In June 2023, a study conducted by the Madras Diabetes Research Foundation in collaboration with the Indian Council of Medical Research and the Union Health Ministry revealed that 11.4% of India’s population or 10.13 crore people are living with diabetes and 15.3% of the population or an additional 13.6 crore people are pre-diabetic. It also found that 28.6% of the population would be considered to be obese as per the BMI measure.
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Consumption of ultra-processed foods
According to the World Health Organization, a major reason for this is the consumption of unhealthy ultra-processed foods and beverages, which are aggressively marketed displacing traditional diets. Such food includes carbonated drinks, instant cereals, chips, fruit-flavoured drinks, instant noodles, cookies, ice cream, bakery products, energy bars, sweetened yogurts, pizzas, processed meat products, and powdered infant formulas.
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Scientific evidence shows that diets heavy with ultra-processed food and beverages or high in sugar, fat, and salt are risky and can lead to diabetes. A 10% increase in the consumption of ultra-processed food a day is associated with a 15% higher risk of type-2 diabetes among adults. When food is ultra-processed, its structure is destroyed and cosmetic additives, colours, and flavours are added. This makes people eat more, gain weight, and heightens the risk of diabetes and other chronic diseases. Further, obesity and diabetes are key risk factors for heart disease and deaths. A study showed that those who had more than four servings of ultra-processed food a day were much more at risk of cardiovascular mortality than those who took less than two servings a day. An upward trend was found for all-cause mortality too.
A playground for the food industry
It is reported that the sale of sugar-sweetened beverages has fallen in the last 20 years in many high-income countries. To compensate for the loss of sales, companies are now focusing on low- and middle-income countries. India is a playground for the food industry. Billions of rupees are spent on marketing and advertising ultra-processed food and beverages, which leads to increased consumption by vulnerable populations. While the food industry blames people for bad choices, it is not the people but the environment around them that is to blame. Marketing targets younger generations and the growing middle class, making it hard for an individual to choose healthy food options. Children in particular are exposed to cartoon characters and given incentives and gifts. Celebrity endorsements also determine their consumption decisions.
The result is a deepening public health crisis, the ticking time bomb of diabetes. Sugar-sweetened beverages are a major source of added sugar in diets and put people at a higher risk of type 2 diabetes. In such a context, policy and regulatory actions are warranted.
The food industry does not want any restrictions on marketing; they offer partnerships as well as arguments of economic development as ‘stakeholders’. The food industry also participates in programmes such as ‘Eat Right’, making false promises. Such partnerships do not allow us to make a strong regulation that could reduce the consumption of ultra-processed food and beverages. The Food Safety and Standards Authority of India has shown a lacklustre response to the crisis and allowed a dominating role to the food industry while suggesting front-of-package labelling, which is still not in place. Many say that people should exercise. While this is good for health, it should be in addition to a regulatory policy on restricting the marketing of ultra-processed foods and providing warning labels on junk food and beverages.
The only way the government can safeguard people from the manipulative strategies of the food industry is through a legal framework or even an ordinance (Article 123 of the Constitution) with the objective of reducing/halting the consumption of ultra-processed foods. It could also include defining ‘healthy food’, a warning label on unhealthy food, and restrictions on the promotion and marketing tactics of unhealthy food and beverages. The people must be informed of the risk of consuming such food. In this process, there is no reason to partner with the food industry that is responsible for ill health.
The governments of South Africa, Norway, and Mexico have recently taken similar actions. The Government of India can show its strength to regulate food labelling and marketing. Such a law will be a clear demonstration of the will of the government. The Infant Milk Substitutes, Feeding Bottles, and Infant Foods Act flattened the growth of commercial baby food. The proposed new law could do the same to unhealthy foods and beverages. This is an idea whose time has come.
Arun Gupta, a senior Pediatrician, is Convener, Nutrition Advocacy in Public Interest, and a former member of the PM’s Council on India’s Nutrition Challenges