Researchers say packaged food in India, which is fast replacing staple and balanced diet, is among the most unhealthy in the world. In the absence of clear policy measures, the population is faced with serious health complications such as obesity, ischemic heart disease, chronic obstructive pulmonary disease, stroke, and Type 2 diabetes.
A teenage boy subsisting solely on fries, chips and ham was brought before the doctor with complaint of exhaustion, loss in hearing and failing vision. Over the next two years, his vision continued to deteriorate and was down to 20/200, which is officially “blind” in the US.
The diagnosis revealed that the optic nerve connecting eyes to the brain of the 14-year-old was damaged, because of prolonged deficiency of Vitamin D and Vitamin B12, copper, and selenium which would be available in the staple diet in the normal course.
This mortifying tale of what “yummy” packaged junk food that children today are “lovin’ it” can do is narrated by eminent public health specialist Dr K K Aggarwal, from the Annals of Internal Medicine. The latest study has only confirmed what was feared most about the packaged food that has fast replaced staple, balanced diet in India.
To make it worse, a separate research by George Institute of Global Health of Australia has found India’s packaged food among the most unhealthy in the world. There is no control on sugar, salt, bad fats and calories that are responsible for obesity and various non-communicable diseases such as ischemic heart disease, Chronic Obstructive Pulmonary isease (COPD), stroke, and Type 2 diabetes.
The situation may not be as extreme for a typical junk food eater as is in the case of the boy, but the lesson here is that this is what a prolonged packaged junk can do and that all the medical intervention by doctors to replenish his body with nutrients could not save the failing vision. The boy was hooked to Pringles, the doctors noted. So it doesn’t matter if the junk was branded.
The selective eating disorder has hit the Indian population like never before and there is nothing stopping it. India is set to become the third-biggest market after China and US, reports Euromonitor.
Driven by the demand of more women members of family stepping out for work, fewer households cooking meals for their children, 24x7 operational offices, odd work hours, and on-the-go snacking in long-distance trains, Indian packaged food industry is expected to grow to $65 billion by the next year with people devouring a staggering 47 million tonne what critics say will be mostly junk.
Absence of any thought or policy measure in the direction of establishing in-house food facilities such as Amma Canteen in Tamil Nadu, the packaged food industry looks to spawn all over unchallenged.
“It is a wake-up call for countries like India where the packaged food industry is burgeoning and expanding its reach to small towns and villages,” says Prof Vivekananda Jha, the Executive Director of George Institute that analysed over 400,000 food and beverage products from 12 countries, including Australia, Canada, Chile, China, Hong Kong, Mexico, New Zealand, Slovenia, South Africa, the UK, and the US.
The products were rated on the scale of half-star to five-stars on Australia’s Health Star Rating (HSR) system. India ranked the lowest at 2.27, below China at 2.43, making it the most unhealthy of all. The UK tops the charts followed by the US and Australia.
Australia’s HSR advocates use of stars on the front of packs, which are visible from far so that the buyer can spot the most healthy product just at a glance. The system has been adopted by New Zealand also.
However, the experts in India are not impressed. The Centre for Science and Environment (CSE) feels the use of red label proposed by India’s Food Safety and Standards Authority of India (FSSAI) is better than stars of Australian HSR.
“Stars only help pick the better option among brands and do not discourage consumption of foods high in fat, sugar and salt. The (proposed) FSSAI label clearly gives warning in red. It does not build any positive perception about the product which HSR could,” says Sonal Dhingra, Deputy Programme Manager, Food Safety and Toxins, CSE.
India's food watchdog is mulling its own version of food safety rating. Although the FSSAI guidelines are replete with disclaimers manufacturers are required to put up on packets, it has posted draft food labelling law on its website to invite suggestions.
The CSE, which has often needled the government and corporates with its reports on policy gaps and health hazards in the mega food industry, has hailed the draft as “a big step” towards curbing unhealthy food in the market.
But it wants the labels should reflect total sugar, not just added sugar; total fats, not just saturated fats. It says the government should also fix one serving size for all product makers and the use of word salt which is easier for all to understand than sodium.
Limitations of the George Institute study are also flagged by Dr Aggarwal: “There are other aspects of food packaging that also need to be taken into consideration: food safety, environmental pollution, additives, preservatives in packaged foods and the harmful effects of the food packaging materials.”
