Caribbean Academics, Researchers and Health Practitioners Support Octagonal Front of Package Warning Labels

by HCC

Caribbean Academics, Researchers and Health Practitioners Support Octagonal Front of Package Warning Labels

Currently, CARICOM Member States are voting on whether to adopt the Final Draft CARICOM Regional Standard (FDCRS5) for Specification for labelling of pre-packaged foods, drafted by the CARICOM Regional Organisation for Standards and Quality (CROSQ) with a deadline of May 31st, 2021. Here we present a letter of support written and signed by Caribbean academics, researchers and public health practitioners in favour of the implementation of front-of-package nutritional warnings on packaged products “High in” sugars, sodium and fats- critical nutrients which contribute to obesity and non-communicable diseases (NCDs) when consumed in excess. This policy measure is backed by rigorous scientific evidence and has the potential to promote healthier food environments in the Caribbean and subsequently prevent non-communicable diseases..

Letter of Support for Octagonal Front of Package Warning Labels from Caribbean Academics, Researchers and Health Practitioners

As Caribbean academics, researchers and public health practitioners, we would like to express our endorsement of the proposal by the CARICOM Regional Organization for Standards and Quality (CROSQ) which supports the implementation of  front-of-package nutritional warnings. These warnings, based on the Pan American Health Organization (PAHO)/ World Health Organization (WHO) standards, are evidence-based and have the potential to promote healthier food environments in the Caribbean and subsequently prevent noncommunicable diseases (NCDs).

Background: Obesity and overweight in the Caribbean

At the global level, the obesity and overweight epidemic has catalyzed joint efforts and the formation of a network of scientists from most food and nutrition academic centers worldwide. This network has generated evidence about key modifiers and determinants of obesity and NCDs. According to multiple studies by members of this network, these diseases have increased in recent decades given the shift of food and dietary patterns especially the proliferation of ultra-processed foods and beverages.[1],[2],[3]

The scientific evidence has demonstrated the negative health impacts of processed and ultra-processed products high in nutrients of concern (sugar, fat, and sodium), and how overconsumption of these foods are linked to obesity and NCDs.[4],[5],[6],[7],[8],[9],[10],[11],[12]

In 2016, NCDs caused 76.8% of all deaths in the English-Speaking Caribbean Region, and 38.1% of all NCD deaths occurred in persons under 70 years of age.[13] High blood pressure, high fasting blood sugar levels and overweight and obesity are the top risk factors driving this burden of disease. In 2019, it was estimated that these three risk factors were responsible for 47% of all deaths in the Caribbean. The Caribbean has high obesity rates, increasing from 6% in 1975 to 25% in 2019.[14] Of great concern, 30% of children and adolescents between 5 to 19 years old are overweight, and 7.2% of children under 5 years old are overweight, surpassing the global average.[15]

Front of package labeling (FOPL) is a potential policy solution to decrease overweight and obesity rates, and subsequent diet-related NCDs:

Implementing front-of-package labeling (FOPL) is an effective public health response to inform the public to make healthy food and beverage decisions. To date, 10 countries have enacted laws making FOPL mandatory. “High in” front-of-pack warning labels, which clearly identify products that are high in nutrients of concern (sugar, sodium, saturated fat, trans fat), are particularly effective at helping consumers quickly identify less healthy foods and increase consumer knowledge around the risks of consuming those foods and beverages. When implemented, this policy can help to guide consumers to make healthy decisions, therein helping to reverse rising rates of obesity, and in turn, helping to reduce cases of diabetes and heart disease.

There are several types of FOPL, however, the most effective type[16],[17],[18] of nutrition warning states that a product is “high in” or has “excessive” amounts of nutrients of concern and has been implemented in Chile, Mexico, Peru, and Uruguay.

