Most of us cannot make head or tail of the often complicated labelling that comes with the food and drinks we buy, so Maverick Citizen journalist Zukiswa Pikoli hosted programmes manager of the Healthy Living Alliance Nzama Mbalati and researcher at the SAMRC/Wits Centre for Health Economics and Decision Science (PRICELESS SA) and high court admitted legal practitioner Petronell Kruger in a webinar on “Front-of-package food labelling: Your health depends on it”.

The Department of Health has gazetted a 238-page document for public comment, the proposed Regulations Relating to the Labelling and Advertising of Foodstuffs. Making the information at the back easy to decipher for citizens by having bigger, simpler labels on the front of a product. They will reinforce rules already in place for product packaging in South Africa, such as ingredient lists and sell-by dates, but also introduce a host of alterations to the modern changes in food advertising such as getting rid of trendy descriptions for food, such as calling products “smart” food or “intelligent” food, which can be misleading.

“Heala went to an old age home in KwaZulu-Natal. Some of the people already have some of the ailments such as high blood pressure and diabetes and they said it is hard to follow the script they have to eat as they cannot read the technical words and signs at the back of the label. “You will buy a yoghurt that says low fat but it doesn’t tell you it has a lot of sugar, so the front-of-pack label can be part of a toolbox people can use to make better decisions,” said Nzama.

Kruger gave delegates a run-down of what ultra-processed food is, since the word often comes up in conversations about front-of-package labelling.

Ultra-processed food “is a step beyond” the standard process of baking a cake – “food made in a way you cannot make in your home”, she said. 

“This is done to preserve the food, or so it can travel for long distances, and to make the food appealing and tastier when you add industrial cosmetic additives and processes that aim to reach a bliss point.”

The only problem is that food can affect the way your brain functions – 40% of adults and 50% of children would qualify as addicts in Latin America, according to the Yale Food Addiction Scale. This study determined, through a systematic review with meta analysis, the prevalence of food addiction using the Yale Food Addiction Scale and its derivatives, exploring possible factors associated with the prevalence of food addiction in several contexts. 

This regulation is about information, not prohibition, unless it prohibits discrete marketing practices which shouldn’t exist.

Asked by Pikoli which groups of the population were prone to eating ultra-processed food, Mbalati said the low-income households, noting that the food issue is about equality, income and the options income gives you. “We can make food that is filling but is less nutritious. The industry has looked at the gaps of hunger, poverty and unemployment and said we can make ultra-processed food that will be 30 bucks.”

Mbalati said he had seen people sharing their details in exchange for cool drinks in a Limpopo village, in an example of the food industry’s marketing power – it has earned people’s trust, markets directly to children, and has shown products that might be detrimental to health in a positive light. 

Mbalati said poor and working-class people are being targeted with ultra-processed foods.

“We know that we have some scary stats. One in two deaths will be caused by a noncommunicable disease. We know we have a crisis and people are dying because of this, and people struggle to understand and interpret what’s in their food.” 

Said Kruger: “This regulation is about information, not prohibition, unless it prohibits discrete marketing practices which shouldn’t exist.”

This was partly a response to a delegate, Nigel Sunley, who asked: How about moderation rather than prohibition? You will never stop people from eating good-tasting and affordable food.”

The food industry will say people must just be educated, but it will not put funds towards it. The industry also asks to regulate itself… we cannot leave it to them.

Kruger said if a product is found to have too much sugar, for example, the next step is to prohibit commercial marketing, advertising to children directly, and to prevent marketing that presents the product as healthy when it has too many harmful elements.

According to Food Facts for Healthy Choices, front-of-package nutrition labelling is simplified information that aims to help consumers with their food choices. It can either be a partial repetition of the information in the nutrition declaration (such as the energy value alone or the energy value together with the amount of fat, saturates, sugars and salt), or it can give additional information about the overall nutritional quality of the food through symbols, letters, colour codes or other graphical formats, as long as they are based on scientific evidence.

The discussion was robust among attendees who were for or against front-of-package labelling. Criticisms included that Chile had adopted similar regulations but this had not changed people’s choices. In South African studies people have said they need simpler labels, which might help them make informed decisions.

Onus on industry

“Profits can’t exceed people’s health. The food industry will say people must just be educated, but it will not put funds towards it. The industry also asks to regulate itself… we cannot leave it to them,” Nzama said.

Kruger echoed those sentiments, saying a study on the implementation of the Coke pledge in South Africa left much to be desired. The pledge has three main actions: First, Coca-Cola said it would no longer supply primary schools with their products that contain added sugar. Second, it would extend the availability of low- and no-sugar options, as well as promote portion control with smaller pack sizes. Last, it would remove all branding and advertising within school premises and replace it with generic red boards with white writing.

Kruger said the pledge is an admission that the food and beverage industry needs regulation.

The industry’s output and profits were measurable, “but the damage to people’s health is immeasurable”.

Mbalati added: “In a country where we are trying to [achieve] health equity it is scary that diseases such as diabetes used to be something you hear about on the radio and now we know a lot of people with noncommunicable diseases.”

Another study, by the World Data Lab, has found that almost half of South Africans are likely to go hungry in 2025. More than half of the population is unemployed and there is low economic growth, while the World Inequality Lab ranks South Africa as the most unequal nation. 

Read more in Daily Maverick: SA has an obesity crisis, regulation needed to protect children from risks of food marketing – experts

Front-of-package labelling doesn’t claim to be a silver bullet for the factors affecting food choices, Mbalati said, but it is a small intervention that food security activists are putting in their toolbox. “Allowing them to make decisions about what food to eat or not eat is a very small policy intervention in creating food security and it can go quite further. For example, there was a lawsuit in India which put an outright prohibition on foods that are high in sugar, salt and fats within schools, and that was deemed to be constitutionally acceptable in that context.

“At the end of the day people still make choices and some people are taking unhealthy products, but knowingly. The issue is a right to know… to create an environment where people can be protected.” DM