Decreases in purchases of energy, sodium, sugar, and saturated fat three years after implementation of the Chilean Food Labelling and Marketing Law

Abstract Background In 2016, Chile implemented a multi-phase set of policies that mandated warning labels, restricted food marketing to children, and banned school sales of unhealthy foods and beverages. Chile’s law, particularly the warning label component, set the precedent for a rapid global proliferation of similar policies. While our initial evaluation showed policy-linked decreases in purchases of products carrying the warning label, a longer-term evaluation is needed, particularly as later phases of Chile’s law included stricter nutrient thresholds and introduced a daytime ban on advertising of labeled foods for all audiences. The objective is to evaluate changes in purchases of energy, sugar, sodium, and saturated fat purchased after Phase 2 implementation of the Chilean policies. Methods and Findings This before- and after-study used longitudinal data on monthly food and beverage purchases from 2,844 Chilean households (138,391 household-months) from July 1, 2013 until June 30, 2019. Nutrition facts panel data from food and beverage packages were linked at the product level and reviewed by nutritionists. Products were considered to carry the warning label if they contained added sugar, sodium, or saturated fat, and exceeded the final phase nutrient or calorie thresholds (thus would carry the warning label). Using correlated random-effects models and an interrupted time series design, we estimated the nutrient content of food and beverage purchases associated with Phase 1 and Phase 2 compared to a counterfactual scenario based on pre-policy trends. Compared to the counterfactual, we observed significant decreases in purchases of foods and beverages carrying the warning label during Phase 2, including a relative 36.8% reduction in sugar (−30.3 calories, 95% CI −34.5, −26.3), a 23.0% relative reduction in energy (−51.6 calories, 95% CI −60.7, −42.6), a 21.9% relative reduction in sodium (−85.8 mg, 95% CI −105.0, −66.7) and a 15.7% relative reduction in saturated fat (−6.4 calories, 95% CI −8.4, −4.3). Decreases were partially offset by increases in non-labeled purchases, but the net effect shows a significant decrease in total nutrients of concern purchased during Phase 2. Reductions in sugar and energy were driven by beverage purchases, whereas reductions in sodium and saturated fat were driven by foods. The pattern of declines in purchases was similar for households of lower vs. higher socioeconomic status. A key limitation of this study is that the data include only a portion of what Chilean households purchase that, while including important categories impacted by the law, do not cover an entire diet. Conclusions The Chilean policies on food labeling, marketing, and school food sales led to declines in nutrients of concern during a more complete phase of implementation, particularly from foods and drinks carrying the warning label.

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