From Chile to the world: Food policy package linked to lower childhood obesity risk

An observational study has linked coordinated food policies targeting products high in fat, salt, and sugar in Chile to a significant reduction in childhood obesity. Such policies include front-of-package (FOP) warning labels, marketing restrictions, and school food regulations. 

Nutrition Insight speaks with the study’s first author to learn why a combined policy approach is more effective, what this might mean for other countries planning similar rules, and about pushback from industry. 

The Lancet paper reveals that children aged six to 18 months showed approximately a 2% lower chance of excess weight after Chile implemented the Food Labelling and Advertising Law (FLAL) in 2016, dubbed the “world’s most comprehensive and ambitious food policies.”

The researchers claim to provide essential evidence and strategies for policymakers to tackle childhood obesity. Although the reductions appear to be modest, they encourage integrated policy approaches to improve long-term food environments. Small reductions could lower the risk of obesity, diabetes, hypertension, and cardiovascular disease later in life, they add.

For other countries planning similar rules, Guillermo Paraje, professor of Economics at the Adolfo Ibáñez University Business School in Chile, tells us they should take a multipronged approach to minimize children’s exposure to high-risk products because “this approach works.”

FOP warning labels, marketing restrictions, and school food rules work better together than as single policies (Image credit: The Chilean Ministry of Health).

The study points out that Chile is among the countries with the highest rates of childhood overweight and obesity.

“In Chile, after only six months, these effects are evident, with excess weight reduced in young children. So, these regulations are very important first steps toward protecting children and reducing childhood obesity,” comments Paraje.

“They are not a ‘silver bullet’ — there is no such thing, unfortunately — but they are needed to clearly inform the population about the characteristics and risks of the products they consume and to provide protected environments for children from advertising, marketing, and selling of these products.”

Impact of policy cocktail

The study emphasizes that FOP warning labels like black octagons, marketing restrictions, and school food rules work better together than as single policies. The FLAL also restricts selling products high in sugars, saturated fats, salt, or calories in schools.

Paraje explains: “This is because integrated policies usually work better than single ones. It makes no sense to have a good FOP labels system and to allow food companies to target children with their advertisements, giving them toys with their products or luring them with cartoons.”

“It is true that labels inform the whole population, which is very good, but the main objective of these integrated policies — at least in Chile — is to protect children.”

Paraje points out that national measures like sugar taxes on beverages have been linked to improved health outcomes, but the new study is the first to “plausibly” show that policy packages can reduce children’s overweight or obesity risk at a national level.

“It is well known that certain behavioral patterns acquired in childhood persist into adulthood. Eating patterns are one of them. It is also well-established that eating unhealthy food during childhood leads to the appearance of certain health conditions that also persist.”

“The results of this paper show that there are real health gains associated with a lower prevalence of excess weight,” he adds.

Decreased overweight risk

The analysis tracked 321,597 students from 2012 to 2017 across prekindergarten, kindergarten, and first grade.

According to Paraje, industry concerns around policies aimed at combating childhood obesity will harm employment are unfounded.

Children who experienced phase one of the FLAL revealed significant reductions in the risk of being overweight.

Those exposed during kindergarten and first grade showed the largest effects. The paper details that girls had a 2.85% lower probability of excess weight, and boys had a 2.4% lower probability.

Children with just six months of exposure or in first grade only had a 1.91% lower probability for girls and a 2.24% for boys.

The researchers used data from the Nutritional Map (Mapa Nutricional) and the Vulnerability Survey (Encuesta de Vulnerabilidad).

Need to unify industry and science

With the paper advocating for a multifaceted policy approach to tackle childhood obesity, pushback from industry is a reality, states Paraje. “Governments are often not prepared to resist.”

“Quite often, industry claims that these policies affect employment. But these claims are unfounded. There are studies published for Chile, Peru, and Mexico showing that, after labeling policies, there were no changes in employment or wages attributable to them.”

“The use of scientific evidence, free of conflicts of interest, is a way to resist pushback and steer the conversation toward evidence. All countries that adopted these measures (and after Chile, quite a few followed that example) were subjected to unfounded claims, and in all cases, broad political coalitions, supported by the academic community and civil society, prevailed,” he warns.

Professor Simone Pettigrew and Dr. Daisy Coyle at The George Institute for Global Health in Australia, who were not involved in the study, comment that “high-quality, real-world evidence” is critical in a policy environment where industry can oppose health-promoting policies.

Paraje highlights pushback in Argentina, where the government recently proposed the repeal of FOP labels, which were adopted in 2022 — “promoted by a broad, across-the-aisle political coalition.”

The Argentine government argues the law is overly rigid, duplicative under Mercosur, and burdensome for small businesses, but critics say regional alternatives are less effective than Argentina’s system backed by the Pan American Health Organization.

However, over 300 civil society and academic groups have opposed the repeal, citing strong evidence that the labels help consumers identify unhealthy products and change purchasing habits.

“The arguments are mostly economy-based and completely disregard evidence from other countries. The response to that is scientific evidence on the economic and health effects of these policies. We have an increasing body of that,” concludes Paraje.