In a significant contribution to public health nutrition research, Dr. Kawther Hashem, Senior Lecturer at Queen Mary University of London (QMUL) and Head of Research and Impact at Action on Salt, has published a compelling review paper urging policymakers to adopt a more sophisticated approach to food reformulation policies. Titled 'Towards a more nuanced understanding of policies that lead to food reformulation for a food system change,' the paper dissects global evidence on strategies targeting trans fatty acids (TFA), salt, and sugar—three nutrients central to diet-related diseases like cardiovascular conditions and obesity. Published online on December 26, 2025, in the Proceedings of the Nutrition Society, this work challenges the oversimplified mandatory-versus-voluntary dichotomy, highlighting how policies can drive reformulation directly or as unintended consequences.
Dr. Hashem's analysis arrives at a pivotal moment for the United Kingdom, where longstanding voluntary programs have yielded mixed results amid rising scrutiny over high-fat, salt, and sugar (HFSS) foods. With the government's recent update to the Nutrient Profiling Model (NPM) in January 2026 tightening definitions of 'less healthy' foods, her findings offer timely guidance for refining UK food reformulation policies to foster sustainable food system transformation.
What is Food Reformulation and Why Does it Matter?🥑
Food reformulation refers to the process by which food and beverage manufacturers alter the composition of their products—reducing levels of harmful ingredients like added sugars, salt (sodium chloride, NaCl), saturated fats, or trans fatty acids while potentially enhancing beneficial nutrients such as fiber, vitamins, or plant-based proteins. This strategy aims to improve population-level nutrient intakes without requiring consumers to change behaviors drastically, making it a cornerstone of public health interventions against non-communicable diseases (NCDs).
In the UK context, where average adult salt intake hovers around 8.4 grams per day—exceeding the World Health Organization's (WHO) recommended 5 grams—and free sugars contribute over 13% of caloric energy despite targets to cap at 5%, reformulation holds immense potential. For instance, the UK's voluntary salt reduction program, launched in 2003 by the Food Standards Agency (FSA), collaborated with industry to set category-specific targets, resulting in a 10-15% drop in population salt intake by 2013. However, progress has plateaued, with recent surveys showing only partial compliance across food categories like bread and breakfast cereals.
Similarly, the 2018 Soft Drinks Industry Levy (SDIL)—a tax on sugary drinks exceeding 5g sugar per 100ml—prompted a 30% average reduction in sugar content within months, demonstrating reformulation's responsiveness to fiscal incentives. Yet, as Dr. Hashem notes, such successes are not universal, underscoring the need for tailored policies.
Historical Evolution of UK Food Reformulation Policies
The UK's journey began with salt in the early 2000s, evolving into a multi-nutrient framework. Public Health England (PHE), now integrated into the UK Health Security Agency (UKHSA), set 2017 sugar reduction targets across 20 categories, aiming for 20% cuts by 2020 through reformulation and portion control. Compliance varied: yogurts and breakfast cereals saw substantial reductions, but pizzas and pastries lagged.
By 2024, new salt targets covered 108 categories, including out-of-home foods like ready meals. A University of Oxford modeling study published January 27, 2026, estimates that full compliance could avert 12,500 heart disease deaths and save £2.7 billion in healthcare costs over lifetimes, using a 1.5% discount rate. The January 2026 NPM update shifts focus from total to free sugars, potentially restricting more products in advertising bans effective from 2025-2026, including a 9pm TV watershed and online curbs.
These policies reflect a gradual shift from purely voluntary pledges to hybrid models incorporating fiscal and regulatory pressures, yet challenges persist in enforcement and monitoring.
Global Evidence: Lessons from Trans Fats, Salt, and Sugar Policies
Dr. Hashem's review synthesizes international case studies, revealing no one-size-fits-all solution. For trans fatty acids—industrially produced fats linked to 500,000 annual deaths globally—mandatory bans have triumphed. Denmark's 2003 limit to 2% of fat content slashed cardiovascular mortality by 14%; New York City's 2006 restaurant ban correlated with 13 fewer heart deaths per 100,000. Conversely, partial limits in Egypt delayed industry response until WHO's 2018 best practice pushed full elimination.
