Impacto da implementação da rotulagem nutricional frontal no consumo de bebidas açucaradas, obesidade e custos diretos relacionados à obesidade no Brasil: um estudo de modelagem.

Abstract

Front-of-package nutrition labeling (FOPNL) has been implemented in several countries, as recommended by the World Health Organization (WHO) and the Pan American Health Organization (PAHO). It is considered a public policy to contain the global advance of the burden of non-communicable chronic diseases, transmissible diseases, including obesity. It is expected that the FOPNL will facilitate the consumer's understanding of the nutritional content of the food product and improve their food choices. In Brazil, the National Health Surveillance Agency (ANVISA) published 2020 the Collegiate Board Resolution – RDC nº429 and the Normative Instruction nº75, which guide changes in the nutritional labeling of foods with the implementation of the FOPNL. The laws came into force in October 2022; however, studies that estimated the possible effects of FOPNL in the Brazilian population through a modeling study are still unknown. In this context, this work aimed to estimate, through modeling, the potential effects of NFR on the prevalence of excess body weight/obesity in the Brazilian population that consumes sugary drinks and associated direct costs for five years. Population base refers to the year 2019 of the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL), carried out in Brazilian capitals/Federal District since 2006. Individuals aged between 20 -59 years were included, consumers of sugary drinks and who knew the amount consumed, and non-pregnant women. Individuals with extreme body mass index (BMI) and those who could not report their consumption of sugary drinks were excluded. For the base (pessimistic) scenario, the consumption trend of sugary drinks was calculated using linear regression based on the results of the VIGITEL survey between 2007 and 2019, except for 2017, adjusted according to inclusion and exclusion criteria. Scenario 1 (median) was composed of the baseline scenario associated with changes observed in the purchase of energy content in beverages after the first phase of the Chilean labeling law (with an energy reduction equivalent to -9.9%). In scenario 2 (optimistic), scenario 1 was associated with the reformulation of food products (beverages) observed in Chile in the period before the first phase of implementation of the RNF standard (energy reduction of -1.6%). The impact of changing energy intake on body weight was modeled using Hall et al.'s Dynamic Model of Weight Change (2011) for five years. Changes in nutritional status (overweight: BMI ≥25kg/m2; obesity: BMI ≥30kg/m2) were estimated in scenarios 1 and 2 and extrapolated to the Brazilian population consuming sugary drinks (using estimates from the Institute of Geography and Statistics - IBGE Also, the trend towards an increase in the prevalence of overweight and obesity per year was considered, calculated using linear regression (based on the same VIGITEL data adjustments). Were obtained by deducing the results obtained in the baseline scenario. Potential impacts on direct health costs were predicted from a Brazilian study that estimated direct costs with obesity in the Brazilian public health system, updated to 2019. of energy from sugary drinks is reduced by approximately 28 kcal/day (95% CI -30, -27), considering the implementation of NFR in Brazil in scenario 1. In scenarios 1 and 2, it is expected that the prevalence of obesity/excess body weight is 25.3%/25.2% and 64.4%/64.2%, respectively, in five years. Extrapolating results to the entire Brazilian population, it is estimated that the implementation of the NFR may have the potential to reduce the prevalence of obesity by -0.32 pp and -0.35 pp (scenarios 1 and 2, respectively) and overweight, at -0.42 pp and -0.48 pp (scenarios 1 and 2, respectively). It is expected that it will be possible to save approximately US$ 5.5 million (95% CI 4.7, 8.8) – in scenario 1, with a potential reduction of US$ 6.1 million (95% CI 5.3, 9,8) in scenario 2. Based on the results of this modeling study, it is concluded that RNF can reduce cases of overweight and obesity and reinforces its role as a strategic public policy to reduce the increase in cases of obesity.