Next time you pick up a box of Coco Pops, imagine it carries a cigarette-style label – complete with graphic photos illustrating that long-term consumption could risk obesity, type 2 diabetes and heart disease.

That was the proposal put forward at a recent meeting of the Commons Health and Social Care Select Committee. And it was twinned with a warning that our children are being ‘fed to death’ by the food industry.

Certainly, the statistics make grim reading. One in four children starting primary school is overweight and one in ten reception class children in England is obese, according to the latest data from the National Child Measurement Programme – the highest since records began in 2006.

Meanwhile, obesity rates among 11-year-olds are 22 per cent – nearly double that of Italy and Spain and almost four times that of Germany and France.

With eye-watering numbers like these, it’s no wonder that food labelling has emerged as a key battleground in countering obesity.

Some experts are calling for mandatory labelling warning of the long-term health risks as the answer – an approach that evidence suggests has worked in other countries.

Currently, in the UK, we have the familiar traffic light system, which started in 2013, and displays red, amber or green. These colours indicate the levels for fat, saturated fat, sugar and salt per serving (as well as calories). They are designed to inform not warn.

Traffic light labelling is voluntary and while the Food Standards Agency (FSA) says 60 to 70 per cent of supermarket pre-packaged food is included, critics say the system is fundamentally flawed.

The system is based on an FSA approach that classifies foods based on fat, salt or sugar content per 100g. Any product with more than 22.5g of sugar, 1.5g of salt, 5g of saturated fat, or 17.5g of fat gets a red warning.

Cynics say this ignores portion size and the degree of processing involved in making the food, which allows some harmful ultra-processed foods (UPFs) to sidestep red labels.

Take Coco Pops. The traffic-light labelling allows it to show amber (medium) for sugar, despite it providing 12-17g (or 3-4tsps) per 100g serving – as it’s under the 22.5g sugar threshold. It’s also amber for salt, but green (low) for fat and saturated fat.

Yet Coco Pops counts as a UPF, as it contains sweeteners, additives and other ingredients that you are unlikely to find in your kitchen.

Evidence is mounting that UPFs can harm health in the long term – and yet they make up two-thirds of adolescents’ daily calories in the UK, according to the Government’s diet survey. And parents picking up Coco Pops in the supermarket might be unaware of this and just see the green and amber label.

Low-fat yoghurt is another example of the anomalies of the traffic-light system. It often gets green for saturated fat and amber for sugar – and is marketed as ‘healthy’ despite often being ultra-processed with a string of additives.

There is another new voluntary system, introduced in October by the Department of Health and Social Care (DHSC), to cover food advertising – it stops foods that are classified as high in fat, salt and sugar (HFSS).

Foods classed as HFSS are banned from TV ads between 5.30pm to 9pm, with a complete ban on online advertising via social media.

Under the HFSS scheme, there are two categorisations – a food is ‘healthy’ or ‘less healthy’ based on a formula that balances ‘positive’ nutrients (fibre, protein) with ‘negative’ nutrients (saturated fat, sugar).

Chris van Tulleken, a professor of infection and global health at University College London (it was he who warned MPs children are being ‘fed to death’), is critical of both labelling schemes.

‘There are two problems with HFSS,’ he told Good Health.

‘One, it fails to reflect how these foods fit into our overall diet. Calling them “healthy” and “less healthy” does not really help people choose a balanced diet.

‘Two, there are exemptions. For example, savoury pastries, such as sausage rolls, are not classed as HFSS and are excluded from regulations. So, no matter how much salt, sugar or fat you put in these products they can never be HFSS.’

Savoury pastries, along with nuts and olive oil (which would have scored above the saturated fat thresholds) are excluded from HFSS categorisation – as are dried fruits (which are above the thresholds, for sugar), because legislation was focused on food categories most linked to childhood obesity.

Professor van Tulleken adds that HFSS ‘is a complex calculation, where, if you add good things to the product, you can offset the high levels of salt sugar and fat’.

