This is an opportunity to halt the exponential rise in consumption of unhealthy diets and to mitigate the escalation of obesity and associated non-communicable diseases.
The answer to the question on whether or not India should adopt NOVA classification for foods is obviously yes. But why?
Well, you might have heard several terminologies about food, which are related to your health. “Fast food”, “junk food”, “street food”, “high sugar/salt” or “high fat” are some that have been popularly used in the past few years and are overtaking our food culture. The Food Safety and Standards Authority of India (FSSAI), mandated to ensure your food safety, in 2018 proposed a draft regulation on labelling and display of unhealthy foods based on the traffic light system. This has, as yet, not seen the light of the day, possibly due to the delicate balancing of “concerns and pressures” from the food industry. Therefore, we propose an alternative approach to Indian policymakers—that of adopting the NOVA Classification of foods.
WHAT IS NOVA CLASSIFICATION?
Brazilian scientists found that the consumption of processed foods made people eat more, and led to increased obesity and type-2 diabetes. This was happening in spite of the fact that people were buying less sugar and oil; but the consumption of highly processed or ultra-processed, ready to eat, sugary and packaged food products had gone up. They began to look at the extent and purpose of food processing, and that led to development of the “NOVA” food classification, which did not depend on food nutrient contents.
NOVA classification proposes four food groups: 1) Unprocessed/minimally processed foods; 2) processed culinary ingredients; 3) processed foods; and 4) ultra-processed foods (UPFs). It is based on the extent and purpose of food processing, instead of the nutrient content. The classification is a valuable new addition to guide our dietary recommendations. UPFs are being manufactured through processing of food elements, which occasionally results in addition of harmful additives. However, the overarching concern is their ability to cause enhanced palatability induced overconsumption of unhealthy nutrients, resulting in obesity and related cardiometabolic disease risk. This classification thus represents an important development in food science. The food industry did realise that their sales could be impacted if people avoid high sugar or high salt foods. They began reformulation of foods by reducing little sugar and fats and claimed the foods to be healthier. However, if ultra-processing is the fundamental issue leading to biological perturbations, then a UPF will remain UPF.
Government of India, by enacting Food Safety and Standards Act (2006), made an attempt to control the marketing of unhealthy foods by prohibiting “misleading advertisements”. However, this has made little impact as we continue to bear the brunt of aggressive marketing of unhealthy food products leading to their overconsumption. India’s per capita consumption of UPFs is currently low as compared to the United States or UK, but we are making a case to halt its exponential rise—the opportunity to act is now by learning from the experience of such nations.
Scientific evidence accumulated during the past decade unequivocally confirms that increased consumption of UPF is deleterious to health. Estimates indicate that 10% increase in the consumption of UPFs enhances the risk of obesity, diabetes, cardiovascular diseases and certain types of cancer by approximately 10%. In children, obesity and asthma are higher in those consuming UPFs. These effects are probably a consequence of alteration of satiety controls and metabolic pathways, high glycemic load, deleterious nutrient profile and harmful additives.
WHAT ARE THE BENEFITS OF NOVA CLASSIFICATION?
Adopting NOVA classification could be helpful in many ways to control consumption of unhealthy foods. This classification helps in quickly identifying if a particular food is harmful, less harmful or safe. It can spur periodic monitoring of food consumption patterns and justify marketing controls of the more harmful foods. NOVA can prove valuable for educating people with simple guidance to identify and consume less of unhealthy foods or eliminate them from their dietary preferences. It has four central recommendations: 1) base your diet on a diversity of Group 1 foods, which are real unprocessed or minimally processed; 2) use small amounts of Group 2 ingredients (salt, oil, vinegar, sugar) to transform Group 1 foods into diversified and delicious dishes and meals; 3) consume Group 3 foods (such as bread and cheese) as part of dishes and meals based on Group 1 foods; and 4) Avoid Group 4 foods, which are ultra-processed. Once this is adopted and confirmed to be useful, we would not need any other terminologies.
Some common examples of ultra-processed foods are packaged powdered baby milk, cereal, instant soups, noodles, packaged breads, carbonated drinks, packaged fruit juices, health or energy drinks, sweet or savoury packaged snacks, ice-creams, yoghurt with added artificial sweeteners, chocolates, biscuits, cakes, protein bars, and others. They have typically five or even more ingredients and this helps in easy identification.
The Food and Agricultural Organisation (FAO) recognises the health risks due to increased consumption of UPFs and concludes that policies should contribute to actions that fully take into account the nature, extent and purpose of food processing. Recently, the UN Special Rapporteur on the right to the highest attainable standard of physical and mental health has also recommended adopting an integral approach to reduce the consumption of unhealthy food products through the use of a broader set of laws and regulations. Several scientists in India and globally, who believe that our food system requires a transformational shift also support these proposals. Regulating marketing of UPFs is one important approach to achieve this objective. In this context, an earlier success is worth replicating, when India enacted a law in 1992 and 2003 to prohibit promotion of baby foods, India now sells about 27,000 tons of IMS foods as compared to 560,000 tons in China, which has a weak law.
We do believe that all types of foods should be available as some people find it convenient and cheaper to eat these packaged UPFs. However, the intense marketing, which pushes people to unnecessarily consume the harmful foods, can certainly be minimized, if not completely eliminated. The Government of India should consider instituting relevant regulatory measures after a thorough evidence-based review and transparent advice from experts and partners without conflict of interest. With the health of millions at stake, this matter cannot be on the backburner any longer.
Finally, we make an urgent appeal to the Parliamentary Committee on Health and all policymakers to consider the following steps. One, adopting NOVA classification and two, make use of this for framing and enforcing relevant regulatory framework for food and business operators. Of course, the third vital component is to educate people on suitable dietary practices and harms of consumption of UPFs. Let us not lose this opportunity to act in time—this is eminently doable as demonstrated by Brazil and a few other countries.
Dr Arun Gupta is a pediatrician and convener of the Nutrition Advocacy in Public Interest (NAPi), a national think tank on nutrition issues. Prof H.P.S. Sachdev is Senior Consultant in Pediatrics and Epidemiology, and also a member of NAPi with special interest in maternal and child nutrition in LMICs. He is also the Chair or Member of FSSAI Expert Committee and Panels. However, these views are in his personal capacity and should not be construed as views or endorsement of FSSAI.