interview | tom frieden Health

‘Transfat accounts for high morbidity in India’

The World Health Organisation-recommended REPLACE initiative can help cut deaths

Early this week, the World Health Organisation (WHO) released REPLACE, a step-by-step guide for the elimination of industrially-produced trans-fatty acids from the global food supply. REPLACE, which is an acronym for Review, Promote, Legislate, Assess, Create and Enforce, is the first global initiative to eliminate a risk factor for cardiovascular disease. Cardiovascular disease is the leading cause of deaths globally, accounting for one in every three deaths. Given India’s disease burden of non-communicable diseases and also the urban movement towards healthier foods, this movement is vital for the country to prevent diseases, and the compromised quality of life and deaths caused due to transfats. The REPLACE action package will provide governments with a strategy to achieve the prompt, complete, and sustained elimination of industrially-produced trans-fat from their national food supplies. This includes six action areas. Dr. Frieden, a leading public health expert, spoke on the initiative. Excerpts.

What percentage of transfat do you see in an average adult human being in middle/lower income groups/countries?

The WHO recommendation is that people consume less than 1% of their energy from transfat. This translates to 2.2 grams for a 2,000 calorie diet. In some countries, and for some populations within some countries, exposure may be five times higher than that.

Just how harmful are transfats? How does it affect children?

Artificial transfat raises bad cholesterol and lowers good cholesterol and is estimated to kill 540,000 people a year around the world. Transfat is harmful across the life course.

What disease burden does it translate into for India?

Published estimates are that transfat kills more than 60,000 people a year in India. However, there is currently limited data on what the level of exposure and consumption is in India.

How would the WHO assist or direct India in reducing its transfat use? How would you work with multinationals operating in the country?

The WHO recommends that every country, including India, eliminate transfat by reducing the allowable level to less than 2% in fats, oils, and all food. Countries such as Canada and Argentina when they controlled transfat have provided technical assistance and funding to national industries to help them replace transfat with healthier oils. Adding soybean, sunflower, safflower and canola oil to mixes will save both lives and money — and increase the proportion of oil consumed in India that is made in India.

If not stopped what could the “abuse” of transfat mean for India?

If the WHO-recommended REPLACE package isn’t implemented in India, there will be lakhs of deaths and heart attacks that could have been prevented. Fortunately, the Government of India has indicated their commitment to eliminating industrially produced transfat in advance of the WHO target date of 2023.

What can be done at home to cut out transfat from our diets?

This is a matter for the government to ensure that transfat is out of the food supply. But families can choose healthier oils such as sunflower, canola, soybean, and olive and nut oils. Also, consume more vegetables and fruits and limit fried foods, salt and sugar.

The REPLACE action package proposes to provide countries with ‘tools’ to eliminate industrially produced transfats from their national food supplies. What are these tools?

The six-step action package shows the way to elimination. This includes examples of regulations and laws that can be adapted to the local context, guidelines for testing of food and human serum to determine levels of exposure, technical assistance to promote healthier oils, and examples from countries around the world that have already eliminated transfat.

Could you elaborate on what realistic commitments/strategies the Indian government has committed to?

The Government of India, through the FSSAI [Food Safety and Standards Authority of India], has required a reduction to 5% transfat in certain oils. The global best practice is a maximum of 2% in all oils, fats, and all foods. No formal decision has yet been made by the Government of India for complete elimination.

A lot of research also suggests that excess sugar too is an impediment to health. By focussing only on transfat, does REPLACE condone sugar consumption?

Absolutely not! First we discourage companies from allowing companies to advertise unhealthy food, including high sugar, high salt, high fat food as “transfat-free” as this is marketing which deceptively implies healthy. Second, as far back as 2009, I had advocated a tax on sugar-sweetened beverage of 1 cent per ounce. Third, a strong component of the ‘Resolve to Save Lives’ global work is the reduction of salt. Finally, REPLACE specifically promotes not just the banning of transfat but also the promotion of healthier oils such as sunflower, canola, soybean and safflower. Excess sugar is a major driver of the obesity epidemic. REPLACE addresses the removal of a very harmful substance as one part of comprehensive action to improve nutrition.

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Printable version | May 31, 2020 8:24:34 PM |

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