The idea that there is a connection between one’s diet and their risk of death from a noncommunicable disease (NCD) is neither new nor shocking to the general public. Time and again, medical and nutrition experts worldwide have underscored the need to make better food choices for better health. In particular, the World Health Organization (WHO) notes that in addition to lack of physical exercise and alcohol misuse, diets that are high in sodium, sugar, and fats increase one’s risk of suffering from NCDs.
Yet, despite decades of health warnings, NCDs remain among the leading causes of death in the Philippines.
According to the Philippine Statistics Authority, ischemic heart diseases — damage to the heart resulting from narrowed arteries — caused the most number of fatalities nationwide during the first half of 2024, accounting for one in every five deaths. Next were neoplasms (which include the different types of cancers), responsible for nearly 11 percent of deaths. Cerebrovascular diseases (conditions which can lead to stroke) and diabetes mellitus accounted for 10.2 percent and 6.2 percent of deaths, respectively.
In theory, shopping for healthier food should be as easy as reading the label on each product before adding it to your cart. Nutrition labels, typically printed at the back of packaged food products, tell the consumer crucial nutrition-related information such as the amount of calories, protein, carbohydrates, and fat in each serving, as well as the ingredients used. But not everyone has the time to read these labels — and even if they do, not everyone can understand them well enough to make properly informed choices.
“For many Filipinos, analyzing traditional nutrition labels isn’t practical and sometimes confusing,” observes Kristine Jane Atienza, a licensed nutritionist-dietitian.
An ounce of prevention: FOPWL implementation in different countries
According to a report by The Guardian, researchers at the Pan American Health Organization (PAHO), WHO’s officially designated Regional Office for the Americas, proposed the idea of implementing front-of-pack warning labels (FOPWLs) as a direct response to increasing incidences and mortalities connected to NCDs in the region. FOPWLs are clear and distinguishable black octagons that allow consumers to identify, at a glance, products that have unhealthy levels of a particular nutrient (i.e., sugar, sodium, trans fats, saturated fats, and total fat).
To date, seven Latin American countries have passed laws for designing and implementing black octagon FOPWLs: Chile (2016, via the Law of Food Labeling and Advertising), Peru (via the Law to Promote Healthy Eating for Children and Adolescents in 2013), Uruguay (following the issuance of decree 272/18 in 2018), Mexico (2020, via an amendment to the country’s General Health Law), Argentina (implemented in 2022), Colombia (2021, passing Law 2120 or the Junk Food Law), and Venezuela (2022, starting with high-sodium labels).
Why black octagons?
In recent years, some countries (particularly in Europe) have tried other nutritional labeling systems, including the Multiple Traffic Light (MTL) and Nutri-Score systems. However, research suggests that the use of warm colors such as red and orange actually encourages food cravings instead of suppressing them. It also doesn’t help that such systems add an extra layer of complication, compared to the more straightforward black “stop sign” warning system that can instantly tell a consumer, at a glance, which nutrient a particular food is high in.
In Argentina, researchers conducted a randomized controlled experiment involving over 700 adults. According to their paper published Revista Panamericana de Salud Pública (Pan American Journal of Public Health), they tested three front-of-package labeling systems — MTL, Nutri-Score, and black octagons — in terms of effectiveness in dissuading adults from purchasing certain unhealthy foods (drinking yogurts, cookies, and cheese spreads). The black octagon system turned out to be the most successful in reducing consumers’ desire to purchase. Meanwhile, the Nutri-Score was described as “inefficacious,” while the MTL system had the opposite effect (convincing consumers that the products were healthy, instead of making them avoid said products).
Moreover, findings of a 2022 PLOS One study affirmed Colombia’s choice to use black octagon warnings as labels, as they outperformed other nutrition label schemes in helping consumers identify and avoid high-sugar, high-sodium, and high-saturated-fat products.
Effects of FOPWLs in Latin American countries
Improved understanding of nutrition and increased health consciousness
According to a paper published in PLOS Global Public Health in 2024, researchers in Peru conducted 18 focus group discussions with 98 mothers two years after the implementation of the FOPWL system. They found that mothers grasped that the number of warnings on each product could tell them how unhealthy it is. Moreover, the labels helped them make better purchasing decisions, regardless of how well they understood the negative effects of a particular nutrient being too high in a product.