Recently, several front of package labels (FOPL) were studied in a sample of Jamaican consumers. This study has found that octagonal warnings (see figure 1) on packaged foods were most effective compared to other front of package label designs (such as the magnifying glass or traffic light labels). This is the first study to test different FOPL types in the Caribbean.

Caribbean Academics, Researchers and Health Practitioners Support Octagonal Front of Package Warning Labels

Figure 1

In the study, Jamaican consumers found octagonal warning labels most helpful to identify the least harmful product and to correctly identify when a product had excessive amounts of nutrients of concern, such as sodium, sugar and saturated fats. The octagonal warning label also increased consumers’ intention to purchase the least harmful product or none at all.

The PAHO Nutrient Profile Model (NPM) can guide development of a Caribbean front of package warning label system:

FOPL are guided by nutrient profile models (NPM) which delineate whether a food product has high levels of nutrients of concern.[19] NPMs state what the threshold is for each nutrient of concern. PAHO’s NPM, developed in 2016, has performed successfully in identifying processed and ultra-processed foods under the NOVA classification[20], a best practice model. The CROSQ Standard for the Labeling of Pre-Packaged Foods, currently being developed, will use the PAHO nutrient profile model (NPM). Further, the PAHO model promotes a diet based on natural and minimally processed foods .

Front-of-package warning labels have been highlighted as a rights compliant tool in a recent Statement by the UN Rapporteur on the Right to Health. The statement noted States’ obligations under the right-to-health framework to regulate the activities of the food and beverage industry, and decisively counter undue influence of corporations on government decision-making.[21] Given COVID-19, it is even more pertinent to regulate products excessive in nutrients of concern, which are associated with NCDs which put people at greater risk of complications and death from COVID-19.[22]

In conclusion, we want to reiterate our support of the graphic octagonal warning label system and the PAHO nutrient profile model. It is our hope that CARICOM becomes a leader in the fight against nutrition-related health risks guaranteeing the right to healthy food and information for its population.


