Reformulation of food products to reduce sugar consumption

Product reformulations are efforts to lower the unhealthy components of foods at the time of production, without reducing healthy nutrients. Reformulation could be used to reduce the amount of sugar, salt, saturated and trans fats consumed on a population level.¹²

Reformulation to reduce sugar consumption aims to reduce the amount of free sugars consumed (all monosaccharides and disaccharides added to foods, plus the sugars that are naturally present in honey, syrups and fruit juices used to sweeten foods).¹³ Reformulation is one of a number of strategies that could contribute to reducing sugar consumption at a country-wide level.⁴⁵

Reformulation of foods to reduce sugar consumption has a number of potential advantages. It does not rely on substantial behaviour change among consumers and when done in a whole country setting, it can reach everyone.¹ Reformulation can also be mandated by governments to promote success and provide a level competitive playing field for the industries involved.² Reformulation can also be achieved through the introduction of front-of-packet health labels that encourage industry to reformulate to meet the required standard for positive labels, such as the Health Star Rating.⁶

Randomised controlled trials have indicated that reformulation of food and drink products can reduce both sugar intake and body weight of consumers.¹⁷⁸ However the quality of evidence is generally low.¹ Modelling studies support the use of reformulation for reduction of sugar intake, but the evidence is not as strong as that for reformulation for salt reduction, which has been used successfully in the UK.⁹¹⁰

Food product reformulation is not without its challenges. It has direct consequences for industry as it requires an investment in research and development, and may change cost of production or retail price. Whilst replacement of sugars with artificial sweeteners in beverages is relatively simple, replacing sugars in other foods is more complicated. Sugars are less energy-dense than fats and similar in energy density to other carbohydrates. It can be difficult to replace sugars without increasing the energy content or altering the texture of the food.⁴ Product quality, industry engagement and consumer preferences are therefore challenges for industry under reformulation programs.¹¹

England’s voluntary sugar reduction program (2015–2019)

Public Health England has assessed England’s voluntary sugar reduction program in a report covering 2015–2019. Product reformulation was a major part of this program. Results from this report show that the voluntary industry program has so far failed to reduce sugar intake.¹²¹³

The voluntary sugar reduction program challenged all sectors of the food industry to reduce sugar by 20% by 2020 for the categories of food that contribute most to the sugar intake in England. Guidelines were published in 2017, outlining a maximum calorie per single serve portion, set for most sugar-rich food categories.¹⁴ Retailers, manufacturers and the businesses that provide the food and meals were expected to take action to reduce sugar intake. The three options available for the food industry to reduce sugar were:

1. reformulation to reduce sugar content per weight or volume
2. reducing portion sizes, and
3. shifting consumers’ purchasing patterns towards consuming less sugar.

Public Health England have assessed the program by separately monitoring food to be eaten in the home (retailers and manufacturers branded products) and out of home (including takeaway and delivered).

For food eaten in the home there was an overall decrease of 3.0% of free sugar content, compared to the target 20%. Some product categories, such as breakfast cereals, saw a higher reduction (average 13.3%) whilst others, such as puddings, saw an increase in sugar content. The overall calorie content for these food products had hardly changed since 2015. Despite the small overall reduction in free sugars, there was an increase in the tonnes of sugar-rich products sold and a change towards consumption of high sugar products that had no reduction in sugar content. These results indicate that this program has not substantially changed the sugar intake of people in England.¹²¹³

For takeaway and delivered foods, there has been little change in the sugar content per weight, but there has been a reduction in average calories per portion. This may be reflecting an industry shift towards smaller portion sizes, but not reformulation of products.

This report indicates that sugar consumption per person in England has not decreased during the voluntary sugar reduction program (2015–2019). The poor outcomes from this voluntary reformulation program directly contrast the success seen for government-mandated reformulation to reduce salt consumption in the UK.⁹ The failure of reformulation described in this report is consistent with other voluntary industry programs and clearly signals the need for government regulation of reformulation.¹³¹⁵ The results of this report reflect a food industry that is complex and adaptive, and therefore policies and programs to reduce sugar consumption need continual and extensive monitoring.¹³

The Dutch Choices program (2006–2016)

In 2006, the Netherlands introduced a front-of-pack Dutch Choices Logo for food and beverage products. The program aimed to provide information to help consumers make healthier choices as well as stimulate product reformulation by industry. It took into account saturated and trans fats, added sugar, salt and fibre content in food and beverage products. Products with a favourable profile compared to others in their category were allowed to display Choice Logos.

A 10-year evaluation of the Dutch Choices program showed that labelled products had healthier compositions and more favourable trends in nutrient content compared with competing products.⁶ The overall energy density was reduced and the caloric content reduced in 11 out of 27 categories of food or drink. However, the changes in added sugar content were inconsistent. There were favourable changes in four categories that saw a decrease in added sugars. However, some categories, such as processed meats and soups, saw an increase in added sugar levels.

These results demonstrate the potential for front-of-pack health logos to improve nutrition profiles by reformulation, but that reducing sugar remains a challenge for such as program. Unfortunately, the Dutch Choices Logo was discontinued in 2016 due to pressure from consumer groups.¹⁶

Reformulation in Australia: The Healthy Food Partnership

The Healthy Food Partnership (HFP), between the Australian Government, public health groups and food industry bodies, aims to improve the diets of Australians. Reformulation is an important part of this program, aiming to push the food supply towards healthier products by gradually reducing harmful ingredients such as sugar. Reformulation by industry is voluntary under the HFP. Companies are encouraged to participate and asked to submit progress reports in June 2022 and 2024.

Proposed reformulation targets were released for consultation by the Reformulation Working Group of the HFP in 2018. The reformulation program started in 2020 and by 2021 has voluntary reformulation targets for 36 subcategories of foods and drinks.¹⁷ The targets cover popular processed foods such as bread, cheese, pizza, savoury snacks, sausages and bacon.

In an independent study, the HFP reformulation targets were assessed to ask if they were feasible and appropriate, or if there was scope for the introduction of more stringent targets.¹⁸ Only one of the seven targets for sugar was considered both feasible and appropriate. The other six categories had one third or more of products already meeting the target sugar levels. In four of these seven categories over half the products already met the targets, indicating that targets were not sufficiently stringent.¹⁸ The HFP targets cover an estimated 22.3% of packaged foods purchased by Australian households in 2018.¹⁹ Researchers from the George Institute for Global Health concluded that these targets did not cover enough food categories and that the program should be broadened to cover most packaged food categories available for sale, not just a few.¹⁸²⁰ The success of the HFP in reducing sugar purchased in packaged foods has not yet been assessed.

An assessment of the HFP’s potential for salt (sodium) reduction, however, predicts that the program will have minimal success. Australians consume almost twice the recommended amount of salt per day. Australia has signed up to the WHO’s global target of 30% reduction in salt intake by 2025. The potential for the HFP to reduce salt consumption was assessed by independent researchers.¹⁹ The reduction in salt from packaged foods was estimated using grocery purchase data from 2018 and a nationally representative consumer panel of households linked to the FoodSwitch packaged food and beverage database. The HFP is estimated to result in a 3.5% reduction in salt purchased from packaged foods.¹⁹ This estimated 3.5% reduction falls well short of the WHO’s target of 30% reduction needed to achieve a healthy level of salt intake.²¹

Critics of the HFP reformulation program doubt that enough companies will voluntarily reformulate their products due to insufficient incentives. They recommend publicly benchmarking companies against targets and against other companies, which is not part of the current program. They also recommend public reporting of progress, including individual company compliance, through independent annual audits of the food supply.²²