Highly processed foods can make you fat and addicted. Switzerland wants to protect its citizens from this with the so-called Nutri-Score. This is to be welcomed. However, consumer education must go further.

How healthy a food is is not just a question of its nutrient composition. The picture shows a piece of meatloaf.

How healthy a food is is not just a question of its nutrient composition. The picture shows a piece of meatloaf.

Christoph Ruckstuhl / NZZ

A 2017 OECD country comparison shows it clearly: In Switzerland, we do not yet have American conditions when it comes to obesity. But we have long since left the green zone, at least if you take Japan as a model. There, less than 4 percent of the population had a body mass index (BMI) of over 30, which corresponds to the definition of morbid obesity or adiposity. In the USA, the proportion was a whopping 38 percent, in Switzerland just over 10 percent – although the proportion has doubled in this country in the last 25 years.

Unlike mild overweight (BMI greater than 25), obesity has been officially considered a disease since 2008. And with good reason. Severe obesity is a significant risk factor for cardiovascular disease, diabetes and some types of cancer. According to estimates by the World Health Organization (WHO), more than four million people die each year from obesity-related consequences. That is twice as many deaths as were attributed to the new coronavirus in 2020.

Great socio-political relevance

Like Covid-19, severe obesity is a pandemic that, in addition to the health consequences for individuals, has enormous economic significance. According to the Federal Office of Public Health (FOPH), the costs of overweight and obesity in Switzerland almost tripled between 2002 and 2012: from 2.6 billion to almost 8 billion francs. This calculation includes the direct costs of treatment as well as the indirect costs due to absence from work, disability and other factors.

Such figures show the sociopolitical relevance of the issue and underline the urgency of measures to promote a healthy body weight. This is all the more true because obesity is preventable – even if it is a complex disease in which genes, social environment and psychology play an important role. It is also true that people only gain weight when they consume more calories than they burn. This energetic imbalance has a lot to do with our comfortable lifestyle – but perhaps even more to do with modern food.

The WHO speaks plainly: Today, too many energy-dense foods with high fat and sugar content are consumed, it writes. This primarily refers to industrially produced food products. These consist of many ingredients and additives that make the food long-lasting, quickly consumable and tasty. In addition, many technical processing steps are necessary for their production, which is why they are also referred to as ultra-processed foods.

A large proportion of people today consume more than half of the energy they need each day through such food. More and more studies show that this is not a healthy way of eating. The main problem is that ultra-processed foods tempt us to overeat unphysiologically through various mechanisms. This means that many people are programmed to become overweight.

Traffic light systems such as the Nutri-Score developed in France are intended to help with this. It shows consumers at a glance how balanced a food is. The color scale ranges from A (green, balanced) to E (red, unbalanced). The score is calculated using a scientifically validated formula. This takes into account the health-promoting aspects of the food (e.g. content of fruit, vegetables, certain oils, dietary fiber and protein per 100 grams or milliliters) as well as its negative aspects (e.g. content of sugar, salt, saturated fatty acids and energy).

Following other countries, Switzerland also introduced the Nutri-Score in autumn 2019. Even if the declaration is voluntary for manufacturers – in contrast to the legally required list of ingredients, which is incomprehensible to laypeople – the step is to be welcomed. Because the Nutri-Score allows similar foods to be compared quickly. This allows consumers to make the nutritionally better choice when shopping. For example, a pizza marked green is the healthier alternative to an orange pizza. And the yogurt marked yellow is more recommendable than the orange one.

Following Danone, Nestlé has also committed to labeling its products with the Nutri-Score by the end of 2021. Migros and Coop have also begun to label the first product categories with it. There is great hope that the label will fuel competition in the industry towards healthier products. On the other hand, however, there is also the risk that companies could engage in “label cosmetics” and, for example, replace sugar with artificial sweeteners, which might not be healthier.

This is one reason why the Nutri-Score should be supplemented. The label only provides information about the composition of the most important nutrients. It therefore allows a statement to be made about the nutritional quality. What is not taken into account, however, is how heavily a product is processed and what additives it contains. Studies in recent years have shown more and more clearly that these factors can also have an impact on health. The type of processing and the additives should therefore also be presented to consumers in an easily understandable manner.

Whether this is done in the form of the Nova classification proposed by experts a good ten years ago – whereby food is divided into four categories based on the degree of processing – or with another system is of secondary importance. What is more important is that politicians, authorities, scientists and the food industry in Switzerland come together and commit to offering consumers the best possible basis for making healthy food choices. There is no need to go as far as with tobacco products and write on the packaging that the product is deadly (which is also nonsense for cigarettes). But a little more information about how healthy a food is would undoubtedly be possible.

When will the information campaign start?

However, the best score is of no use if the population is not aware of it. After the Corona crisis, it is therefore time for the FOPH to launch a broad information campaign on the Nutri-Score. People need to know what it is and how they can use it to eat healthier. Its limitations must also be communicated. The Nutri-Score is not a nutritional recommendation. Anyone who only eats pizzas marked green is eating extremely unhealthily. This is because they are ignoring the recommendations made in the Swiss food pyramid on which foods should be consumed, in what quantities and how often.

In addition to providing useful information about healthy eating, knowledge should also be put into practice more often. For individuals, this means that they may have to change their behavior. This is not easy, as we are biologically programmed to maximize pleasure. Therefore, nutritional knowledge should also have an impact on environmental design. This requires everyone. Anyone who runs a canteen, for example, can implement findings from nutritional psychology research. For example, we know that more pasta is eaten when a menu includes a pasta dish and a vegetable. If you change the menu and put three vegetables next to the pasta, people suddenly eat more vegetables.

Such concepts, which motivate consumers to choose healthier alternatives, are to be welcomed – at least as long as they allow people personal freedom of choice. Before we consider far-reaching advertising bans for “unhealthy” foods and a sugar or fat tax, we should strengthen such approaches. The same applies to the population’s ability to cook, which must be maintained. Ultimately, all traffic light systems and labels point in the same direction: a balanced and healthy diet is one in which as many fresh and minimally processed foods as possible are used. Because this is no longer the norm in today’s hectic world, we rely on aids such as the Nutri-Score when making our food decisions: so that we can improve the situation in Switzerland when it comes to overweight and obesity and avoid having American conditions in the future.

All articles in the nutrition series can be found at nzz.ch/ernaehrung

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