Labelling Sugar-sweetened Beverages (SSBs)

Understanding the policy environment, people’s perception and use, and co-creating intervention for labelling of SSBs to reduce consumption

Introduction

Sugar-sweetened beverages (SSBs) refer to any beverage with added sugar or other sweeteners, including soda, tonic, fruit punch, lemonade (and other ‘ades’), sweetened powdered drinks, sweetened flavoured milk beverages, sweetened tea and coffee and other hot beverages, as well as sports and energy drinks. Frequent intake of SSBs is associated with obesity, Type 2 Diabetes Mellitus, heart disease, kidney diseases, non-alcoholic liver disease, gout (a type of arthritis), and dental caries. SSB consumption is high and growing in many low- and middle-income countries (LMICs), and becoming a major public health threat for achieving good nutrition.

Interventions such as taxation, nutrition profiling and labelling, and marketing restrictions have been found to be effective in improving diets, tackling obesity, and reducing health care costs. Nutrient profiling of foods is defined as the science of ranking foods based on their nutrient composition. Their goal is to identify nutrient-rich foods, generally defined as those that contain more nutrients than calories and are low in fat, sugar and salt. Assigning foods into categories based on their nutrient content can contribute in consumer education and dietary guidance, nutrition labelling, and the regulation of health claims. Many nutrient profiling systems have been designed, including front-of-pack (FOP) labelling to guide food selection decisions and the regulation of marketing to children. A number of studies have suggested that appropriate labels reduce predicted preferences for and reported probability of purchasing SSBs. However, little is known regarding the policies and laws on food nutrient profiling and regulations on nutrient composition in many LMICs.

Research Aim and Objectives

The aim of this multi-country research study is to generate evidence to support effective food nutrient profiling and regulations on nutrient composition with a special focus on SSB labelling in Bangladesh, Nepal and Pakistan, and to inform policy discussions. Specific objectives of this study are:

1. To analyze the current policies and laws on food nutrient profiling and labelling? regulations on nutrient composition, and identify gaps in the existing policies and laws on nutrient profiling in the region with international standards
2. To conduct SSB pack analysis, as a case study, for understanding the current type of nutrient labels, health claims and other marketing strategies used by SSB produced in selected countries and compare those against international standards
3. To co-create culturally relevant and understandable package labels of SSBs with relevant stakeholders in each country
4. To improve the generalisability of the findings, contribute in policy advocacy and policy influence in the region and support the next stage of research by establishing a multi-country network of people and organisations

Methodology

This research will involve a mixed-methods study in Bangladesh, Nepal and Pakistan, with invitations extended to Sri Lanka and India to join Knowledge and Networking partners. These countries have been selected due to their wide experience of food nutrient profiling, high prevalence of SSB use and associated non-communicable diseases, high proportion of children and youth having demographic dividend, considerable volume of SSB export and import, strong industry influence, and existing gaps in policy, enforcement, and monitoring. The diversity of experience/context across the three research implementing countries and the two additional Knowledge and Networking partners will enable the study to identify common successful implementation strategies to share across Asia and LMICs with a similar context. This study aims to be a first step and entry point to conduct joint research on food nutrient profiling in the future.

This research is divided into two phases. The first phase will be coalition formation and context analysis, which includes establishing a multi-country network of people and organisations. This will bring together multiple sectors across governments and civil society for strengthening overall food nutrient profiling with a focus on SSB labelling systems. This phase will also involve a scoping review, analysis of secondary data, and semi-structured interviews to understand the existing policies relating to SSB packaging and labelling as a case study, and identify the gaps in policy, administration, reporting and monitoring systems of SSB labelling. Finally, pack analysis and household surveys will be conducted across three countries to understand the perceptions, attitudes, and practices regarding SSB labelling on perceived product healthfulness, and people’s interest in consuming, and patterns of consumption of, SSBs.

The second phase will focus on co-creating interventions. The co-creation will be a highly iterative process, involving community dialogues through a series of workshops and stakeholder events. The review, analysis, and survey findings will inform discussions at the workshops and meetings with a diverse range of stakeholders, including community representatives, policymakers, healthcare staff, and researchers. The Knowledge and Networking partners will also bring findings from their own policy gap analysis, country experiences, and expertise to support the co-creation process.

Research Partners

This 30 month research project is a collaborative effort between the ARK Foundation, a research NGO in Bangladesh, Aga Khan University in Pakistan, and HERD International in Nepal. The Center for Health innovation and Policy Foundation in India, as well as the Institute of Policy Studies of Sri Lanka, will serve as Knowledge and Networking partners.