Creating a healthier food environment

What is shaping our eating patterns and what can be done about it?

Firstly, food choices can be influenced by individual factors such as genetic predispositions, beliefs, skills and attitudes towards food and motivation to eat healthy food. In early childhood, eating patterns are considerably moulded by the influence of family and the home food environment. Environmental factors such as the availability, accessibility and cost of healthy foods also play a crucial role. Policies at a local and national level can also influence healthy food consumption, such as dietary guidelines, child care nutrition policies, tax and subsidy policies and food marketing policies. The factors influencing food consumption are outlined in the ecological model, which will be discussed in further detail in coming weeks.

The accessibility and exposure to energy dense, nutrient poor foods in the current food environment of developed countries and many developing countries of the world is incredibly high. At a global level, the World Health Organisation has released a number of strategy documents aimed at addressing childhood obesity, chronic disease and risk factors. In 2016, the World Health Organisation released a Report of the Commission on Ending Childhood Obesity. One of the 6 key recommendations of this report is in relation to early childhood diet and physical activity. Specifically in regard to early childhood diet, the WHO recommend the following:

• Enforce regulatory measures such as the International Code of Marketing of Breast-milk Substitutes and subsequent World Health assembly resolutions
• Ensure all maternity facilities fully practice the Ten Steps to Successful Breastfeeding
• Promote the benefits of breastfeeding for the mother and child through broad-based education to parents and the community at large
• Support mothers to breastfeed, through regulatory measures such as maternity leave, facilities and time for breastfeeding in the workplace
• Develop regulations on the marketing of complementary foods and beverages, in line with WHO recommendations, to limit the consumption of foods and beverages high in fat, sugar and salt by infants and young children
• Provide clear guidance and support to caregivers to avoid specific categories of foods (eg sugar-sweetened milk and fruit juices or energy-dense, nutrient-poor foods) for the prevention of excess weight gain
• Provide clear guidance and support to caregivers to encourage the consumption of a wide variety of foods
• Provide guidance to caregivers on appropriate nutrition, diet and portion size for this age group
• Ensure only healthy foods, beverages and snacks are served in formal child care settings or institutions
• Ensure food education and understanding are incorporated into the curriculum in formal child-care settings or institutions
• Ensure whole of community support for caregivers and child care settings to promote healthy lifestyles for young children (WHO (2016) WHO Report of the Commission on Ending Childhood Obesity)

Many countries already have established dietary guidelines specific for children in this age group as we have discussed earlier. Many countries have adopted the WHO Ten Steps to Breastfeeding and policies on breastfeeding have also been established in some countries, either as part of the dietary guidelines or separately, such as the Australian Infant Feeding Guidelines, The American Academy of Pediatrics – Breastfeeding and the Use of Human Milk and Infant and Young Child Feeding: standard recommendations for the European Union. Countries differ in regard to policies such as maternity leave and breastfeeding in the workplace.

In regard to formal child care settings or institutions, some countries have adopted policies that address the type of food that is served or allowed to be sent to these settings and/or nutrition education in the curriculum; however, such policies can differ by region.

There is mounting evidence of the negative effect of unhealthy food marketing in relation to purchase requests from children and children’s eating behaviours. In 2010, the World Health Organization released recommendations urging countries to develop or strengthen food marketing policies. Countries such as the UK, Ireland, Chile and Spain have passed legislation regulating food marketing to children. Other countries, such as Australia, have implemented self-regulatory industry codes. Despite these regulations, children continue to be exposed to high levels of unhealthy food marketing. Further action is clearly needed at both a national and international level to reduce children’s exposure to unhealthy food advertising.

The ever increasing accessibility and low cost of unhealthy foods has motivated some countries to implement taxes and subsidies. Most recently, the UK has announced that they will introduce a sugar-sweetened beverages tax in 2018. Berkeley in the US and Mexico have also recently implemented a tax on sugar-sweetened beverages, with Philadelphia in the US also considering a similar tax. French Polynesia’s tax also includes sugary foods. Hungary has a broader public health tax which includes salt, sugar and caffeine. Chile introduced a sugar-sweetened beverage tax in 2015 and from July 2016 will be implementing front of package warning labels on foods and drinks high in energy, sugar, saturated fat or salt. While the implementation of these taxes has been recent, there is evidence in Mexico that sugar-sweetened beverage consumption in those who consume a high amount is decreasing. Many countries including Argentina, the UK, South Africa, Denmark, Austria and Ghana have taken a different approach by implementing food supply regulations such as reducing salt, saturated fat and trans fat.