That’s because the modelling used to work out what’s HFSS allows manufacturers to offset a product’s ‘less healthy’ classification by adding ‘positive’ ingredients, such as fibre and protein. (For instance, in snacks, using chickpea flour, which has higher fibre and protein, and lower sugar, instead of wheat flour.)

Professor van Tulleken adds: ‘But our labelling system does not tell us anything about ultra-processed foods. It has no basis in science or public health.

‘Unless we use tobacco as the template for regulation, I’ll come back in ten years, 20 years and 30 years, and we will keep having the same conversation, as we did ten, 20 and 30 years ago.’

The introduction in 2017 of large pictorial health warnings as well as other changes on cigarette packets has had a real impact.

For instance, a 2019 study in the BMJ, involving more than 278,000 people, found this type of warning was associated with a ‘significant’ reduction in the likelihood of people taking up smoking. And in 2021 a research review showed it prevented young people especially ‘from starting or continuing to smoke’, reported the journal Risk Management and Healthcare Policy.

The UK Health Security Agency and the DHSC endorse the HFSS system – and research by Leeds University backs the classification as a step in the right direction.

However, Professor van Tulleken believes that the UK should, instead, be looking at Latin America for best practice.

Leading the way is Chile, which in 2016 began a mandatory front-of-package label warning system with unambiguous ‘stop sign’ icons and blunt warnings that foods are high in sugar, fat, salt and calories.

This uses two food classifications, liquid and solid, and focuses on nutrient limits for 100g or 100ml.

In Chile, with solid foods anything per 100g over 275 calories, 0.4g salt, 10g sugar and 4g saturated fat, must carry a black octagonal label ‘high in…’ on the front of the package.

By contrast, the UK’s traffic light labelling for 100g food shows red if there is more than 1.5g salt, 22.5g sugar, 5g saturated fat and 17.5g fat.

The mandatory system in Chile, its supporters point out, allows for no exclusions and prevents manufacturers offsetting good with bad.

Even artificial sweeteners, found in sugar-free ‘diet’ fizzy drinks, can get an octagonal warning.

Professor Camila Corvalan, director of the Center for Research in Food Environments and the Prevention of Chronic Diseases Associated with Nutrition at the University of Chile, who helped draw up Chile’s food labelling policy, said: ‘We rapidly evolved to having one of the highest rates of obesity worldwide – and about two decades ago the government started to take action, implementing programmes and policies primarily to change behaviour.

‘Food companies know exactly what they are providing to consumers, but consumers are unable to understand what they are eating.

‘We increased the information using black octagons. The idea was to use labels that warn consumers about unhealthy food. We wanted to develop a message that was easy to understand, visual and simple.’

Under the new rules, a product that has a black octagon cannot be marketed to children under 14 in any form. They are not allowed in schools or school canteens.

Perhaps the best example of the contrast between the UK and Chile rests in fizzy diet drinks, such as Diet Coke or Pepsi Max.

In the UK they get green traffic lights for sugar, fat and saturated fat, but in Chile they get black octagon warnings that they are high in sweeteners and are therefore considered ultra-processed.

The result was many food manufacturers reformulated their products to avoid these warning labels.

Research in the journal PLOS in 2020 found that sales of sugary fizzy drinks declined by 24 per cent since the implementation of the law.

But what impact has it had on Chile’s obesity surge? Professor Corvalan and her team have submitted the first comprehensive review of the impact of the regulations to the BMJ for publication – she cannot reveal the details, but insists the results are a ringing endorsement of the scheme.

‘This is the starting point to reverse current trends in obesity and diseases such as type 2 diabetes,’ says Professor Corvalan.

This month, a study published in The Lancet by Liverpool University appeared to endorse her optimism. It predicted what would happen to obesity-related deaths in the UK over the next 20 years under the UK’s current voluntary traffic light labelling, compared with mandatory traffic light labelling, and the compulsory Chile-style black octagon scheme.

