We developed the NOURISHING framework to highlight where governments need to take action to promote healthy diets and reduce overweight and obesity.
The framework is accompanied by a regularly updated database (last updated 21 February 2018), providing an extensive overview of implemented government policy actions from around the world.
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The evidence suggests people who want to eat well use nutrient lists to choose healthier options. Interpretative labels help them when they find the labels hard to understand. Nutrition labels also create incentives for food manufacturers to reformulate their products, so helping populations more broadly by increasing the availability of food of higher nutritional value.
Clear standards are also needed on the use of nutrient and health claims. Evidence shows these claims alter the perception people have of these products – making it essential that they do not mislead.
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*Most other countries follow Guideline CAC/GL 2-1985 from the Codex Alimentarius Commission in requiring nutrition labels only when a nutrition or health claim is made and/or on food with special dietary uses
EU Regulation 1169/2011 on the Provision of Food Information to Consumers, passed in 2011, requires a list of the nutrient content of most pre-packaged food to be provided on the back of the pack from 13 December 2016. This Regulation is also applicable in Iceland, Norway and Liechtenstein as members of the European Economic Area. In Switzerland, nutrient content labelling is only mandatory for products bearing nutrient or health claims or sold to the EU (but most manufacturers already label nutrient content on their food products voluntarily).
The Swedish government set nutritional criteria for the use of the Keyhole logo established in Sweden in 1989 and launched as a common Nordic label on 17 June 2009 in Sweden, Denmark and Norway. The Lithuanian Ministry of Health signed the agreement to join the Keyhole programme in 2013 and approved criteria for products to bear the logo in 2014. In Iceland, the programme entered into force in November 2013. The aim of the Keyhole logo is to help consumers choose products that contain less fat, salt and sugar. Use of the logo is voluntary, but products must conform to the nutrition criteria, which are identical among participant countries of the programme. New, stricter requirements came into force on 1 March 2015, with a transition period until 1 September 2016 for products adhering to the old requirements. Under the new requirements, Keyhole products will need to contain less salt, sugar and saturated fat, and more whole grains. For the first time, criteria were introduced for maximum salt content in meat and fish products.
EU Regulation 1169/2011 on the Provision of Food Information to Consumers, passed in 2011, permits EU Member States to develop voluntary guidelines for front of pack nutrition information, to be used in addition to the mandatory nutrition information on the back of pack. Information on energy value, fat, saturated fat, sugar and salt content is permitted. Different styles of presentation (eg % Guideline Daily Allowances or traffic lights) are permitted. This Regulation is also applicable in Iceland, Norway and Liechtenstein as members of the European Economic Area and Switzerland based on its bilateral agreements with the EU.
Regulation 1924/2006 (applicable as of July 2007) establishes EU-wide rules on the use of health claims (claims on nutrient function, disease risk reduction and children’s health). Companies may only use health claims that are substantiated and authorised by the European Commission and Member States (various regulations authorising health claims to date). The European Food Safety Authority is responsible for verifying the scientific substantiation of claims; it has done so for claims currently in use and continues to do so for claims that are proposed and applied for by companies that want to use health claims in the EU. In theory, health claims may only be used on food defined as "healthy" by a nutrient profile. This nutrient profiling restriction was due to be implemented in 2010 but no model has yet been established. Therefore, permitted health claims can be used as long as the conditions for use of the claim as set out in the respective regulations are met. Once nutrient profiles are established, health claims may only be used on food products deemed "healthy". This Regulation is also applicable in Iceland, Norway and Liechtenstein as members of the European Economic Area; Switzerland amended its foodstuff law based on its bilateral agreements with the EU to include permitted EU health claims.
We know from the evidence that making fruit and vegetables available in schools increases consumption. There is also evidence that food standards to restrict availability have the effect of reducing consumption of the restricted food.
For these actions to be effective for all children, they need to be sustained over time and accompanied by complementary behaviour change communication techniques, such as "modelling", school gardens, and communication to all stakeholders involved in the provision and consumption of school food. Worksites and healthcare also present strong potential for improved eating among adults.
In 2007, the Norwegian government introduced legislation requiring schools to offer one free piece of fruit or vegetables, five days a week to pupils in grades 1–10. This was repealed in autumn 2014. In its place, a subsidised programme that requires parents to subscribe has been expanded to all primary schools.
Øvrum A, Bere E (2013) Evaluating free school fruit: results from a natural experiment in Norway with representative data. Public Health Nutrition 17(6), 1224-1231
Empirical estimates show that food prices influence, to a varying degree, how much food people buy. Targeted subsidies have been shown to help overcome affordability barriers to healthy food for people on low incomes. Incentives, like financial rewards or price discounts, have also been shown to encourage people to switch to healthier options.