The concerns raised by Dr Aggarwal are right as well as timely. Another new study reported in Annals of Internal Medicine has established the presence of microplastics in the human stool. These small shreds and granules of ingested plastic come from none other than the plastic used in packing the food.
So far it is reported that only cows and fish are supposed to have plastics in their gut. Bigger particles pass through stool. It is also widely known that deadly chemicals are released from poor quality plastic containers into the food which is called “leaching”. What is not known is what happens to finer particles of plastics that wear off from plastic food packets. Are they getting deposited in our body?
FSSAI regulations prohibit the use of recycled plastics in food packaging, and the use of newspapers and such other materials for packing or wrapping of food articles. But it has been easier to pass the rules than to enforce it.
Are the packaged foods only bad?
“Certainly not,” says Dr Aggarwal, “Easy availability, convenience, protection of food from contamination, increased shelf life, can be stored; all these factors have contributed to the growing popularity of packaged foods.”
“The key drivers of their increasing demand are a busy lifestyle, nuclear family structure. Given the lack of time, packaged foods are alluring and certainly convenient,” he adds.
Packaging also protects the food inside from external contamination. This is not only helpful but can also be life-saving as has been seen during natural calamities like Kerala floods. Lakhs of people surrounded by spiralling slush threatening disease outbreak, with no means to cook, were distributed lakhs of food packets. This overnight mega-production was made possible only by food giants such as Britannia and ITC.
In the larger picture, because of improved medical interventions, the life expectancy in India is increasing, but so is the incidence of deadly lifestyle-related diseases.
In an India-specific study of disease burden from 1990 to 2017, the Institute for Health Metrics and Evaluation (IHME), an independent global health research centre at the University of Washington, had found lifestyle-related diseases such as diabetes, blockages in heart (ischemic heart disease), breathlessness of lungs (COPD), failing kidneys, high blood pressure and stroke had rapidly moved up in the top ten killer list during this period. Precisely these are the ones also linked to an increased availability of unhealthy packaged foodstuff in the Indian market.
Ischemic heart disease, COPD and stroke have also moved up during the same period in the list of diseases that strike early and cause premature death, says IHME.
The IHME analysis has also thrown up some interesting facts. The life expectancy of Indian men and women has shown a remarkable increase of about 10 years during this period (60.4 to 70.2 years for women and 58.9 to 67.8 years for men). Women have always tended to live longer than men by about four years on average in India. However, compared to 1990s, women now tend to live slightly lesser than projected expectation, pointing to new factors affecting their lifespan. It may not be wrong to infer that drastically changed lifestyle, which includes degraded nutrition and workplace pressure, is one of these.
Children, Easy Target
“These foods are most ambitiously advertised, especially among children. Ways such as attractive and bright-colour packaging, use of cartoon characters, kids’ favourite celebrities create such impressions that after that a lot doesn’t need to be done to make kids buy and consume such foods.”
Sonal Dhingra, Deputy Programme Manager, Food Safety & Toxins Programme, Centre for Science and Environment
- Have a comprehensive framework to restrict junk food advertisements targeted at children through mediums like TV, online marketing through social media and advergaming, newspapers, and outdoor spaces.
- Notify regulations such as Safe and Wholesome Food for Schoolchildren. This will restrict availability of packaged food to children.
How they are Impacted
“All the ills children are facing today are because of packaged food which has no control of harmful additives and preservatives. I would still blame the parents because society has departed from traditional ways. At very early age we see children are given medicines and nebulisers, and many additives cause cancer. They lose appetite and health, and then start underperforming in school.” Dr Anurag Tandon, ENT specialist
Infamous Contamination Cases
The iconic Indian snack, Maggi noodles, came under intense controversy in 2015 after it was reported to have found laced with higher levels of lead and Mono Sodium Glutamate or MSG. Indian food watchdog FSSAI banned the top-selling product of Nestle after food labs confirmed the contamination. The widespread outrage, especially among the parents of schoolchildren fond of two-minute noodles, led to ban and recall of packets from all shops, retail stores and warehouses. It was back on shelf after compliance to FSSAI rules.
