Background Paper to Supporting Healthy Choices

2. Reformulation

2.1 Introduction

The key focus for reformulation is to reduce calories, achieved by reductions in fats (including saturated fats) and added sugars as reductions in these nutrients can help to reduce the calorie content of foods.

In tandem with calorie reduction, salt reduction is an important public health goal, essential for the reduction of high blood pressure and lowering the risk of cardiovascular disease. Around 75% of salt consumed comes from processed foods^[22]. Therefore salt targets, encompassing 76 categories of manufactured foods, have recently been revised and agreed across the four countries in the UK, set for achievement by 2017. Further reduction in the salt content of foods will require continued determined action by the whole food industry. All businesses are encouraged to meet the targets which will assist the population to move closer to our Scottish Dietary Goal of no more than 6g of salt a day.

The term non-milk extrinsic sugar (NMES) is used to report sugar intakes and in monitoring against the dietary goal. However, for the purposes of reformulation in this paper we use the term added sugars (see text boxes below). While fruits, vegetables and milk naturally contain sugars, these foods also convey considerable health benefits. Therefore use of additional fruits and vegetables, in particular, are welcomed as part of any reformulation.

Non-milk extrinsic sugars (NMES) are sugars that are external to the cell structure and exclude milk sugars; they include sucrose, fructose, honey, fruit juices and syrups (including high fructose corn syrup) that are added for sweetening purposes plus 50% of the sugars in canned, stewed, dried or preserved fruits.

For the purposes of reformulation we refer to added sugars which largely equate to NMES

Added sugars are defined as any mono- or disaccharide or any other food used for its sweetening properties. This would include, but is not exclusively limited to: sucrose, fructose, glucose, glucose syrups, fructose-glucose syrups, corn syrups, invert sugar, honey, maple syrup, malt extract, dextrose, fruit juices, deionised fruit juices, lactose, maltose, high maltose syrups, agave syrup, dextrin and maltodextrin. The sugars contained in dried fruit are assumed to be intrinsic and are not included as added sugars. The sugars in milk/milk powder are not included as added sugars

Fats, salt and sugars are prevalent in many manufactured products. In order to have the biggest impact on public health, priority should be given to reformulation of the standard or most commonly consumed products to contain less calories, fats, salt
and/or sugars. This approach can have immediate benefits to the consumer without requiring any change in behaviour. The cumulative effect of reductions in a wide range of foods has the potential to have the greatest impact on dietary intakes. The term standard products refer to those in the mainstream and therefore does not include speciality, luxury or reduced fat/salt/sugar versions of existing products.

2.2 Foods and drinks which contribute to the nutrients of public health concern

Data from the Living Costs and Food Survey (LCF)^[23] have informed the prioritisation of food categories for reformulation. The food and drink categories summarised in Table 3 contribute the most total fat, saturated fat and added sugars in the Scottish diet and offer the opportunity for reformulation to support achievement of the Scottish Dietary Goals. A full list of the main contributors to fats, sugar and energy from both LCF and KWP data are detailed in Appendix 2, Tables A-H.

Table 3: Foods and drinks contributing significant percentage contribution to fats and sugar (data from the Living Costs and Food Survey secondary analysis 2001-10)

Food category using LCF definition	% contribution to total fat	% contribution to saturated fats	% contribution to added sugars (NMES)
Total confectionery and sweet biscuits	10.3	14.0	23.2
Sugar containing soft drinks	n/a	n/a	25.2
Total processed red meat	12.2	12.0	n/a
Crisps and savoury snacks	4.7	4.1	n/a
Cakes, pastries and puddings	3.3	3.7	5.8
Total milk	6.5	10.4	n/a
Total cheese	5.1	8.2	n/a
Ice cream and dairy desserts	2.1	3.5	3.5
Yoghurt and fromage frais	n/a	n/a	2.1

The data presented in Table 3 are also in line with recent market research data for Scotland from Kantar Worldpanel (KWP) which suggest a similar pattern of contribution (see Appendix 2, Tables F, G & H). Furthermore, data from surveys of children's intakes indicate that sugar sweetened beverages, confectionery, cakes, biscuits and pastries, crisps and savoury snacks provide the greatest contributions to sugar and fats in their diets^[12]; these data have also informed the prioritisation of food and drink categories for reformulation.

