Research Supporting Chile's Anti-Obesity Regulations Doesn't Tell Us if the Regulations Work
We still know very little about whether regulations meant to curb obesity actually do so.
A host of anti-obesity measures adopted in Chile in 2016 are working, according to a new study by U.S. and Chilean researchers that was published last week in the International Journal of Behavioral Nutrition & Physical Activity. But that's only true if you define success down to a meaningless level.
The Chilean law, considered by many to be the world's strictest, was intended to combat high obesity rates in the country, where nearly one-third of adults and one-quarter of children are obese. It was championed by Chilean Senator Guido Girardi, a surgeon by training who's called food companies "pedophiles."
As the study details, the Chilean food law targets the marketing and sale of foods and beverages that are deemed high in calories, saturated fat, salt, or sugar. Foods deemed high in salt under the law, for example, must carry a front-of-package label announcing that fact. If that same food were also deemed high in sugar, say, then it would be required to carry a separate front-of-package warning. What's more, under the law such foods cannot be served in schools, advertised on television shows popular with children, or use marketing strategies that may appeal to kids. The rule applies only to packaged foods, and doesn't cover, for example, sales of fast foods or bread.
The study announcing the law as a success, meanwhile, is intended "to examine mothers' understanding, perceptions, and behaviors associated with Chile's food regulation using a qualitative approach." The study authors focused their research on mothers because, they note, mothers make food purchasing decisions and act as food gatekeepers. The qualitative study is based on the results of nine focus groups of mothers of children aged 2-14 in Chile. In total, the focus groups consisted of just 84 participating mothers. The focus groups were organized and divided by socio-economic status ("SES").
The study's authors, who express support for the Chilean law, were quick to tout the results of their research.
"This study shows that regulations really change how mothers think about and purchase food for their children," says study co-author Lindsey Smith Taillie, assistant professor of nutrition at University of North Carolina (UNC).
UNC's Barry Popkin, another co-author, says the "study, and others that follow, suggest that this cluster of regulations represents the first potential set of policies that may change food norms" and improve children's diets.
Despite those internal praises, the law's impact on obesity has been negligible thus far. Obesity rates actually rose in Chile during the law's first year in existence. (Supporters counter that it will take years for the law to reduce rates of obesity.)
Instead of pointing to actual health improvements, the greatest impacts the study identifies are that most mothers are familiar with the law and that very young kids seem to be impacted by classroom discussion of healthy foods and of lunchroom policies carried out under the law.
(The latter claim seems dubious. For example, the study concludes young kids support the regulations by noting that mothers "agreed that their children, particularly the youngest ones, had positive attitudes toward the regulation[.]" The study includes mothers of children as young as two-years old. I suspect it's more than a bit of a reach to claim babies understand or support any regulation.)
Other than those conclusions, though, the bar for what's perceived to be success seems rather low. In fact, several facets of the study raise some cautionary flags.
Right off the top, some of the authors' key takeaways appear to amount to little more than tautological gobbledygook. "Mothers declared that they perceived that the regulation was changing the perceptions, attitudes and behaviors toward healthier eating patterns," the study declares. Assessing how a person perceives their own and others' perceptions of a law seems several steps removed from policy analysis.
For every positive outcome of front-of-package labeling (e.g., that mothers generally understood that "the more labels, the unhealthier the product"), the authors found at least one negative (i.e., that mothers are confused about the specific basis for the front-of-package labels and were confused, too, about "what the label was suggesting").
Some mothers don't use the labels, the study reports. In particular, low-SES families—who typically suffer higher obesity rates—are less likely to use the labels. And many consumers only use the labels when deciding whether or not to buy a new food product, "which suggests that the impact on behaviors is less strong for products in which there is a consumer loyalty."
Some study participants found the labels "invasive," counterproductive, or otherwise negative, while others stated that the labels had become so ubiquitous as to be effectively invisible. In the words of the study authors, these mothers felt "the pervasive presence of them was overwhelming and may not end up contributing to better decision making." Some middle- and upper-SES mothers said the law stigmatized them. Some "expressed that they felt 'guilty' and 'bad mothers' if they did not send healthy snacks to school."
Parents of older students said their children often rejected the "healthier" foods now served in schools. One student, for example, told his mother he'd stopped eating at school entirely. Another reported that "the kids 'don't eat, they leave everything on the table.'" That raises the specter of increased food waste, a dramatic problem in America's public schools (and one I discuss at lengthy in my recent book, Biting the Hands that Feed Us).
Other predictable problems arose under the law. "Some [low-SES] moms complained that their freedom to choose products for their children was diminished," the study notes, with "some saying that they had to stop giving their children 'junk food' for school snacks because those snacks could be taken away from their children at school."
The law has also faced open contempt from some of the businesses it regulates. Carozzi, a company sells the majority of its pastas, juices, and other food products in Chile, branded the law "an utter failure" last year.
"We now have a regulation that gives a false sense of security, and when time goes by people are going to notice that we're in the same place and will blame the food industry again," the head of Carozzi's Chilean operations told Bloomberg Radio last year.
The purpose of the Chilean food law is to reduce high rates of obesity in the country. The study published this month demonstrates that some consumers say the Chilean law has impacted their perceptions of the foods they and their families buy. It's unclear right now what, if anything, the latter has to do with the former.