Doctors call for front of pack labels and scientific limits on sugar, salt, fats in junk food to contain India's growing diabetes burden

Leading doctors from the All India Institute of Medical Sciences (AIIMS) have called for a systemic approach to manage the rapidly rising prevalence of diabetes in the country, with particular emphasis on policy actions to establish science-based limits on salt, sugar and saturated fats in packaged and ultra-processed food and beverages.

The doctors emphasised on this in the backdrop of the devastating second wave of Covid-19, as there is growing evidence that diabetics are likely to have poorer treatment outcomes and could be at a greater risk of fatalities from Covid-19.

This call to action was made at a national session on Tuesday, by AIIMS Jodhpur, on 'Addressing Diabetes Mellitus through Front of Package Labelling in India.'

Participants included Dr Sanjeev Mishra, Director, AIIMS, Jodhpur; Dr Rashmi Malhotra, Senior Dietician, Dept of Diatetics, AIIMS Jodhpur; Dr Madhukar Mittal, Addt. Professor, Dept. of Endocrinology and Metabolism, AIIMS, Jodhpur; Dr Pradeep Aggarwal, Associate Professor, Dept. of Community and Family Medicine from AIIMS, Rishikesh and Dr Pankaj Bhardwaj, Addt. Professor, Dept of Community and Family Medicine, AIIMS, Jodhpur.

Participants included Dr Sanjeev Mishra, Director of Jodhpur AIIMS, his colleagues- senior dietician Dr Rashmi Malhotra; Dr Madhukar Mittal, Asst Professor, Dept of Endocrinology and Metabolism; Dr Pankaj Bhardwaj, Asst Professor, Dept of Community and Family Medicine. Dr Pradeep Aggarwal, Associate Professor, Dept. of Community and Family Medicine from Rishikesh AIIMS also participated.

According to the International Diabetes Federation (IDF), India, with more than 77 million diabetics, has the second-highest number of people suffering from this chronic condition in the world.

Dr Sanjeev Mishra cautioned that this number will double in the next 25 years.

"At least 134 million Indians will have diabetes by 2045 and the well-being of our people will take a major hit. It cannot be ignored that the shift in the disease pattern since 1990 can be correlated with the increase in consumption of processed food. The rapid rise in diabetes across socio-economic categories and age groups has been fuelled by a massive alteration in the dietary habits of Indians," said Dr Mishra.

"If we want to control the diabetes epidemic, we have to act now," he added.

A nutritious diet that eliminates or caps the amount of sugar, salt and saturated fats consumed, has long been considered the mainstay of diabetes management.

According to Dr Mittal, lab studies have revealed that sugar is as addictive as cocaine and it increases insulin production, driving up fat storage causing damage to all organ systems.

The ultra-processed food industry has grown at a record pace in India which is also second among the top five global markets for sugary beverages. Studies have shown that despite the need to promote and adopt healthy diets, particularly in the wake of this pandemic, multinational food companies have continued to promote unhealthy, ultra-processed foods and sugary drinks with no governmental limits on any of the harmful ingredients.

Per capita sales of ultra-processed foods grew from about 2 Kg in 2005, to about 6kg in 2019 and is projected to grow to about 8 kg by 2024. Similarly, ultra-processed beverages are up from 2 L in 2005 to about 6.5 L in 2019 and are projected to be about 10 L in 2024.

Dr Pradeep Aggarwal, Associate Professor, Dept. of Community and Family Medicine from AIIMS, Rishikesh, said that strong regulations to cap salt, sugar and other ingredients of concern and simple to understand front of package labelling (FOPL) on the food are critical to help consumers and parents understand how much empty calories and harmful nutrients are being consumed by children.

"Globally, WHO has established evidence-based cut-offs for sugar, salt and fat consumption region wise and governments should adopt these cut offs for packaged food. Food labels should provide clear guidance to consumers," Dr Aggarwal added.

Many countries today are adopting science-based nutrient profile models and making front of pack warning labels on food products mandatory. Labels on the front of the package make it readily visible for consumers to read the ingredients, specifically, sugar, sodium and saturated fat, and can discourage the purchase of unhealthy packaged food.

Thus far, 11 countries across the world have enacted laws making FOPL mandatory.

In 2018, the Food Safety Standards Authority India (FSSAI) published draft regulation for FOPL which was subsequently withdrawn for further deliberation.

In the following year, the FSSAI delinked FOPL from general labelling regulations.

In December 2020 it restarted the process and is currently seeking consultations with civil society, industry and nutrition experts for a viable model for India.

The FOPL works best when it is made mandatory and applies to all packaged products.

( With inputs from ANI )

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