Chile Battles Obesity With Stop Signs On Packaged Foods

Enlarge this image toggle caption Eileen Smith for NPR Eileen Smith for NPR

What if you were about to buy some packaged food at a supermarket, newsstand or vending machine and you noticed a black stop sign staring back at you from the label? On it was a message from the U.S. Department of Health: This snack is high in sugar, saturated fat, salt or calories.

Would it give you pause?

Chile is banking that it will. Sixty-seven percent of people older than 15 in this South American nation are overweight or obese, according to Chile's Ministerio de Salud (MINSAL, Ministry of Health).

Lorena Rodriguez, head of the Department of Food and Nutrition, says this number is troubling.

About 50 years ago, Rodriguez says, Chile's biggest nutrition issues were related to malnutrition. Now its problems are the type associated with nations that, for the most part, do not experience food insecurity. The ready availability of convenient, packaged food has changed the country's eating habits. Particularly in the past 20 years, Rodriguez says, the consumption of packaged food has risen in Chile, across all economic strata and in both rural and urban populations.

In December, the World Economic Forum reported Chile as the world's largest per-capita consumer of sugary drinks, at 188 calories per person per day, ahead of Mexico and the United States, which clock in at 157 and 158 calories, respectively.

In Chile, the most significant chronic, noncontagious public health issues are cardiac problems, certain cancers — such as stomach and gallbladder — and diabetes. The first two together cause half of the deaths in Chile, Rodriguez says.

For the past 10 years, Chile has used consumer food labels developed in accordance with the Codex Alimentarius, a standard set by the World Health Organization and the Food and Agriculture Organization of the United Nations. But these labels, which are similar to those on packaged food in the United States, are written in small font and often printed on package seams, making them difficult to read. Not only that, says Rodriguez, but in Chile, "only 30 percent of people read the labels, and of those, maybe 30 percent really understand them."

Enlarge this image toggle caption /Eileen Smith for NPR /Eileen Smith for NPR

After scientific studies indicated that modifying the purchasing environment could lead to behavioral changes, MINSAL identified four key nutritional factors in causing lost "health years." The agency then developed a label to help consumers make quick choices at the supermarket.

After focus studies, the ministry settled on octagonal black labels, printed with the words "alto en" (high in), plus key nutritional factors for packaged foods that exceed, per 100 grams: 275 calories, 400 milligrams of sodium, 10 grams of sugar or 4 grams of saturated fats.

Why 100 grams [about 3.5 ounces]? Because it's universal. "Portion size is relative and depends on many factors. But 100 grams is 100 grams," Rodriguez says.

She says that the bulk of sodium that Chileans consume, for example, is not from the salt shaker, but from highly processed foods in which it is used as a flavor enhancer and preservative. These are foods that people do not even consider salty.

"Even sweet, packaged food has salt in it," Rodriguez says, and many people don't realize what they're ingesting.

The labels are actually just one part of a three-pronged approach set in motion by a law passed in 2012, though they just started appearing at the end of June. The other two parts have to do with kids: Black-labeled food cannot be advertised to children under 14 or include toys (think McDonald's Happy Meals, unless they meet MINSAL's requirements, Rodriguez says), and they also may not be sold in or near schools.

It is not the government's intention to regulate the content of food, but to "change the environment" by informing consumers of the fat, sodium calories and sugar in foods, Rodriguez says. The new labels are easily visible, and already appear to be changing what people think about buying.

"It takes less than a second to decide to buy something," she says, "The labels had to be something you could see in that short period of time."

In a supermarket in the neighborhood of República in Santiago Centro, Mabel Sepúlveda Perez, thinks out loud as she reaches for a jar of mayonnaise. "This one doesn't have," she trails off, looking for the black labels. "We try to eat healthy," she says.

Enlarge this image toggle caption Eileen Smith for NPR Eileen Smith for NPR

Her companion, Patricio Sanchez, points to the shelf and says, "But they're on everything. It's like you can't eat anything anymore." There's one mayonnaise that isn't labeled, but it isn't the kind they like. He puts his original choice into their cart.

Many items in the supermarket have black labels: salted peanuts, potato chips, soda, ketchup, mayonnaise, crackers, all but one breakfast cereal, cream cheese. In the cookie aisle, every package has at least one label.

"I guess it's like the warnings on cigarette packages," Sanchez says. It's a warning, but in the end, it's up to the consumer.

Nancy Cardénas Luarte runs a freestanding kiosk that sells mostly snacks on the pedestrian mall of Paseo Huérfanos in downtown Santiago. She says the new labels have not affected her sales.

"Everyone knows these snacks are not healthy. On the weekends, I work at a food court, and you should see the quantity of french fries people eat. They know they're not good for them, but they eat them anyway," she says.

As to whether the labels will make any difference, Luarte says: "Maybe for little kids, who are just learning what and how to eat."

And that is one of the main goals of the Ministry of Health: to get school-age children in on the game. Rodriguez even suggests that peer pressure could play a positive role. In the past, she says, kids might make fun of the one child who brought a hard-boiled egg as a snack, while everyone else had cookies. Now they're going to point to the one who has the food with the black labels, and that's going to have an effect, she says.

But Gastón Gabarró, a father of four, is concerned that now his children will reject products with sugar in them because they have the label, and choose instead products that have artificial sweeteners. For example, he thinks parents should have the right to decide between regular Coca-Cola, which has the label, and Diet Coke, which does not.

But Rodriguez says, "We don't have proof that sweeteners are harmful. We have proof that sugar is harmful."

MINSAL will present its first official evaluation in December, just six months after the mandatory labeling went into effect. "If the labeling makes things harder to understand, we'll change it. It's not set in stone," Rodriguez says.

But the ministry is hoping that Chileans will move away from processed food, and "return to [their] roots, to [their] culture, return to cooking, planning family menus and sharing responsibilities, including going to their local feria [produce markets] together."

Eileen Smith is originally from Brooklyn and has been living in Santiago, Chile, since 2004. She writes for guidebooks, magazines and websites, mainly about food, linguistics, culture and travel. She blogs about her expat experience in Chile at www.bearshapedsphere.com.