No one ever suspected the elixir of life will suddenly become something to be wary of till a 2010 Centre for Science and Environment test lab confirmed the presence of antibiotics in top brands selling packaged honey. Dabur Honey came at the top of the list while low-profile Hitkari was found least contaminated.
E Coli deaths, Germany
Fearsome stories of outbreaks of disease from packaged food are not limited to developing or underdeveloped world. In May 2011, at least 48 people died and 70 taken seriously ill after E Coli in German food stores hit the consumers. Till today, investigators have not been able to track the source of infection whether it was packed cucumbers or imported fenugreek.
Singapore restaurant deaths
Like Germany, Singapore is another country with tough food laws and high quality of food sold by restaurants. As many as 81 staffers of security company Brink’s Singapore were taken ill and one died after consuming food packet ordered from popular Spize restaurant on Diwali last year. The company has defended in court saying the deceased fell to food consumed after three hours. But among hospitalised were also those who consumed within the given time.
Not exactly the packed food but this macabre human experiment has eerie similarities. Agents of contamination were not companies but scientists of Britain’s Medical Research Council, Coventry, UK, who gave radioactive-laced rotis to migrant Punjabi women in 1969 in order to check the iron deficiency levels from the radiation emitted by their bodies. Poor and hungry women consumed the rotis. The project was condemned not only unethical but also racist.
FSSAI follows Food Safety and Standards (Packaging and Labelling) Regulations. But amended rules seek to put a red label in place which will set an unhealthy food apart from the rest. There is no grading like HSR. FSSAI guidelines cover entire range of foods, not only packaging and labelling, but also their advertisement.
Warning captions such as the following to be used:
“Contains Artificial Sweetener and for the Calorie Conscious”
“Contains Additional Salt”
“This Packet Contains Monosodium Glutamate — Not Recommended for Children.”
Australian HSR Rating
- Health Star Rating, or HSR, is a ½-to-5 star rating system evolved by Australia that enable consumer to make a healthier choice by looking at the star rating displayed on the food packets.
- The front of pack labelling system was developed in 2014 by the Australian government in collaboration with industry, public health and consumer groups. This was prompted by a survey that revealed Australia had the highest number of obese population at 63 percent, and one in four children was overweight.
- The prevailing health profile was linked to presence of risk nutrients such as saturated fat, sodium in form of salt, sugars and energy in the packaged food. Australia’s HSR is also in vogue in New Zealand.
- Though under the law, the manufacturer is required to give a break-up of nutrients or ingredients on the packets, display of stars helps consumers make their food choices at a glance.
What should we eat?
- Instead of junk food such as pizza, burger, chips, etc, opt for natural fast foods such as bananas, orange, dry fruits, and milk.
- Reduce salt intake as much as possible, lower the better.
- Most importantly, balance your food choices with your activity level.
- The importance of eating healthy should be stressed at school and home right from a young age.
- Our ancient rituals and traditions advocate the principles of ‘variety’ and ‘moderation’. They also recommend including all seven colours (red, orange, yellow, green, blue/purple, white) and six tastes (sweet, sour, salty, bitter, pungent, and astringent) for a balanced diet.
- Practice mindful eating or ‘eating with awareness’—using all the five senses while eating. These include noticing the colours (eye), smells (nose), flavours (taste), textures (touch) and sound while chewing (ear) of the food. Mindful eating prevents impulsive eating.
Dr K K Aggarwal, cardiologist and preventive healthcare evangelist, who heads the Heart Care Foundation of India. He advocates lifestyle changes as best cure to modern-day ills.
WHO Policy Recommendations for India
Adapted by WHO South-East Asia Region from WHO Euro
- Direct investment toward improving the healthiness of products by enhancing the product mix and reformulating unhealthy products to healthier compositions
- Redirect marketing towards healthier products
- Ensure that labels comply with international standards
- Compile and maintain a national food composition database
- Establish a government-led programme to reduce salt, sugar and harmful fats in the food supply
- Develop and implement effective and enforceable legislation to prevent the marketing of unhealthy products to children
- Extend nutrition labelling requirements to comply with minimum international standards
- Given the growing evidence of harm and increased consumer interest globally, added sugar labelling may also be considered in any legislative reform