Michael Boyne, Jamaica
Nathan Lovell, Barbados
Allicia Rolle, Bahamas
Tashauna Harris, Jamaica
Tanya Martelly, Barbados
Sharon Dawson, Jamaica
Jane O’Flynn, Netherlands Antilles
Sylette Henry-Buckmire, PhD, Trinidad and Tobago
Desmond Croker, Turks and Caicos Islands
Joanne Paul-Charles, Barbados
David and Rosemary Neilands, Barbados
Karl Theodore, Trinidad and Tobago
Sabrina Compton, Grenada
Dona Da Costa Martinez, Trinidad and Tobago
VIRGINIA Asin-Oostburg, Suriname
Indira Patel, Trinidad and Tobago
Carl Niamatali, Guyana
Christine Richards, Grenada
Tonia Frame, Grenada
Sandra Granger, Guyana
Diane Ignacio, Trinidad and Tobago
Joanne Smith, Jamaica
William Aiken, Jamaica
Nadario Ferguson, Bahamas
Peter Harriott, Jamaica
Levonne Taylor, Jamaica
Marlene Robinson, Jamaica
Lavell Carey, Bahamas
Vivian Alleyne, Barbados
Karen Chin, Jamaica
Janet Shaw, Jamaica
Cheryl-Ann Williams, Barbados
Vernon Gardiner, Jamaica
Brandon Laird, Jamaica
Kadian Gilpin, Jamaica
Geoffrey Barrow, Jamaica
Heather Brathwaite, Barbados
Jeffrey Meeks, Jamaica
Julie Meeks Gardner, Jamaica
Nigel Barker, Barbados
Nancy Charles Larco, Haiti
Jean-Claude Dorsainvil, Haiti
Susan Walker, Jamaica
Xenia Douglas, Saint Lucia
Miriam Alvarado, Barbados
Ricardo Hood, MD, Barbados
Rosemarie Wright Pascoe Williams, Jamaica
Iman Beckles, Barbados
EM Davis, Trinidad and Tobago
Patricia Murray, Jamaica
Ronique Thomas, Trinidad and Tobago
Excellence Dazzell, Guyana
Christina Howitt, Barbados
Lynda Williams, Barbados
Rian Marie Extavour, Trinidad and Tobago
Leila Raphael, Barbados
Shakira Emtage, Barbados
Jennifer Connolly, Barbados
Sara-Lou Christie, Jamaica
Gail Coulthrust-Fitzpatrick, Barbados
Sanghita Mallik, Barbados
Bianca Minnis, Bahamas
Raymond F Adebiyi, Barbados
Simon Anderson, Barbados
Nathalie Watty Brouwer, Barbados
Courisse Knight, Barbados
Prudence Hall, Jamaica
Rhonda McIntyre, Barbados
Sunil Danhi, Jamaica
Carol Oladele, Barbados
Keo Forde-St.Hill, Barbados
Anique Atherley, Barbados
Rhea Corbin-Harte, Barbados
Shontelle Millar, Barbados
Dr.Sonita Alexander, Barbados
Casilda Diaz, Jamaica
Tamara Donaldson, Bahamas
Ashia Forde, Trinidad and Tobago
Marsha Richards, Jamaica
Joyan Chicot, Saint Lucia
Sharon Golding, Jamaica
Beverly Blake Scarlett, Jamaica
Jamie Medard, Saint Lucia
Catherina Taliam, Saint Lucia
nadia ameen, Trinidad and Tobago
Zonja Bain, Bahamas
Cleannie Henry, Saint Lucia
Amelia St. Ange, Saint Lucia
Keisha Thomas-Gibson, Barbados
Janelle Bryan, Barbados
Camille Hope, Barbados
Lisa Chin-Harty, Jamaica
Cheryl Alexis, Barbados
Annalee Gray Brown, Jamaica
Leonor Guariguata, Barbados
Starla Yarde, Barbados
Dr. Mortimer Moxey, The Bahamas
Remi Soyombo, Barbados
Subira Hinds, Barbados
Sharon Harvey, Barbados
Samantha Mathurin, Saint Lucia
Maxine Nunez, U.S. Virgin Islands
Frank Bishop, Barbados
Graeme Marquez, Barbados
Rashida Daisley, Barbados
Dawn Scantlebury, Barbados
John Haynes., Barbados
Ashley Foster-Estwick, Barbados
Stacey Chin, Jamaica
Eden Augustus, Barbados
Raman Walwyn-Venugopal, Antigua and Barbuda
Sheena Warner-Edwards, Barbados
Renee Thomas, Grenada
Heather Reneau, Belize
Colette Cunningham-Myrie, Jamaica
Karlene Morrish-Cooke, Jamaica
Dr. Salihah Dick, Trinidad and Tobago
Lorraine Wilson, Jamaica
Shay Stabler-Morris, Barbados
Stephanie Date, Barbados
Rachel Duncan, Jamaica
Avonda Reid, Barbados
Stephanie Whiteman, Barbados
Rosanna Pike, Jamaica
T.Alafia Samuels, Jamaica
