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Plain packaging worked to reduce smoking. Unhealthy food should be next

Removing branding from cigarette boxes has reduced smoking among young people. We must now do the same with unhealthy food and drinks as childhood obesity can trigger disease in later life

The cigarette box was wiped of its branding with the introduction of the Public Health Act in 2015. Plain packaging would also help cut the consumption of high-fat, high-salt, high-sugar food and drinks. Photograph: Martin Rickett/PA Wire
Prof Donal O’Shea
Wed Aug 14 2024 - 06:00

Tobacco brands were among the best-known and most popular consumer brands of the 20th century, thanks in no small part to their instantly recognisable packaging and advertising. Nowadays, most people under the age of 40 would most likely struggle to differentiate one brand of cigarettes from another. The cigarette box, once a fashion accessory and a signifier of self-image, was wiped of its branding with the introduction of the Public Health Act in 2015. It’s an initiative that’s gone a long way to addressing the problem of smoking in young people. Almost 10 years on, the time has come to apply the same thinking to unhealthy food and drinks – especially those targeting children.

Plain packaging involves removing all branding and standardises the packaging to a uniform colour and design. This would help in reducing the consumption of high-fat, high-salt, high-sugar food and drinks; a critical step if we are to make headway with our obesity problem.

Our health service is under enormous strain because of obesity. One in five Irish children have either overweight or obesity, a problem that will track into adulthood. Childhood obesity is linked to accelerated weight gain in the fourth decade of life, the time when we gain most weight at a population level. We are now coming to terms with managing obesity itself as a disease, not a lifestyle choice and realising that, for decades, we have been treating the complications of obesity, such as Type 2 diabetes, cancer, heart disease and dementia. In the same way that we learned smoking tobacco can cause cancer, heart disease and many other illnesses, we now know that a poor diet can have long-reaching health effects and impact our life spans. The health burden of obesity is snowballing, and we need an array of measures that will change the trajectory of our food environment which over time has become increasingly unhealthy.

The proliferation of unhealthy foods and drinks promoted and marketed to us is now a bigger driver of disease than smoking

There is agreement that no single measure will buck the trend of unacceptably high obesity rates. That, however, must not stop us from pursuing changes within the system that might ultimately help. The sugar tax was one step in the right direction. Calorie posting on menus is another evidence-based and effective measure. Three ministers for health (two of whom have gone on to be taoiseach) promised to legislate for it, but it has been successfully opposed by the food and drinks industry. It appears to be dead in Government Buildings.

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We know that plain packaging works – we have the evidence from the tobacco area. Young people immediately find cigarettes less appealing and find the health warnings more striking against a plain background. If applied to food and drinks, plain packaging would ensure that the labelling with all the nutritional content of the product will not be crowded out. Combine this with measures that prevent access and you begin to transfer the learnings from successes in the tobacco space to the childhood obesity space. Healthy vending machines and removing the placement of unhealthy foods away from checkouts would build on the tobacco lessons.

Brand is everything – especially for younger people. Coca‑Cola has been promoting Christmas since the 1920s, sponsoring the Olympics since the 1930s and putting peoples’ names on bottles since 2011. The latter resulted in a surge in consumption of sugar-sweetened drinks by young people in particular – and reversed a downward trend. Plain packaging would have made the “Share a Coke” campaign impossible.

One in five Irish children have either overweight or obesity, a problem that will track into adulthood. Childhood obesity is linked to accelerated weight gain in the fourth decade of life, the time when we gain most weight

There is evidence that children are particularly open to the power of packaging – and that changes to make it plain would reduce the appeal of the products. The food and drinks industry have a very scientific approach to establishing the “bliss point” for a child’s palate for a particular product – the point at which maximal enjoyment is reached for a particular offering. They know that this is different for a three year old, a seven year old and a 12 year old, and they know that different-aged brains will respond differently to cartoon characters, fonts and enticing images. They influence children’s choice and pattern of consumption. Increasingly, the display of products targeting children in shops is at that child’s eye level – just look at the shelves of sweets and confectionery in your local supermarket and compare what is higher up versus closer to the ground.

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Protecting children’s health is at the heart of Safefood’s new public health campaign, “Building a healthier food environment”. This five-year initiative represents a new approach to public health campaigning, focusing on the factors that influence consumer decision-making, including how foods are packaged and sold to us. Safefood is asking consumers to start a conversation with one another about the food environment and consider ways we can change it.

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From a health or economic perspective, we can’t afford to continue as we are. The proliferation of unhealthy foods and drinks that are promoted and marketed to us is now a bigger driver of disease than smoking. Bold public policy is essential in shaping a food environment that protects our children’s health, so we need to learn from the positive impact of plain packaging on cigarette-smoking behaviour in young people and apply it to unhealthy food and drinks.

Donal O’Shea is professor of medicine in University College Dublin, a consultant endocrinologist at St Vincent’s University and St Columcille’s Hospitals, and the national clinical lead for obesity with the Health Service Executive. He is supporting Safefood’s ‘Building a healthier food environment’ campaign