As public interest organisations concerned with the primary prevention of NCDs through healthy food and improved nutrition, we welcome the PLoS Medicine Series on Big Food.

The excessive consumption of foods that are high in fats, salt and sugar (HFSS) contributes to poor nutrition and is one of the most important drivers of the recent rise in NCDs and the worldwide epidemic of obesity (1).

A unique characteristic of NCDs is that widely and heavily promoted consumer products have been identified as ‘vectors’ of these diseases (2). The production, promotion and consumption of highly processed HFSS foods and non-alcoholic beverages high in added sugar continues to increase globally, and this is reflected in an increasing prevalence of obesity and diet-related NCDs in low- and middle-income countries. The key drivers and conditions underpinning this trend are consumption-based growth and deregulatory approaches that promote market and trade liberalisation (3).

This Series on Big Food dealt sensitively with these very real issues, and argued ‘against an uncritical acceptance of the food industry in health’. We support this conclusion as our collective experience in the policy-making setting has shown that there is a need for caution when engaging with the food and drinks sector.

The evidence base for the most effective, cost-effective and sustainable interventions to address food and nutrition as risk factors points to regulatory and market-based interventions, including fiscal measures (4,5,6). These include policies to address the price, marketing, labelling, composition and promotion of unhealthy foods. These policies are affordable, and in many cases will ultimately be cost saving for governments (7).

The Series also examined the global drivers of the NCD epidemic, including cross-border trade and market integration, which are shaped by the global regulatory environment. While national action on NCDs is crucial, coordinated global action to address trans-border challenges on trade and marketing is equally important (8). Academics and independent experts have recommended policies based on Framework Conventions as ultimately the best model for a global coordinating mechanism (9).

Some countries have had early success in introducing population-level measures, including marketing restrictions and reformulation initiatives in the UK and fiscal measures applied to food in several European countries and Pacific Island states. Crucially such policies address the environmental determinants of choice – a rebalancing in favour of healthy foods - rather than putting pressure on individuals to make the right choice in an obesogenic environment.

Importantly for this debate on Big Food, many sectors of the food and beverage industry do not support such policies. Research is starting to expose how some multinational food and beverage companies that produce HFSS foods actively and successfully lobby against public health measures, spending significant sums that public health organisations cannot match (10).

Voluntary measures preferred by many multinational food companies acting at global and regional levels are less effective and may delay or pre-empt more effective regulation (11). Their voluntary nature means that coverage is not comprehensive across all companies and markets. Furthermore, commitments are not guaranteed and can be reversed at any time.

There are clear conflicts of interest for corporations that contribute to and profit from the sale of unhealthy food and beverages, with significant costs to society. In line with previously agreed WHO principles, the private sector should not be involved in policy and strategy development, norms or standard setting. These activities underpin the regulatory measures required to address NCDs and help to uphold the public health objective.

Additionally, there is a need for clarity on the role of public-private partnerships, with an important distinction to be made between participation-based interactions and joint decision-making processes. This is particularly important in the context of the follow-up to the UN Political Declaration on NCDs.

We thank the authors that have contributed to this Series and welcome this new area of study into Big Food.

List of supporting organisations

World Cancer Research Fund International (www.wcrf.org)
Consumers International (www.consumersinternationa...)
Consensus Action on Salt & Health (www.actiononsalt.org.uk)
National Heart Forum (www.heartforum.org.uk)

Contact
Jo Jewell, World Cancer Research Fund International
j.jewell (at) wcrf.org


References:
(1) World Health Organization (2004) Global Strategy on Diet and Physical Activity
(2) Gilmore (2012) Public health, corporations and the New Responsibility Deal: promoting partnerships with vectors of disease? Journal of Public Health Vol. 33, No. 1, pp. 2–4.
(3) Swinburn B, Sacks G, Hall D et al (2011) The global obesity pandemic: shaped by global drivers and local environments. The Lancet 378: 804-14.
(4) Ceccini M, Sassi F, Lauer JA et al. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. The Lancet (2010): Chronic Diseases and Development Series. Paper 3. November 11.
(5) Gortmaker S, Swinburn B, Levy L et al Changing the future of obesity: science, policy and action. Lancet 2011; 378: 838-47.
(6) Sassi F. Obesity and the economics of prevention: fit not fat. Paris, France: OECD. 2010.
(7) WHO (2012) Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Cooperation. Report of the Consultative Expert Working Group on Research and Development. http://www.who.int/phi/CE...
(8) Chopra M and Darnton-Hill I (2004) Tobacco and obesity epidemics: not so different after all. BMJ 328:1588-60.
(9) Lancet Editorial (2011) Urgently needed: a framework convention for obesity control. The Lancet Vol 378 August 27.
(10) Wilson D and Roberts R (2012). SPECIAL REPORT: How Washington went soft on childhood obesity. Reuters, 27 April. http://graphics.thomsonre...
(11) Hawkes C (2007) Regulating and litigating in the public interest. American Journal of Public Health. 97(11) 1962-73.