British ready meals deemed healthier than those sold in India and China

A new report has shown that British processed and pre-packaged foods are among the healthiest and most nutrient-rich in the world. Concerningly, India and China, two of the biggest nations in the world rank lowest for packaged food product quality. The report was recently published in the journal Obesity Reviews.

Ready meal, also known as processed foodJoe Gough | Shutterstock

Both high- and middle-income countries are struggling to cope with the burden of chronic diseases like type 2 diabetes, hypertension and obesity. Each of these conditions is linked to an increased intake of processed and packaged foods and beverages, with higher-income countries consuming two-thirds of their energy from calorie-dense foods. Recently, poorer regions have been rapidly taking to these foods.

The main issue with processed food is its poor nutrient profile. These foods typically contain added sugar and salt and are high in saturated fats, trans fat, and salt. Thus an easy dietary intervention to improve public health would appear to be increasing the nutrient content of packaged food.

What is nutrient profiling?

The nutrient profile of a food refers to its classification by nutrient composition. There are over 78 nutrient profiling tools currently in use, some from the food industry itself and others from governmental and non-governmental sources.

Nutrient profiling is used for many purposes, including nutrition labeling and food marketing to children. It is also used to frame policies targeting the nutritional quality of the food available to a population.

The HSR rating

The current study used the HSR nutrient profiling model, which looks at the nutrition label on the front of the package. This voluntary system was developed through a collaborative effort of the Australian government with the food industry, consumer groups and public health experts.

The HSR model aims to help manufacturers develop healthier food products.  The basis of the profile is the United Kingdom Ofcom model, with 14 major categories of food and beverages.

The model assesses the density nutrients that have been linked to ill-health (“nutrients of concern”), like energy, sodium, total sugars, and saturated fats per 100 g or 100 ml in packaged foods and drinks. It also looks at the percentage of fruit, vegetable, nut and legume (FVNL%), and the density of protein, fiber and certain minerals per 100 g or 100 ml. The individual scores add up and are finally converted to an HSR number, from a minimum of ½ to a maximum of 5.

What did the researchers do?

The study included 12 countries, with data from the years 2013 to 2018. All of them are part of the The International Network for Food and Obesity/non‐communicable diseases Research, Monitoring and Action Support (INFORMAS) that is concerned with providing an environment of healthy foods to reduce the incidence of diet-related chronic diseases. The data comes from The George Institute for Global Health database, and is therefore uniform in quality.

Almost 400,000 products were analyzed. The mean HSR for each country, along with the median content for nutrients like saturated fat and total energy, was used to classify countries into three tertiles, from highest to lowest scores. Visual representations of the healthiness of packaged food for each country were provided to allow comparison across national boundaries.

What were the results?

The researchers used this data to arrive at an HSR for six categories for food products. The overall mean HSR was 2.73 out of 5 stars. By category, there were no surprises: the Seafood, Eggs and the Fruit, vegetables, nuts and legumes, classes got 3.5, 3.6, and almost 3.8 stars, respectively. Confectionery and sugars had the lowest HSR, just above 1 star.

According to the report, “Overall, packaged foods and beverages in the UK, USA, Australia and Canada ranked healthiest (mean HSR: 2.74 to 2.83 from a possible maximum of 5.00), and Indian, Hong Kong, Chinese, and Chilean foods ranked least healthy (mean HSR: 2.27 to 2.44).” The UK had an HSR of 2.83, the US at 2.82 and Australia at 2.81.

However, Canada and US products were remarkable for their unhealthily high sodium content, at well above 300 mg/100 g). Sodium in foods was lowest in Slovenia and Chile, at only 80 and 140 mg/100 g respectively.

Meat products and snack foods have the highest overall sodium content and beverages the lowest.

The lowest HSR rating was for India at 2.27, China (2.43), Hong Kong and Chile (about 2.44), all of which had six or more categories in the lowest HSR tertile. Indian packaged food was among the worst in regard to its nutrient composition.

Surprisingly, no country remained in the first tertile across all six categories. Neither did any remain in the lowest tertile throughout. When separate foods and beverages are considered, China is among the highest for beverages, (HSR 2.9), but just below 2.4 for foods. Conversely, South Africa has a beverage HSR of only 1.9 but for foods, it is almost 2.9.

China and Canada had the most and the least saturated fat, respectively, mostly as Edible oils and Confectionery. The least was found in the Beverages, Sugars, and Fruits and vegetables categories.

Chinese and Indian foods and beverages had the highest total sugar content (at 8.5 and 7.3 g/100 g respectively, almost double that of the UK’s 3.8 g/100 g), and overall energy content, with the lowest sugar content coming from the UK, Canada and Slovenia. South Africa had the lowest energy content overall.

By food category, sugar content was lowest for edible oils, seafood and eggs. Energy content was least for beverages, at 182 kJ.100 g. Eggs came second at almost 600 kJ/100 g.

The winner was, eventually, the UK, while the biggest loser was India. In fact, Chinese and Indian foods ranked highest for levels of saturated fat, sugar and energy content. This agrees with the earlier findings that the largest 11 food chains in India sell mostly unhealthy packaged food.

In addition, food discrimination is still active globally.  The foods sold by the same 9 manufacturers in rich countries like Australia or the UK have a higher overall HSR compared to that sold by them in poorer countries like China and India, which have some of the highest levels of nutrients of concern worldwide.

This is concerning, as these countries have a host of commonly consumed traditional foods that are extremely healthy, palatable, and affordable. However, a change-over is in progress and is causing both obesity and undernutrition to rise in these countries.

Globally we're all eating more and more processed foods and that's a concern because our supermarket shelves are full of products that are high in bad fats, sugar and salt and are potentially making us sick. Our results show that some countries are doing a much better job than others. Unfortunately, it's the poorer nations that are least able to address the adverse health consequences that have the unhealthiest foods.”

Elizabeth Dunford, Lead Author

Even with the same nutrient of concern, the mean HSR ranking varied surprisingly between countries. In Meat products in China earned a 1.9 compared to 3.3 in India. Mexico, fruits, vegetables, nuts and legumes achieved almost 4 stars, but in India, only 2.9.

The limitations of the study include its reliance on several different methods of data collection, both with respect to time and to the source. From surveys to crowdsourced data, a variety of methods were used. Complete data collection was not possible for any country. The product number and range varied from country to country.

Despite the limitations, the message is clear. Billions of people are exposed to unhealthy packaged foods and drinks. Monitoring and reporting on food product quality will be necessary for change, aided by repeated nutrient profiling. If this fails, the epidemic of diet-induced disease is waiting to overwhelm public health.

Journal reference:

A comparison of the healthiness of packaged foods and beverages from 12 countries using the Health Star Rating nutrient profiling system, 2013–2018. Elizabeth K. Dunford, Cliona Ni Mhurchu, Liping Huang, Stefanie Vandevijvere,  Boyd Swinburn, Igor Pravst, Lizbeth Tolentino‐Mayo, Marcela Reyes, Mary L'Abbe, & Bruce C. Neal. Obesity Reviews. 22 July 2019.

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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