2.2.1 Total fat including saturated fats

Population intakes of total fat in Scotland are estimated to be around 39% food energy (FE) which is above recommended levels of less than 35% FE^[9]. Similarly, intakes of saturated fats are too high at around 15% FE, which is above the Scottish Dietary Goal of less than 11% FE^[9].

The biggest contributors to total fat and saturated fats in the diet include total processed red meat, confectionery and sweet biscuits, total milk, total cheese, ice cream and dairy desserts, cakes, pastries and puddings, crisps and savoury snacks. These findings are supported by market research purchase data from KWP which include red meat and products, biscuits, cakes, pastries and cheese as some of the major contributors (for full details see Appendix 2, Tables F & H).

2.2.2 Added sugars

Levels of added sugars are above the dietary goal for NMES of less than 11% food energy (FE) in both children (15.6% FE in 2010)^[12] and in the overall population in Scotland (14% FE in 2011)^[9]. The biggest contributor to added sugars in the Scottish
diet is soft drinks. Other significant contributors to added sugars are confectionery and sweet biscuits, cakes, pastries and puddings, ice cream and dairy desserts and yoghurt and fromage frais. Data from KWP show that the top contributors to added sugars are similar and include confectionery and total biscuits, regular soft drinks, cakes and pastries (see Appendix 2, Table H).

2.2.3 Salt

The FSA Scotland commissioned analysis of Scottish data from Kantar Worldpanel in 2012, showed that the main contributors to salt were similar in Scotland and across GB^[18]. The categories providing the most (around 20%) of the total salt purchased into the home, were bread and rolls (9.2%), bacon (4.3%), Italian and traditional ready meals (3.5%), cheddar and hard pressed cheese (2.5%) and fat spreads (2.3%). Other top 20 contributors to salt in Scotland included sausages, sweet and savoury biscuits, crisps and cakes (see Appendix 2, Figure A for the top 20 contributors).

2.3 Categories contributing most to the nutrients of public health concern

The food and drink categories detailed below have been highlighted for reformulation due to their significant contribution to fats and/or added sugars and may therefore be considered as having potential for overall calorie reductions. The basis for including each of the categories is discussed below.

a) Soft drinks with added sugars

Sugar containing soft drinks make the biggest contribution to added sugars in the population; they contribute to over a quarter of added sugars in the diet and also make a significant contribution to overall energy intakes9. Sugary soft drinks also provide the greatest contribution to added sugars in the diet of intake in children and young people^[12][13]. Purchase data from KWP is in line with dietary intake data (see Appendix 2, Table H). Intakes of sugary drinks also vary by deprivation; those living in more deprived areas have the highest levels of consumption. This trend is consistent across the population, including children.

Soft drinks are also one of the most promoted food and drink categories; data from KWP data indicates that they have been increasingly promoted between 2011 and 2013. More than 50% of (sugar containing) soft drinks sold are on promotion. When eating out of the home, sugar containing soft drinks are the most popular category consumed by both adults and children.

b) Biscuits, confectionery, cakes, sweet pies and pastries

Data from the LCF survey show that total confectionery and sweet biscuits contribute significantly to all of the nutrients of public health concern.23 When cakes, pastries and puddings are included, this combined category provides the biggest contribution to calories, fats and added sugars in the Scottish diet (see Table 2 and full details are available in Appendix 2, Tables A-H). Furthermore, biscuits, confectionery, cakes, sweet pies and pastries are among the most highly purchased categories when eating out of the home (see Figure 3).

A recent analysis of progress against the salt targets in Scotland18 showed that biscuits and cakes were also significant contributors to salt intake, with sweet biscuits, savoury biscuits and cakes all in the top 20 of the food categories considered. Sweet biscuits alone were estimated to contribute around 2% of the salt purchased into the home from all the food categories analysed with a slightly higher contribution in Scotland compared to GB^[18].

