Health Star Rating As Solution For Double Burden Malnutrition in Indonesia

Adibah Rasikhah Amanto
6 min readJun 28, 2020

Double Burden Malnutrition (DBM) is a term which refers to a concept explain the advantages and disadvantages of both macronutrients and micronutrients in the same population thru life. DBM now is a global problem that arises in developed and developing countries. DBM can be formed in malnutrition upon pregnant women and fetal or with the excessive increasing of eating patterns which leads to obesity and non-comunicable diseases in the future.

Furthermore, obesity has became one of the serious problem of the rapidly growing Double Burden Malnutrition in this two decades. Obesity has increased three times more rapidly by last two decades in the developing countries like Indonesia. Based on Rikesdas 2013 results said that 26.3% of Indonesians are overweight and 14.8% are categorized as obese with BMI> 27. Hence, Indonesia becomes a country with highly average for obese people in the world (25%). This becomes very concerned when we do know obesity not only causes bad impact on the health, but also affects the development of the well-being of the country. Many people who are obese and suffer from noncommunicable disease, they will diminish work productivity and affect the country’s welfare.

One big factor that causes high obesity level in Indonesia is bad eating pattern since kids. Example is the number of snacking and eating instant food packaging or a fast food (fast food) such as pizza, fried chicken, fried potato, burger, and much more. Fastfood or junkfood can be found easily in every corners of the city. It is often found particularly among school children or teenagers. Thus, it is such an unhealthy eating pattern of teenagers which triggers NCD as they become mature.

Besides, Indonesia which has not been able to manage its natural and human resources optimally, forces the nation to be disposed to become one of the largest markets for other developed countries like America and Tiongkok. The entrance of various daily products into Indonesia has given an impact on the increasing of taxes and resulted in the increase in the diversity of daily products consumed, especially in food and beverages. Therefore it is very urgent to have a good selections in consuming pattern, particularly towards nutrition needed in products.

As the source of nutritional value information on each food packaging label, Badan Pengawasan Obat dan Makanan (BPOM) has provided guidance of nutritional value information on each industrial products. These guidelines are further known in the form of the AKG Table (Angka Kecukupan Gizi). AKG or RDA (Recommended Dietary Allowances) is the average nutritional adequacy for almost all healthy people (97.5%) classified by age, sex, body size, physical activity, genetics, and physiological state to achieve optimum health status.

We do know AKG Indonesia is prepared by Widyakarya Nasional Pangan dan Gizi (WNPG) every 5 years since 1987. If nutritional needs give the minimal nutrients needed by individuals, the AKG usually shows the average daily intake consumed by a population based on individual intake. AKG gives the references food label that includes nutritional value information so that it can be used to assess the nutritional adequacy in a process of food consumption by individuals or groups. In addition, the AKG can be used as a plan for supplementary feeding in the providing of regional and national food.

Furthermore, in some cases of NCD patients (Non communicable disease) AKG gives a function as reference in determining food consumption of the patients. Therefore, it is expected that the good food can reduce the impact of unhealthy foods (fast food or junk food) in their body. However, in consument food selection, the selection with AKG will take a long time. Especially in the eating pattern of young people which tends to be very diverse. Thus, a new method is needed to provide effective, fast, accurate, and applicable nutritional value information upon the package of food products in Indonesia.

In the world of Public Health (Self-Health), it has been recorded various methods to provide information on the nutritional value of a food product towards consument. Kind of well-known method is the Health Star Rating (HSR). HSR is one of the public health products for labeling system that able to reflect almost the overall nutritional status of a food product. This system has been implemented in Australia since 2014. HSR has an assessment range from ½ star to 5 stars as an indicator of nutritional status. The assumption used is the more stars the more healthy the product is to be consumed.

HSR is calculated using a special calculator which can assess nutritional content or risk on food. The calculator is called The Health Star Rating Calculator. This algorithm calculation was developed in consultation with Food Standards Australia New Zealand and nutrition and technical experts whose made the calculations accurate in presenting the consistency of nutritional information. However, the HSR system until now itself is still going through the development, improvement, and periodic evaluations of the Australian government. Moreover, one of the advantages of HSR is that it can easily, accurately, and quickly provide information about the nutritional value of a product without having to check the AKG details on the packaging. However, this method does not necessarily eliminate the AKG table in food product packaging. This method able to make the selection of food product be more efficient in time because consumers only comparing the quality of the product roughly by reading the total star on the packaging. Besides this method is also quite easy to understand by children to adults. So it can be applied to many processed food products, such as breakfast cereals, light snacks, canned food, dairy products, or confectionary that most children love. However, in practice, there are several types of products that are not purposely exposed to HSR, such as fresh packaging products (fruits and vegetables), alcoholic beverages, products formulated for young children and toddlers, spices and herbs, tea and coffee (non- Nutritive foods), food with a single composition such as flour, and any foods that do not require the Nutrition Information Panel.

Components in HSR not only revolve around the number of stars, but there are other indicators of risky nutrients such as saturated fat, salt and sugar, each of those are calculated in a packaged serving (100g or 100ml), as well as calories / energy products (Kilojoules). Nutrition at risk (risk nutrients) is a substance that is closely related to the problem of obesity or chronic illness. Risk Nutrients are given with explanation of the level (low/high) composition of the product so that it can indirectly help the consumer (patient) in selecting the food. The content of HSR labels also contains positive nutritional components such as protein, dietary fiber, some vitamins or minerals that play a role in the balance of diet.

However, the Implementation of a new system such as HSR gives its own impression and challenge to Indonesian food policy. Nevertheless, system requires the hand of government to conduct an independent assessment related to all kinds of local and imported food products which of course will affect the investment policy of foreign food companies / industries. We are already know even HSR indirectly affects the motivation of consumers who will choose products with high HSR. Ttha is logic. However, further research on this system should be done, so that the purpose of HSR which is to decreasing number of people with NCD and DBM can be accomplished well.

As a new method in public health HSR system is expected to be a solution as a provider of nutritional information upon products as quickly, accurately, and easily. So that people can get a healthy and balanced daily food consumption. Thus, it is expected that HSR can decrease the rate of obesity (DBM) and prevent the prevalence of non communicable diseases in Indonesia. At the same time HSR can be a reference in the food industry is growing rapidly in Indonesia as a healthy and balanced food indicator.

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