The result? The Chile-style scheme would prevent 110,000 obesity deaths, as consumers change their buying habits and the food industry remodels its products.

Lead author Dr Becky Evans, an expert in psychology and public health, said: ‘We found mandatory traffic light labels would reduce obesity by 2.3 per cent and prevent 57,000 deaths.

‘But mandatory warning labels, like in Chile, were found to be more effective, with a 4.4 per cent decrease in obesity and 110,000 deaths prevented or postponed.’

But she says the most effective approach would be to have multiple policies, such as marketing restrictions, taxation and labelling, running side-by-side.

The study also examined the European Union’s Nutri-Score front-of-pack nutrition label system which, like the UK system, is voluntary. 

Foods are ranked from A, which is green and healthiest – to E, which is red and least healthy. This is based on a formula that weighs up beneficial nutrients such as fibre and protein, against negative ones such as sugar, salt and saturated fat.

The Liverpool team found that it was almost identical to the UK’s traffic light labelling, with a 2.14 per cent reduction in obesity and 54,000 fewer deaths. 

Professor Mike Rayner, an expert in population health at Oxford University, who was involved in developing the UK’s traffic light labelling system, acknowledges problems but defends the scheme – and believes it should be made mandatory.

‘There are lots of things wrong with traffic light labelling – it is not perfect, it focuses on only a few nutrients and does not take into account a balanced diet,’ he says.

‘But it is consumer friendly and simple. I think we should go with what is practically possible and go for compulsory traffic light labelling. You might tinker with it to make it better – it’s not perfect, but it is what we have got, so why not make it compulsory?’

He believes that the problem with warning labels is that they tell people what food is bad, not good, and labels alone will not solve the problem.

He adds: ‘There are lots of ways you can affect people’s choices. Labelling is just one. There is food marketing and advertising. I would ban advertising of HFSS foods in their entirety.

‘But the big thing is the price of food, which is a major determinant of food consumption patterns. So the logical thing is to tax unhealthy foods and subsidise healthy foods.’

One of the ironies that Professor Corvalan points out is that Chile looked to the UK when formulating its food policies.

‘The idea of having front of package labelling in Chile came from the UK,’ she says.

‘We were highly influenced by your traffic lights. But people in Chile could not understand the combination of colours with the traffic light system. We needed a simpler image that would say “No, this is not OK”.’

S he adds: ‘We also felt that a voluntary system means no one is monitoring what food manufacturers are doing, and we needed to move to a mandatory system.

‘The UK has developed some of the greatest policies in these areas, but unfortunately you have never moved forward with them.

‘I think that the food industry plays a huge role in your economy, in your policy making, and it is not allowing you to reverse this epidemic – that is very bad, because it is killing people.’

A DHSC spokesperson told Good Health: ‘This Government is bringing in a modernised food nutrient scoring system to reduce childhood obesity.

‘We are taking strong action to tackle the obesity crisis as part of our 10-Year Health Plan, which will shift the focus from sickness to prevention.

‘We are also restricting advertising of junk food on TV and online, limiting volume price promotions on less healthy foods and introducing mandatory reporting on sales of healthy food.’

A spokesperson for Kellanova, the owner of Kellogg’s, said: ‘We’re making ongoing efforts to improve our cereal range to give families better choices.

‘That’s why we’ve cut sugar in Coco Pops by 50 per cent since 2017 and clearly show traffic light labelling on all packs. All of our children’s cereals are non-HFSS.

‘Fortified cereal, such as Coco Pops, has been shown to make significant contribution to vitamin D intakes in British children.’

The Food & Drink Federation, which represents the food ad drink manufacturing industry, told Good Health: ‘The traffic light system [the Government recommended system] provides clear information on what’s a ‘high’ level for certain nutrients, such as fat, salt and sugar, as well as what’s ‘low’.