Intakes of confectionery are significantly greater in the more deprived areas and are also highly promoted; more than 50% of confectionery was purchased on promotion in 2013.

c) Processed meat (savoury pies, sausages and burgers)

The LCF survey shows the contribution that the total processed red meat^[h] makes to nutrients in the diet. The processed meat category is within the top three largest contributors for calories, total fat and saturated fats^[23]. Data from KWP indicate a similar contribution of processed meat products to fat and saturated fats. Sausages, savoury pies and pasties are also amongst the most promoted food categories.

Sausages and other meat products (e.g. bridies, Scotch pies, other meat pies and meat puddings) were also significant contributors to salt intake and in the top 20 salt providers of the food categories considered^[18]. Sausages alone were estimated to contribute more than 2% of the salt from all the food categories analysed based on purchase into the home.

Those living in the more deprived areas consume more processed meat products and derive more of their calories and saturated fats from processed meat products^[24]. Data from KWP support these findings with purchase of sausages and burgers being highest in the most deprived.

This is also a very popular category when eating out of the home. Burgers are the third fastest growing category in Scotland with pies and pastries, cheeseburgers and sausages also popular choices (in the top 25). The category is also widely promoted within the out of home setting; over half of all cheeseburgers eaten out are purchased on promotion.

d) Dairy (milk, cheese, yoghurt and fromage frais and ice cream)

Milk and dairy products, such as cheese and yoghurt, are good sources of protein and calcium and form an important part of a healthy balanced diet. Dairy products also contribute significantly to fat, saturated fats and sugar in the diet. Milk contributes significantly to both fat and saturated fats and consumption patterns vary with deprivation; whole milk is consumed most in the most deprived^[9].

Cheese makes a large contribution to saturated and total fat. The cheddar and hard cheese category also provided the fourth largest contribution towards salt intakes in Scotland in 2012 which contributed around 2.5% to salt intake for foods purchased
into the home^[18].

Yoghurt and fromage frais make a more modest contribution to intakes of fat and saturated fats. This category does however make a greater contribution to added sugars, particularly in children. In the 2010 survey of children's intake, yoghurt and fromage frais were the fourth largest contributor to added sugars providing a contribution of around 7%. At a population level this category contributes 2.1% towards total added sugars.

The current legislative requirements regarding the composition of 'ice cream' (i.e. a minimum of 5% fat and 2.5% milk protein) and 'dairy ice cream' (i.e. a minimum of 5% fat exclusively from milk) will fall when most of the Food Labelling Regulations 1996 are revoked on 13 December 2014. However, there is an EU-wide ice cream industry code of practice which sets compositional standards for these products^[25]. While the code continues the requirement for 'dairy ice cream' to contain a minimum of 5% fat (exclusively from dairy), it does not set a minimum fat content for 'ice cream'. This offers the opportunity to develop new products or reformulate existing ones to reduce fat levels below 5% and still use the term 'ice cream' in future. There is a large variation in fat content of the ice cream products that are currently on the market (between around 5-21%) and therefore many products still have scope to reduce the fat content. There is also the possibility of reducing added sugars in these products which would also contribute to a reduction in calories. In terms of purchases made when eating out of the home, ice cream remains the seventh most popular choice for children.

e) Savoury snacks

Crisps and savoury snacks contribute significantly to total fat and calorie intake (see Appendix 2, Tables 2 and 6). Savoury snacks are also one of the top contributors to salt intake, with a slightly higher contribution of salt from potato crisps in Scotland compared to GB^[18].

Consumption of savoury snacks has been shown to increase with age in children and young people^[12][13]. There is also an association with socio-economic group, with consumption of savoury snacks highest in the more deprived areas^[12][13]. Similar trends are also found at a population level with savoury snacks providing a greater contribution to calories and saturated fats in the most deprived areas^[9].