For years, I’ve eaten All Bran Flakes for breakfast believing that my choice was healthy, but I recently learnt that this cereal is classified as high being in sugar and salt, according World Health Organisation dietary guidelines, – not what I expected given the bland taste and its extensive marketing as a healthy option!

Worldwide, people are eating more and more processed food and drinks – and cereal, polony, two-minute noodles, yoghurt and fizzy drinks are some of South Africa’s favourites.

It’s convenient, accessible and often cheaper than healthier options – and there are massive marketing campaigns to get us to believe that we need this food.

Sugar, salt & fat

But almost all “junk” food relies on high sugar, salt and saturated fat, processed with chemicals, to make it palatable and long-lasting. These are precisely the ingredients that are driving obesity and, with it, diabetes, hypertension, heart disease, strokes and cancer. Yet most of us are unaware of what is really in our processed food.

Obesity is growing in every single country in the world – even famine-wracked Somalia. The average adult today is three times more likely to be obese now than in the 1970s, and not a single country has been able to stop this trend.

Governments are now faced with the dilemma of how to protect citizens from eating ourselves to death, consuming food and drink that we have been encouraged to associate with pleasure.

“Sugary drinks should be seen in the same light as tobacco. They have no nutritional value, they are seriously toxic to the body and our sugary drink intake is out of control,” says Professor Karen Hofman, who heads PRICELESS, a unit at Wits School of Public Health that assists government to develop cost-effective health interventions.

While government introduced a tax on sugary drinks in April last year, Hofman believes that “tackling obesity needs a series of different measures that work together”.

Proper labels

“We can seriously consider a tax on junk food, as they have done in Mexico. But processed foods must also be properly labelled so that people know what they are eating,” she said. “I attended a conference recently where, at the tables for every meal, the food and its health implications, was labelled. Next to the ice cream machine, there was a sign that said ‘go ahead and enjoy this if you want diabetes’. We need to know what we are eating.”

Lynn Moeng, Chief Director of Nutrition in the Department of Health, says that government is working towards getting warning labels onto packaged food by the end of this year or early next year.

The department is considering simple warnings about high sugar, salt and saturated fat on the front of processed food, but it is still busy researching what will work.

“This will assist people to know what’s in packaged food,” said Moeng. “But there is the problem of non-packaged food. People are excited to buy that combo – chicken, chips and a fizzy drink – and they don’t know what’s in that.”

She was speaking at the launch of an awareness campaign about the dangers of junk food, organised last week by the Healthy Living Alliance (HEALA). The #Whatsinmyfood campaign aims to help people to understand what is in the food they are eating, according to alliance executive director Sibongile Nkosi.

Right to know what we eat

“People have the right to know what is in the food they eat,” said Nkosi. “Think of the mother in a squatter camp preparing a lunchbox for her child. She just goes to the nearest shop and buys polony. She doesn’t have time to read what’s in it. We want to help her to identify unhealthy food, but also get shops to stock the healthy food grown by local small scale farmers.”

[quote float = right]Consumers’ choice is not “free” when it is being manipulated by an industry that is intent on selling us unhealthy products.’

Getting unbiased information about what is in processed food is not that easy. There is a long history of industry manipulating science. During the 1960s, a US industry body called the Sugar Research Foundation paid three Harvard scientists to publish a review of the research on sugar, fat and heart disease.

The review studies were chosen by the sugar industry and the article, published in the prestigious New England Journal of Medicine in 1967, minimised the link between sugar and heart health and blamed saturated fat and cholestrol instead.

This manipulation only came to light recently when a researcher, Cristin Kearns, unearthed food industry documents and published her findings in 2016.

But in the meantime, the review had helped to launch a worldwide fat-free fad. This fueled sugar consumption as, once the producers had removed fat from processed foods, they generally pumped them with sugar to make them edible.

From 2008, Coca-Cola provided millions of dollars to researchers who identified lack of exercise rather than diet, as the cause of obesity – yet diet is around three times more influential than lack of exercise in obesity. Then there was a 2011 study, which found that children who eat sweets tended to weigh less than those who don’t – funded by the US National Confectioner’s Association!

Many aliases for sugar

While I should have read the pack label on my All Bran to check the ingredients, the industry-produced labels can be hard to understand on some foods. Sugar has various aliases, like sucrose and fructose and glucose, while there are 21 disguises for salt in food, including monosodium glutamate, sodium bicarbonate, disodium guanylate and even fleur de sel!

“Information displayed on food packages is often difficult to understand,” says Tamryn Jenkings, a researcher at the UWC School of Public Health. “The energy, fat, sugar and salt content are often displayed per ‘portion’ on packages but this portion is not equivalent to the size of the package. If you look at a box of a popular sweet brand, for example, one portion equals 15 sweets (15g). But the standard pack size is 40g and people are likely to eat the box in one sitting without being aware that they are actually consuming more than they should be.”

Professor Professor Rina Swart, Programme leader for Nutrition in Centre of Excellence in Food Security at the University of the Western Cape, says that many South Africans “are not confident in their ability to understand the provided information”.

“Although it is good to have the detailed information on the content of food products on the container, it will be much easier for consumers if food products with excessive amounts of critical nutrients could be made easily identifiable by a simple labeling system,” says Swart.

“Several countries, in their fight against obesity, have recently launched such information systems such as Chile, Canada, Israel, Peru to name a few.”

Chilean labels

In Chile, one in four schoolchildren and one in three adults are obese and the country’s the main causes of death are related to obesity and diet. In 2016, the Chilean government decided to regulate junk food. Foods high in added salt, sugar and saturated fat, have to display a black stop sign on the front of the package and cannot be sold or promoted in schools or advertised to children under the age of 14.

A study published two weeks ago to evaluate how mothers of young children had responded to the new policy found that it was changing what they were buying.

“Many mothers described that their children requested healthier food and used the stop signs as shortcuts to distinguish healthy from unhealthy food choices. As a result, many mothers said that they have changed the foods they purchase for their children,” said the study’s lead author, Dr Teresa Correa, from Diego Portales University in Santiago.

Professor Swart says it will take time to get people to change their eating habits, but strategies used elsewhere include “consumer education initiatives, reformulation of foods, taxation and front-of-package labelling”.

No doubt there will be screams of “nanny state” about these measure, but the bleaters are not having to deal with the 240 South Africans who have strokes every day or the 10,000 new diabetic patients reporting to clinics every month. Consumers’ choice is not “free” when it is being manipulated by an industry that is intent on selling us unhealthy products.

An edited version of this story was published by Daily Maverick.