating countries, and a Mobile Health intervention package will bolster and support the more traditional existing methods of combatting NCDs.
Mobile solutions will be primarily SMS- or app-based, and will include a range of services including mAwareness, mTraining, mBehavioural Change, mSurveillance, mTreatment, mDisease management and mScreening. These services will build on the existing successful pilots and scale them to fit population levels. Countries will be able to choose the interventions that are the most feasibly affordable, and most suited to their needs.
Addressing NCDs at the Workplace
Industry also adds value in improving public health not only through innovating and generating effective responses for the prevention and control of NCDs, but also by leveraging the workplace as a means of providing information and healthcare provisions for all workers, their families and communities. USCIB thus recommends that governments work closely with local business since its involvement is crucial for the successful outcomes of these goals. Identifying barriers and challenges and working with national employers’ organizations, as well as local private sector representatives, is a good path to address the issue effectively and to drive progress.
One example of a partnership with an employer is China’s National Centre for Cardiovascular Disease’s “Healthy Heart - New Life.” This pilot project, which received support from Pfizer, focuses on developing multiple healthcare services, such as worksite health monitoring and guidance, disease guidelines-based health risk appraisal, individualized health intervention and follow-ups and information services, to explore the effective and sustainable model for chronic disease control amongst the working population.
Thank you again for the opportunity to provide our thoughts on these vitally important matters.  We hope we have demonstrated the depth and breadth of industry’s commitment, and we look forward to continued engagement.
Helen Medina
US Council for International Business