Iniciativas del Ministerio de Consumo y Aesan para mejorar la alimentación, comentarios y sugerencias

During the last months the Spanish Government, specifically through the Ministry of Health, Consumption and Social Welfare and the Spanish Agency for Food Safety and Nutrition (AESAN), is addressing some initiatives to try to improve citizens’ nutrition. Something that is a laudable principle, since we had been without relevant programs or initiatives in this regard for many years. And what they did was missing.

In this post I am going to do a brief review of three of them, the ones that are having the most media impact, following the usual perspective of this blog, that of evidence and scientific studies.

The first of the measures announced by the government is the increase in taxes on sugary drinks, an increase in VAT from 10% to 21%.

Regarding the studies on this measure, according to the latest systematic reviews it is usually effective and it seems that it can help reduce the consumption of sugary drinks:

Although there are important variations in the results, from these investigations it could be deduced that a 10% increase in the price of beverages usually leads to reductions in consumption that are around that same percentage (in round numbers).

As a possibility to explore, according toSome of the experts who have carried out the reviews, it is possible that «scaling» taxes could improve their effectiveness. That is, if it is increased even more in those products that provide more sugar (similar to what happens with alcohol, adding extra taxes to those drinks with a high alcohol content), even better results could be achieved.

In relation to this initiative there is another aspect that must be managed and about which complex decisions must be made. I am referring to sweetened drinks, which often replace sugary drinks when it comes to changing habits, something that can be expected to happen if sugary drinks are taxed but not sweetened ones. However, the evidence indicates that the consumption of drinks with sweeteners is not the best option, since in the long term they do not offer significant health advantages compared to sugary drinks, as can be seen in the latest reviews:

The precise reasons for this phenomenon are not known with certainty, although it is possibly due to the fact that the adverse effects of chronic consumption of sweet drinks of any type do not only lead to excess calories. Some hypotheses speak of negative effects on the microbiota of some sweeteners, although the latest reviews, such as this, this oh This other They do not reach clear conclusions in that sense. Other experts, as explained in the review»Neuroendocrine and metabolic effects of low and non-caloric sweeteners» (2020), believe that the problem could be in possible effects of a neuroendocrine nature that occur when chronically drinking this type of beverage.

Future studies will provide us with more light, but with current data in hand and given that to improve health the most appropriate and widely agreed upon dietary recommendation is to replace drinks with sugar or sweeteners with water, it is possible that as a measure of public health, taxes on the latter are also advisable.

In any case, it is worth insisting that increasing taxes is a measure that by itself has limited effects. To achieve greater results, policies must incorporate more initiatives. As an example – as I tell in detail in the book «The war against overweight«and in this post – in the study published in JAMA»Partnering a community campaign for better beverage options with supermarket beverage purchases«(2017) describes in detail an intervention carried out in Maryland to reduce the consumption of sugary drinks, which proved to be exemplary. It included a good number of actions, focused on achieving changes at the personal level, at the company and organization level, at the community and political level. In this way, they managed to reduce the consumption of sugary drinks by close to 20% in a period of 3 years.

Advertising campaign against sugar.

The second initiative that I am going to comment on is the one that has had the most visibility in recent days, an advertising campaign against sugar. As the government itself explains in this link, is made up of various actions, content and tools. Possibly the most popular is this video:

It also includes images with powerful messages, such as the following:

I am not going to evaluate the appropriateness of the campaign’s marketing strategy, because I am not an expert in that area. But from a health perspective I would like to point out that one of its problems is focusing on one nutrient, sugar, instead of focusing on foods or products. It is not because I think that it is not necessary to reduce sugar consumption, there is plenty of data that shows that we consume it in excess and that it does us no good. However, I do not believe that nutrient-focused approaches are effective for food education for the general population. Sugar is present in countless foods and in very diverse quantities; Even some foods considered very healthy whose intake should be promoted, such as fruits, contain it in a significant proportion. It is difficult for the average citizen to identify «sugar» precisely and evaluate the «malignancy» of its presence, which is why these types of messages do not usually help them purchase and eat healthier foods.

On the other hand, as explained in this previous post, there is no significant evidence to show that reformulating processing products by reducing their sugar level serves to improve health. Additionally, as with beverages, manufacturers of processed products often reduce the amount of sugars by increasing the amount of sweeteners, and as with beverages, this change is not especially good for health. I explain all this in more detail, including the studies that justify it, in the book «What science says about healthy eating«And in this post.

From the point of view of studies, I have not been able to find any publication that concludes that it is possible to significantly reduce the consumption of a nutrient – in this case sugar – with this type of advertising campaigns. The closest thing that can be found is a study related to campaigns aimed at reducing the consumption of sugary drinks:

But these two investigations do not refer to nutrients, but to specific products that are clearly identified. In any case, even in this case the results are modest, with purchase reductions below 5%, at best.

From a more general perspective, the recent systematic review «Media for communicating public health messages in six health issue areas: a systematic review and other evidence reviews» (2019) analyzed advertising campaigns aimed at promoting habits associated with better health: reduction in tobacco and alcohol consumption, changes in diet, use of preservatives…. He concluded that in the dietary field, evidence is conspicuous by its absence And in the rest of the areas they found very diverse effectiveness results and with modest effects that are not usually maintained over time. It is worth noting that the authors comment that those that focus on promoting very specific and quite simple behaviors may have some effectiveness. . .

In summary, I believe that an advertising campaign of this type is an initiative with high visibility and great media impact, which is politically interesting for the organization, but from the point of view of results, to date there is no evidence of May it serve a lot.

Nutriscore implementation

The third star initiative of the Ministry of Consumer Affairs in the field of food is the implementation of the Nutriscore front labeling system (FOPL). I am not going to expand on the analysis of this initiative because I already made a detailed presentation a few weeks ago, including the related studies, in this post. I concluded that the evidence that Nutriscore is going to improve the health of Spaniards is scarce and that there are possibly FOPLs capable of achieving better results (those that include warning messages such as «high in sugar», «high in salt» and similar).

In any case, given the nature of the other two government initiatives, both aimed at reducing sugar consumption, I would like to draw attention to another issue related to Nutriscore: In the latest systematic review that has analyzed the ability of FOPL systems to reduce the consumption of certain nutrients, including sugar, Nutriscore was the system that obtained the worst results and for which there is the least evidence. This is research is «Front-of-package nutrition labeling schemes: a systematic review and meta-analysis of recent evidence related to objectively measured consumption and purchasing.» (2019) and includes the following graph, in which you can see the results of each FOPL system regarding sugar (the Nutriscore ones are framed in red):

The reasons why Nutriscore obtains such mediocre results on this topic are explained in this post and are summarized in the fact that it has a lot of «freedom» with sugar. It only severely punishes those products with exorbitant amounts of this nutrient and positively values ​​some that provide a significant amount, such as the following, which all obtain a B:

Conclusions

In summary, we must applaud the fact that the Ministry of Consumer Affairs is encouraged to launch initiatives to improve the diet and health of Spaniards. But I think that to achieve relevant results, many more actions are needed. And there are issues for which it seems that more support should be given to the population’s priorities and the existing evidence of effectiveness.