Emerging evidence from implemented taxes, as well as modelling studies, indicate the potential for effectiveness to reduce consumption. Given food choices are influenced by a whole host of factors, especially in modern, complex food markets, taxes must be designed very carefully to maximise effectiveness.
Implemented in 1981, Norway taxes non-alcoholic beverages containing added sugar or sweeteners, chocolate, sugar and sugar products. In 2017, beverages are taxed at 3.34 NOK per litre ($0.40), concentrated syrups at 20.32 NOK per litre ($2.44), chocolate and sugar products at 20.19 NOK per kg ($2.43), and sugar at 7.81 NOK per kg ($0.94).
There is clear evidence that the advertisements children see influence their food preferences and habits. There is also a lot of evidence that children and adolescents around the world are exposed to a whole host of other promotional techniques, whether on a billboard or through a phone or computer.
Emerging evidence shows that restrictions work to reduce children’s exposure to marketing, but this depends on the criteria used in the restrictions. Given the role played by parents and caregivers in what children eat, consideration is needed of how they are also influenced by promotional activities.
Based on the Broadcasting Act No. 127 of 1992 (Chapter 3.1), Norway prohibits marketing directed at children under 18 and advertising in connection with children’s programmes on television, radio and teletext. The ban includes any product, including food and beverages, but only applies to broadcast media originating in Norway. The Broadcasting Regulation No. 153 of 1997 (Section 3.6) provides guidance on how to determine whether advertising is directed to children under 18: whether the advertised product or service is of particular interest to children; if animation or other forms of presentation are used that particularly appeal to children; the time the advertisement is broadcast; and whether children under the age of 13 appear in the advertisement. The use of persons or figures who have played a prominent role on radio and TV programmes for children and young adults received in Norway in the previous 12 months may not be used for commercial advertising.
The Norwegian government already restricts all broadcast advertising to children through legislation (See "Mandatory regulation of broadcast food advertising to children" above). A voluntary initiative agreed in 2013 calls on industry to follow standards (set largely by government) on a further range of communications channels. It applies to marketing to children under the age of 13. In 2011, the Ministry of Health signed a Memorandum of Cooperation with the Federation of Food Enterprises and the Association of Soft Drink Companies to encourage companies not to advertise soft drinks to children aged 12 or under. The Memorandum applies to soft drink marketing in movie theatres and on TV if the audience consists of at least 50% children, and includes marketing activities on the internet and in the press.
We are all influenced by the food that is available and affordable when we grow up, and the habits of the people around us. That’s why people in different countries and communities consume differently. We know that when the food supply changes, so does what people eat. This is why we need to improve the quality of the food supply. Evidence from salt reduction indicates that people’s tastes can change.
In 2014, the Norwegian Food Act was amended to prohibit the sale of fats or food with fats that contains more than 2g of trans fats per 100g of fat, in effect since January 2014. The regulation does not apply to naturally occurring trans fats.
Awareness is one precursor to eating well. The evidence suggests that public campaigns can boost awareness. To influence consumption, they need to be sustained and use multiple channels.
New countries added February 2018: Food-based dietary guidelines are an information and communication tool involving the translation of recommended nutrient intakes or population targets into recommendations of the balance of food that populations should be consuming for a healthy diet. They typically promote increased intake of fruit and vegetables and limited intake of salt/sodium and sugar. They may also include guidance on physical activity and healthy weight, and provide guidelines for different population groups. Countries use various formats of presenting the guidelines including cooking pots (Guatemala, Paraguay), pineapples (Fiji), pyramids (Australia, India, US), plates (Colombia, UK), pagodas (China), spinning top (Venezuela), traditional African house (Benin) and circles (Argentina). Some countries have started to include sustainability criteria in their dietary guidelines (eg Germany in 2013, Finland and Brazil in 2014, Sweden and Qatar in 2015, the Netherlands and UK in 2016). Brazil’s revised dietary guidelines, launched in 2014, present food- and meal-based recommendations that take into account cultural dimensions and promote the consumption of minimally processed food as well as health, wellbeing and sustainable food systems, and recommend avoiding ultra-processed food. Details on the content of national dietary guidelines can be found on the FAO database on Food-based dietary guidelines.
The Norwegian Health Directorate runs a national dietary advice campaign called Small steps, big difference (Små grep, stor forskjell), launched in 2012, using brochures, online webpages, TV and social media.