Josefa Martinez, International
Catherine Brown, Barbados
Jonell Campbell, Jamaica
Waneisha Jones, Barbados
Capriles José, International
Owen Gabriel, Saint Lucia
Moyia Taylor, The Bahamas
ijah thompson, Jamaica
Saria Hassan, International
Sharmaine Edwards, Jamaica
Stacey-Ann Aiken, Jamaica
Mervin Mark, Saint Lucia
Karisha LaCorbiniere, Barbados
Dorothy Graham-Charles , Antigua and Barbuda
Marguerite-Joan Joseph, Grenada
Stacia Whittaker, Barbados
Julie-Ann Laudat, Antigua and Barbuda
Fitzroy Henry, Jamaica
Selby Nichols, Trinidad and Tobago
Rachel Harris, Barbados
Vanessa Cumming, Jamaica
Minerva King, Saint Lucia
Juanita James, Antigua and Barbuda
Joeanna Curry, The Bahamas
Roxanne Foster, Saint Lucia
Marilyn Lawrence Wright, Jamaica
Kwesi Marshall, Jamaica
Paul Archibald, Saint Lucia
Cleopatra Altenor , Saint Lucia
Leslie Culmer, The Bahamas
Azmina Long, Saint Lucia
Debbie-Ann MC Millan, Trinidad and Tobago
Simone Bishop-Matthews , Trinidad and Tobago
Abi Begho, Saint Kitts and Nevis
Hiroko Yoshida, Barbados
Kurlene Cenac, Saint Lucia
Monique Monplaisir, Saint Lucia
Natasha Innocent-Thomas, Saint Lucia
Martin Didier, Saint Lucia
Gillian Mc Lean, Trinidad and Tobago
Christopher Laurie, Barbados
Merle Clarke, Saint Lucia
Riche D., The Bahamas
Amanda King, Saint Lucia
Jacqueline Bird, Saint Lucia
H Wendy Gardner, Jamaica
Eugene Cooper, The Bahamas
Tamara Marie, Saint Lucia
Shanel Adderley, The Bahamas
Laura Tucker-Longsworth, Belize
Heather Silvera, Jamaica
Tamara Remy, Saint Lucia
Rudolph Hypolite, Trinidad and Tobago
Judith Henry-Porther, Trinidad and Tobago
Judy Payne, Antigua and Barbuda
Tisha Peters, Barbados
Pqmela Payne-Wilson , Barbados
Tracy McFarlane , Jamaica
Tracey Charles, Antigua and Barbuda
Nellene Henry, Jamaica
Vonetta Nurse, Jamaica
Lisa Levee, Jamaica
Dominique Millen, Jamaica
Lewis Campbell , Jamaica
Kezia Philip , Trinidad and Tobago
Micah Murray, Barbados
Gary Sewell, Jamaica
Yolanda Paul, Jamaica
Jakaila Hewitt, Barbados
Abigail Johnson, Barbados
Nequesha Dalrymple, Trinidad and Tobago
Tameka Duncan Baker, Jamaica
Sunetra Ramsingh, Jamaica
Nicole Griffith, Barbados
Paula Henry, Trinidad and Tobago
Marita Marshall, Barbados
Kia Lewis, Barbados
Phillipa Sylvester, Barbados
Sakina Bakharia, Barbados
Suleiman Bulbulia, Barbados
Colin Alert, Barbados
Margaret O’Shea, Barbados
Vanessa White-Barrow, Jamaica
David Yawson, Barbados
Karen Sealey, Trinidad and Tobago
Margaret St John, Barbados
Kathryn Daniel, Barbados
Dr. Gillian Birchwood, Barbados
Deborah Chen, Jamaica
Dr Carnille Farquharson, The Bahamas
Indira Singh-Minott, Anguilla
Christine Chin, The Bahamas
Ira Simmons, Saint Lucia
Paula Lashley, Barbados
Terence Seemyngal, Trinidad and Tobago
Keerti Singh, Barbados
Md Anwarul Majumder, Barbados
Barbara McGaw, Jamaica
Kandamaran Krishnamurthy, Barbados
Timothy Arthur, Barbados
Graham Griffith, Barbados
Najuma Comissiong, Barbados
K Weekes, Barbados
Joseph Herbert, Barbados
Clyde Cave, Barbados
Geoffrey Lafond, Barbados
Francine Charles, Barbados
Kirk Douglas, Barbados
Clive Landis, Barbados
Dwayne Devonish, Barbados
Nicole Foster, Barbados
Kenneth Connell, Barbados
Suzanne Soares-Wynter, Jamaica
Jennifer Knight-Madden, Jamaica
Maisha Hutton, Barbados

*Some persons have exercised their right to not display their name publicly however their signature has been verified

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