Papers in English

Nutri-Score: despite scientific evidence and high public health stakes, lobbying never ends….

Successfully implementing a public health measure that disturbs the interests of powerful economic actors – in the fields of tobacco, alcohol (particularly wine) or food – is not an easy task, even if the measure has been scientifically proven to be useful for the health of the population. The history of the front-of pack nutrition label Nutri-Score is an emblematic example.

Proposed in 2014 on the basis of extensive scientific work, this label translates the poorly intelligible data mandatorily shown in the nutrition table on the back of the packaging into a synthetic logo clearly visible on the front of packaging and easily understandable by everyone. It characterizes five classes of nutritional quality, from green/A (most favourable) to dark orange/E (least favourable). It allows consumers, at the time of their purchase, to compare, at a glance, the overall nutritional value of foods.

Although Nutri-Score has been strongly supported by scientists, public health authorities, and consumer associations, it has been the subject for nearly 4 years of multiple attacks by the French National Association of Agri-Food Manufacturers (ANIA), relayed by politicians (some ministers and parliamentarians) and institutions close to the food companies that have done everything (or almost) to block its implementation. A true saga that was thought to be over after the official adoption of Nutri-Score in France in 2017 (on a purely voluntary basis due to European regulations). While all manufacturers were opposed to it when it was proposed in 2014, under pressure from consumers and the accumulation of scientific evidence, more than 800 brands have finally adopted it today in France, covering about 60% of the French food market.

But in 2021, the vote of the European Commission’s proposal « Farm to fork » in the Green Deal Strategy including the implementation of a unique and mandatory nutrition label for all European countries by 2023 has awakened lobbies that had hitherto been satisfied with the optional character of the Nutri-Score. Opponents to the Nutri-Score, with sometimes divergent interests, have thus united to prevent Nutri-Score from being selected as the mandatory label for Europe, and at the same time to try to distort it where it has already been adopted on a voluntary basis. This united front includes major agri-food groups such as Coca-Cola, Ferrero, Mars, Mondelez, Kraft, Lactalis, etc., agricultural sectors, including cheese and charcuterie producers, members of the powerful European trade union and professional organization COPA-COGECA; and a country -Italy- acting as lobbyist state, because of its government’s proximity to powerful manufacturers (notably Ferrero) and certain agricultural sectors (such as Parmesan, Gorgonzola, Prosciutto, etc.). In France, the Confédération Générale du Roquefort (with Lactalis in the background, which commercializes 70% of Roquefort volumes) and other PDO/PGI cheese and processed meat production sectors have also been particularly active in lobbying against Nutri-Score, mobilizing many political forces (including elected representatives of production areas) to push for the exemption of their products from the Nutri-Score.

This request is not based on a scientific and public health basis. Indeed, while these PDO/PGI labels guarantee the origin of a food product, its development in a geographical area determined according to a recognized know-how respecting a specific production and manufacturing process – all interesting and relevant criteria – they do not at all include any nutritional quality dimension. Even with a PDO/PGI label, foods rich in fatty acids, salt and calories remain rich in fatty acids, salt and calories. But a Nutri-Score D or E on a cheese or cold cut does not say that they should not be consumed, but only alerts the consumer that they should be consumed in limited quantities and not too frequently, which is consistent with the public health nutritional recommendations.

Besides, among the (false) arguments put forward by the opponents to Nutri-Score poorly informed or not wanting to listen to the voice of scientists, is the fact that Nutri-Score does not include ultra-processing in its computation (and the presence of additives associated with it). In fact, ultra-processing and nutritional composition are two different dimensions of foods each having the ability to impact the health of individuals through different mechanisms. If no research team, national or international expert committee, nor the WHO has been able to define a scientifically validated synthetic indicator combining nutritional composition and ultra-processing so far, it is surely not due to lack of competence but rather because of unavailable data to do so. Front-of pack nutritional labels provide information on the nutritional composition of foods, which is very important and useful as such. In addition to the Nutri-Score, this does not prevent from giving specific information to help consumers identify whether a food is ultra-processed. Suggesting that Nutri-Score favours ultra-processed products is totally misleading. Similarly, the provocative argument «cheese is less well classified than breakfast cereals» is absurd. When purchasing their food products, consumers do not hesitate between cheese or breakfast cereals. In contrast, they need to be able to compare products having the same usage: between different breakfast cereals, or between different cheeses. 

Finally, among the arguments put forward to discredit Nutri-Score we often find the fact that it is calculated per 100g while obviously one does not eat 100g of cheese (PDO/PGI or not), 100g of rillettes or else 100g of mayonnaise or 100g of Nutella…  This choice is totally assumed and is explained by the fact that the data on the nutritional composition of foods that are accessible to build a front-of-pack nutrition label (whatever it may be) are those contained in the mandatory nutrition table that appears on the back of the packaging that has been defined by European regulations and is presented for 100g (or 100ml). If these data are not expressed per serving, it is because setting portion sizes is impossible for specific foods because they should be adapted to energy needs of each individual, which differs according to age, sex, physical activity…  As the portion sizes are not standardized, they are left to the discretion of the manufacturers who very often fix them well below the portions actually consumed, opening a breach to possible manipulations. Considering a standard quantity, such that 100g is the best choice, a common denominator allowing a valid comparison between foods without inducing estimation error: compare 100 ml of olive oil to 100 ml of another vegetable oil; 100g of breakfast cereals to 100g of other cereals; 100g of a pizza to 100g of another pizza; 100g of Comté to 100g of Roquefort or Mozzarella…

The fear of the obligation to display Nutri-Score on all foods in Europe has thus brought out a new discourse from opponents. This discourse involves elements from the usual arguments of lobbies that describe Nutri-Score as simplistic, reductive, guilt-ridden, stigmatizing, hygienist or even oppressive, which would also threaten the culinary legacy and traditions and challenge the economic and social balance of the local areas. This is of course completely false. But especially what is striking today is that this discourse totally denies the importance of the science behind the Nutri-Score (especially the many studies showing its interest), and the support of hundreds of scientists and associations of Experts and international institutions. Worse, we see that the economic lobbies and their political relays, all without particular scientific skills, do not hesitate to claim themselves nutritionists and to express their views on points relevant to science to criticize Nutri-Score. They make statements on questions that, of course, scientists have or are currently addressing themselves (on ultra-processed foods, additives, portions, elements to be included in the calculation of a logo, etc.) and for which they have established their decisions, on a scientific basis (this is their job!), to build and validate Nutri-Score.

Today , we are therefore witnessing a new form of lobbying in which economic and political actors are taking the place of public health experts and give their opinion on what should or should not be a nutritional logo challenging the choices of scientist experts in the field! And yet, only real scientific evidence from real experts with no financial connections should guide public health policy decisions…  So, what will be the weight of these economic and political lobbies in the final decision of the EU regarding the obligation to display Nutri-Score in Europe? And if they do not block the European decision, will they get an exemption of certain products? In a few months, we will know whether the political authorities in France and Europe will choose public health or economic interests!

Pilar Galan1 (MD, PhD), Serge Hercberg1,2 (MD, PhD), Mélanie Deschasaux-Tanguy1 (PhD), Bernard Srour1 (PhD), Emmanuelle Kesse-Guyot1 (PhD), Mathilde Touvier1 (PhD)

1 Sorbonne Paris Nord University, INSERM U1153, INRAe INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris (CRESS), Bobigny, France

2 Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France