Salt policies show mixed outcomes: South Africa's mandatory caps since 2016 reduced bread sodium by 27%, but voluntary South Korean efforts faltered without caps. Sugar interventions blend taxes, labels, and standards; Mexico's soda tax cut purchases 10%, spurring reformulation, while front-of-pack (FOP) warning labels in Chile drove 25% sugar reductions across categories.
Read the full paper for detailed evidence: Cambridge Core.
Photo by Alexandra Tran on Unsplash
Direct vs. Indirect Drivers of Reformulation
Policies explicitly target reformulation, like nutrient caps or levies, differ from indirect ones like FOP labeling or school standards. The UK's SDIL exemplifies direct action: manufacturers reformulated to avoid tax tiers, reducing sugar by 4.5g/100ml on average. Indirectly, Chile's black octagon labels prompted voluntary changes to evade warnings, cutting sugar 24% in cereals.
Dr. Hashem argues the binary mandatory/voluntary label masks this spectrum: "Within what is commonly described as mandatory reformulation, we find a broad mix of policy tools that operate very differently." Combinations amplify impact—e.g., taxes plus labels outperform solo efforts.
| Policy Type | Examples | Outcomes |
|---|---|---|
| Direct Mandatory | TFA bans, salt caps | Consistent reductions |
| Direct Voluntary | UK salt pledges | Initial success, then stall |
| Indirect | FOP labels, school rules | Unintended reformulation |
Challenges and Industry Perspectives
Food industry groups, like the Food and Drink Federation, contend new NPM changes unfairly penalize natural sugars in juices, potentially stifling innovation. Compliance costs rise with complex targets; a 2025 Action on Salt survey found only 50% of crisp brands met salt goals. Technical hurdles—maintaining taste, shelf-life—persist, as salt reduction beyond 20% risks consumer rejection.
- Monitoring gaps: Self-reporting lacks verification.
- Substitution risks: Lower sugar may increase fats.
- Equity issues: Reformulation benefits all but small firms struggle.
Government reports acknowledge these, balancing with incentives like R&D tax credits. For deeper career insights in policy analysis, check higher ed career advice.
Stakeholder Views and UK Health Organizations
Action on Salt praises Dr. Hashem's work, emphasizing policy synergies for 'meaningful and sustained food system change.' Obesity Health Alliance calls NPM updates 'long overdue,' aligning with modern guidelines. Explore Dr. Hashem's profile: QMUL.
Consumers support reformulation: Danone's 2026 index shows 70% favor clearer 'healthy' definitions. Academics at universities like Oxford underscore modeling's role in evidencing impacts.
Implications for UK Universities and Research Careers
QMUL's leadership via Action on Salt exemplifies higher education's pivotal role in policy evidence. Dr. Hashem's NIHR-funded work on sugar reformulation bridges academia and action. UK universities host key units—Edinburgh on fortification challenges, Oxford on salt modeling—driving data for FSA targets.
Aspiring researchers can pursue research jobs or faculty positions in public health nutrition, contributing to national health strategies.
Photo by Katharina Bill on Unsplash
Future Outlook: Towards Integrated Policy Mixes
Dr. Hashem advocates multi-tool arsenals: levies + caps + labels + standards. Upcoming UK HFSS promotions bans from October 2025 may indirectly boost reformulation. Globally, WHO pushes TFA elimination by 2025; UK could pioneer combo approaches.
- Enhance monitoring with independent audits.
- Invest in taste-masking tech via university-industry partnerships.
- Align with net-zero goals through sustainable reformulation.
Government consultations on SDIL strengthening signal momentum.
Actionable Insights and Next Steps
Stakeholders should prioritize evidence-based combos, as no isolated policy suffices. For academics, opportunities abound in postdoc roles modeling impacts. Industry: leverage R&D for compliant innovations. Policymakers: evaluate indirect effects rigorously.
Visit Rate My Professor for insights on nutrition faculty, or browse university jobs in the UK. Engage via comments below to discuss reformulation's role in healthier futures.
For FSA targets: GOV.UK Sugar Reduction.