Junk food regulations in Chile ag obesity

 The NY Times (Feb 7, 2018) had a really interesting article on an extensive public health initiative in Chile to decrease obesity (see https://www.nytimes.com/2018/02/07/health/obesity-chile-sugar-regulations.html )

Details:

--Chile, as many countries, has "skyrocketing rates of obesity". Chile's health ministry claimed that 3/4 of the population is overweight or obese, including over half of all 6 year-olds 

--And, the cost of obesity (just the monetary health care costs): $800 million in 2016 (2.4% of health care spending), but likely to reach 4% by 2030

--They have developed a many-tiered public health approach to the problem:

    ​--2 years ago they forced multinational food companies (eg Kellogg) to remove iconic cartoon characters (eg Tony the Tiger) from advertising sugar-laden cereals, which had targeted the attention of little kids

    --banned the sales of candy which comes with alluring toys (eg Kinder Surprise, Cracker Jacks)

    --prohibited sales of junk food (ice cream, chocolate, potato chips) in schools

    ​--proscribed advertising these junk foods on television shows targeting kids; and beginning next year, to eliminate TV, radio, and movie theater advertising between 6am and 10pm

    ​--will ban marketing infant formula this spring as a means to encourage breast-feeding

    ​--18% tax imposed on highly sugared-beverages (the steepest soda tax in the world)

    --and, requiring package food companies "to prominently display black warning logos in the shape of a stop sign on items high in sugar, salt, calories, or saturated fat"

--Perhaps not so surprisingly, the food industry is not really ecstatic about these changes, stating "government overreach" and "invasive" and "scientifically flawed", and that the best approach is "through consumer education"  [i've heard this type of argument somewhere before....]

--PepsiCo and Kellogg's have taken this to court, arguing that "the regulations infringe on their intellectual property" [and perhaps undercutting the real adverse effects of these products on the future intellectual development of the consumers, arguably an important intellectual property...]. results of case: pending

--This public health initiative did run into some of the usual roadblocks, leading to a decade long delay in the law: on 2 occasions, huge numbers of lobbyists representing corporate interests flooded the Congressional hearings and forced the suspension of the sessions

--the leading Senate advocate was a surgeon (Senator Guido Girardi), commenting: "sugar kills more people than terrorism and car accidents combined" [a reasonable perspective]

--and, also not surprisingly, food companies are modifying the food contents in order to avoid the dreaded black stop sign logos and continue to make money. A representative of the food industry stated that 20% of all products sold in Chile (>1500 items) have been so reformulated. Coca-Cola and PepsiCo are rebranding about 2/3 of their sodas to have low or reduced sugar, and up to 90% of their snacks, in order to avoid the black logo (of course, they did focus groups before doing this, and found to their surprise that kids actually really did look at the these black logos and asked their parents not to buy those foods: stating for example, "i can't bring this to school. my teacher won't allow it" )

--so far, not much change in obesity, but that would be expected to take some time….

--Ecuador and Brazil are looking into similar initiatives

Commentary:

--one local, but much smaller initiative in the US was to get rid of trans fats. It took lots of people spending many years to dramatically decrease trans fats in the diet, despite pretty convincing epidemiological data showing that eliminating trans fats would be the single most effective intervention to reduce cardiovascular disease.  And many of the issues were the same as above: massive campaigns by industry, stating for example that their trademarked production processes using trans fats (eg for mcdonalds french fries) was necessary for cost reasons and taste (it turns out that France, as i remember, passed an anti-trans fats law, and there were studies showing that the cost production change was trivial and that consumers could not tell the difference between mcdonalds french fries with trans fats vs a nontoxic substitute)

so, this really striking public health issue is actually being tackled in Chile. it is noteworthy that their obstacles are pretty similar to ours (eg, outsized influence of industry over the public good). unfortunately, we in the US are galloping in the wrong direction at this time. but with concerted effort, we can "right this (otherwise sinking) ship", and protect ourselves. in this regard, there was a really powerful community-based initiative in rural Maine over 4 decades to tackle reducing an array of cardiovascular risk factors, see http://blogs.bmj.com/bmjebmspotlight/2015/01/21/primary-care-corner-with-geoffrey-modest-md-community-wide-rural-cardiac-health-program/​ )