Trick or treat?

Posted by Dr Henry Clover on 12/06/2017
Henry Clover, Director of Dental Policy

In the same year that the Department of Health introduced a new dental contract - 11 years ago - the Food Standards Agency (FSA) was looking at several new ideas regarding food labelling, principally due to the concerns in rising obesity levels.

One option was a Guideline Daily Amount (GDA) and the other was a traffic light system - a postage-stamp-sized sticker that used a colour code to denote the percentage of an individual's recommended daily allowance contained in each produce - red for high, amber for medium and green for low. Consumer testing, perhaps not surprisingly, showed a clear preference for traffic lights. So did health organisations that saw the scheme as a major step in the fight against heart disease and obesity. No great surprises - people understand traffic lights, as clearly demonstrated by 37 million car drivers. Red signifies danger, and green is good. 

Indeed, other visual displays of this nature have been shown to be highly effective. Take the patient reports of the Denplan PreViser Patient Assessment - research has now demonstrated his form of immediate biofeedback can influence behaviour. A study by King's College demonstrated that patients who received the report felt more confident in their ability to adhere to a home oral health routine that those who received advice alone1

Health Halo

Back to food labelling. So, the FSA made clear recommendations that traffic lights should be adopted. However, the food industry giants were not so keen, for the simply reason that a product with an apparently damning red sticker would not sell as well. In the end, the recommendations never received Government backing, leaving consumers at the mercy of marketing departments. In fact, a research project at this time demonstrated that if familiar chocolate treats were labelled 'low fat', consumption increased by around 50%2. This has been referred to as the 'health halo' effect - when food is marketed as healthy, people tend to think it has fewer calories.

Some companies voluntarily introduced traffic light labels, which encouraged some healthy market competition to produce foods with green-only stickers, that meant lowering fat and sugar contents. However, the majority of foods have GDA's. Is it just me, or is the print size on these labels such that they can only be deciphered with high magnification loupes usually reserved for finding that elusive second mesio-buccal canal in an upper molar?

Sugar consumption and its potential health impact is frequently centre stage in the news - and rightly so in my opinion. The impact of obesity; Jamie Oliver's initiatives to promote healthy school meals; the links with increased risks of diabetes; the Government's sugar tax initiative, and perhaps closer to home for us in the dental profession, the appalling statistics on general anaesthetic in children for tooth extraction. All have received many, many column inches. 

HENRY success

However, HENRY has achieved less of a profile. I'm not being self-centred here. This HENRY (no relative) stands for 'Health, Exercise, Nutrition for the Really Young', a Department of Health Initiative targeting the under fives with behaviour change strategies, parenting skills and improved knowledge. After running for more than eight years, there is now evidence of its success. In Leeds, where HENRY is part of the city-wide obesity strategy and delivered in children's centres across the city, obesity rates at reception stage have fallen from 10.3% to 8.7% over a seven-year period, as well as reduced consumption of foods high in fat and/or sugar such as cakes, biscuits, chocolate and sugary drinks, for both adults and children3.

So, while the Government has a plan to tackle obesity, I do think a trick is being missed. The technical guidance on food labelling was updated as recently as March this year, with the caveat that it is non-statutory advice. Still no proposals to introduce traffic lights. 


1. J Clin Periodontol. 2015 Apr;42(4):350-5. doi: 10.1111/jcpe.12377. Epub 2015 Mar 24. The effects of providing periodontal disease risk information on psychological outcomes - a randomized controlled trial. Asimakopoulou K, Newton JT, Daly B, Kutzer Y, Ide M.

2. Brian Wansink and Pierre Chandon (2006) Can "Low-Fat" Nutrition Labels Lead to Obesity? Journal of Marketing Research: November 2006, Vol 43, No.4 pp. 605-617

3. Combating child obesity: impact of HENRY on parenting and family lifestyle. Willis TA, George J, Hunt C, Roberts KPJ, Evans CEL, Brown RE and Rudolf MCJ. Published Pediatric Obesity 2014. 

Henry writes a regular column in our Insight  magazine, available to all member dentists. To find out more about how to become a member, click here.