Technical Paper 1:
Obesity in Australia: a need for urgent action

4.2 - Food composition

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The development and reformulation of existing products is one way to increase the availability and accessibility of healthy food options and help create a supportive environment for behaviour change.[66] For example, an estimated 75% of salt intake comes from foods people purchase; clearly, product reformulation by industry has a key role to play in improving health outcomes.

There are policy examples for voluntary targets for salt reduction in food associated with reductions in population salt intake. In an initiative to reduce population salt intake, the UK Food Standards Agency (FSA) set voluntary targets for the level of salt in 85 categories of food in March 2006, involving around 70 firms and trade associations, and a broad range of products. The FSA is currently reviewing the targets and considering further reductions to maintain progress towards the daily average intake target of 6g of salt.[67] Existing initiatives in Australia involve the food industry reformulating food products with lower salt options through the Heart Foundation ‘Tick’ program and the Australian Division of World Action on Salt and Health (AWASH) ‘Drop the Salt!’ Campaign.

The UK Government is using the achievements in salt intake reduction by FSA and sectors of the food industry as a model for achieving reductions in levels of saturated fat and sugar in food.[35] The Code is intended to be voluntary; however, ‘the Government will clearly continue to examine the case for a mandatory approach where this might produce greater benefits’.[35]

Interventions to reduce population-wide salt intake have been shown to be highly cost-effective.[68] The most recent survey evidence (July 2008) indicates the UK’s average daily salt consumption has fallen from 9.5g to 8.6g since 2000.[69]

The North Karelia Heart Health Program in Finland is an example of the successful use of an integrated food policy approach in significantly improving population health.[151-157] The program was a comprehensive population intervention that led to significant improvements in risk factors and lifestyles, and favourable changes in chronic disease rates and population health. It involved a large-scale community-based intervention that began in the early 1970s to address regionally high rates of coronary mortality by targeting critical causal risk factors and their relationships with community lifestyles. While strategies were focused on tobacco use and the typical dietary habits of the population (high saturated fat and salt intake, low vegetable and fruit consumption), physical activity, weight, diabetes, alcohol consumption and psychosocial factors were also taken into account. The program incorporated an integrated food policy approach and combined general health education (through media, campaigns and meetings), local health service measures and training of personnel with environmental changes (smoking restrictions, collaboration with food manufacturers and retailers, and promotion of vegetable growing).
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Crucial components of the intervention included expert advice, evaluation, coordination of activity and media information. Interventions included:

  • Health information and nutrition counselling for the regional population
  • Health agencies working nationally with the food industry to reformulate food, leading to low-fat dairy and meat products, and the reduction of salt in a range of food items
  • Close collaboration with national vegetable oil product manufacturers to produce healthier spreads.
The regional success of the project led to nationwide nutrition education to target the rest of the country, leading to significant changes in the North Karelian and Finnish diet such as:
  • Increased consumption of fish, vegetable, fruit and berry consumption over 20 years
  • Increase in proportion of people using mainly vegetable oil for cooking between 1972 and 1997
  • Decreased consumption of salt and energy from saturated fats between 1972 and 1997, with an associated drop in cholesterol levels by 18% over 25 years.
Changes were substantial. Notable health impacts included a decrease in heart disease rates nationally by 65% between 1971 and 1995. Trends in stroke and cancer mortality also showed a downward turn, with impacts on life expectancy and diminished mortality. Evidence suggests that most of the decrease in coronary heart disease mortality can be explained by changes in the target risk factors, and that the reduction in serum cholesterol level has been the strongest contributor.

Regulate the amount of trans fats, saturated fat, salt and sugar content in foods.

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