The FGDs also highlighted that, in implementing a system like FOPWL, establishing a strong, long-term communication campaign tailored specifically to the target audience should go hand in hand with the execution of the warning label mandate. Additionally, it’s not enough to warn consumers about unhealthy products; healthier options should be available and affordable, too. Lastly, it’s important to explain to consumers that just because a product doesn’t have a warning label, doesn’t mean it’s automatically a “healthy” option.
A month after Uruguay implemented its FOPWL system, researchers conducted an online survey of more than 1,700 Uruguayan adults to gauge how effective the nutritional warnings were. The findings, which were published in Public Health Nutrition, revealed that among the respondents, there was an increased awareness about nutritional warnings, self-reported adherence to nutritional warnings, and an improved capacity to choose which among a given number of food options is the healthier choice, based on what the warning labels indicated.
Furthermore, interviews conducted in 2023 (via the Journal of Nutrition Behavior and Education) revealed how the nutritional warning labels influenced Uruguayan parents’ perceptions and experiences with regard to healthy food after a year of implementation. The informants revealed that they had a “high awareness, acceptance, and understanding” of the information the labels provided, and that the labels made them more conscious about which food products to buy.
Better purchasing habits in the household
A 2021 assessment published in The Lancet Planetary Health gauged the effectiveness of Phase 1 of Chile’s FOPWL implementation. The researchers found that within just a year, it changed the purchasing behavior of many households, persuading families not to purchase extremely salty and sugary products. In 2024, researchers published findings in PLOS Medicine that further proved the efficacy of the warning system: Aside from purchasing fewer high-sugar and high-sodium products, Chilean households were also increasingly avoiding products that were high in saturated fat and calories.
Meanwhile, in Mexico, warning labels succeeded in getting teenagers and young adults to rethink their food-related purchasing decisions, based on the results of a 2024 study published in the International Journal of Behavioral Nutrition and Physical Activity. In an online survey answered by nearly 1,600 14- to 17-year-olds and close to 7,800 individuals 18 years of age and above, 38.7% of below-18 youth and 44.8% of adults shared that warning labels successfully deterred them from buying unhealthy food, especially carbonated beverages. In particular, the warning labels were especially effective among women, indigenous persons, households with children, overweight persons, persons with higher nutrition knowledge, and persons with lower educational attainment.
The road towards implementing FOPWLs in the Philippines
As a means to address this pressing health issue, legislators and concerned groups in the Philippines have been pushing for the implementation of FOPWLs. Notably, Senate Bill No. 2700, which is still pending in the committee as of this publication, prescribes the use of “black octagons with a white edge and capital letters” that indicate whether a product is high in sugar, sodium, total fat, saturated fat, or calories, or if it contains sweeteners that are not recommended for children. “These labels provide a quick, clear way to identify products high in sugar, salt, or unhealthy fats,” says Atienza.
Aside from simplifying the decision-making process, the presence of such warning labels can deter Filipino consumers from purchasing unhealthy products. This, in turn, would prompt manufacturers to improve the quality of their products by using healthier ingredients in order to eliminate the need for the labels to begin with.
As chronicled in a 2023 study from Mexico published in Public Health Nutrition, researchers analyzed news articles, government releases, and publicly accessible legal documents to gauge how well the law was implemented in the country. They not only reported a high compliance rate, but also observed that the warning labels prompted companies to change or replace ingredients so that their products would no longer need to sport the warnings. Ultimately, the researchers expressed hope that low- and middle-income countries seeking to implement FOPWLs could “learn from the Mexican experience to maintain scientifically proven best practices, counter industry barriers and minimise delays in implementation.”
Likewise, Atienza emphasizes that, if paired with an adequate public education campaign and “policies that improve access to affordable, nutritious food,” FOPWLs can be “a powerful tool in helping Filipinos make better food choices.”—MF
Research reported in this publication was supported by a media fellowship from ImagineLaw, Inc. The content is solely the responsibility of the authors and does not necessarily represent the views of ImagineLaw.
Author: Mikael Angelo Francisco
Bitten by the science writing bug, Mikael has years of writing and editorial experience under his belt. As the editor-in-chief of FlipScience, Mikael has sworn to help make science more fun and interesting for geeky readers and casual audiences alike.
