Challenges and opportunities for increasing the effectiveness of food reformulation and fortification to improve dietary and nutrition outcomes

Reformulation, a change to a food or beverage's processing or composition, can reduce potentially harmful ingredients such as salt, added sugar, and saturated and trans fats or increase potentially beneficial ingredients or nutrients such as fiber, protein, and micronutrients. Poor nutrition and health outcomes of populations have stimulated programs and policies to reduce the intake of salt, added sugar, and unhealthy fats and increase healthy nutrients and ingredients to meet recommended targets of a healthy diet. Alongside promoting the consumption of whole, nutritious foods (e.g., fruits, vegetables, and whole grains), reformulation, including fortification of processed foods, has been utilized by food industry manufacturers to contribute to improving diets and aligning with national dietary guidelines. This paper summarizes a literature review and twenty semi-structured interviews with experts on food product reformulation and fortification to highlight the challenges, limitations, and opportunities for increasing their effectiveness. While studies have shown that reformulation could have beneficial public health impacts, such as iodized salt, there are a dearth of rigorous evaluations, particularly for some types of reformulations. Importantly, some evidence suggests that ultra-processing has significant adverse health effects independently of nutrient adequacy. To improve population health, reformulation should be complemented with a range of approaches, including food taxes and subsidies, public food procurement, restrictions on food advertising and marketing, front-of-pack labeling, and changes to food environments that improve availability, affordability, and demand for whole and minimally processed foods.