Can mandating nutrition labels on the front of food packages reduce obesity rates?

The Food and Drug Administration is expected to propose a change to prepackaged food sold in America: a requirement that the front of packages display key nutrient information, in addition to the nutrition label that is already on the back.

The concept, designed to quickly convey to busy consumers the health consequences of the foods and beverages they’re considering buying, isn’t new: Around the world, dozens of countries already have front-of-pack nutrition labels that come in different designs. In Chile, for example, a stop sign symbol on the front of an item indicates whether it is high in sugar, saturated fat, sodium or calories. In Israel, there is a red warning label on such foods and drinks. And in Singapore, drinks display a letter scale based on how nutritious they are.

Advocates have been urging the FDA for nearly two decades to require front-of-package labels, which they say help people make healthier choices and prompt food manufacturers to reformulate their recipes more effectively. to have fewer warnings on their products. The FDA remained largely silent on the issue until it announced intentions to explore the first package labels as part of a national health strategy released during a landmark White House Conference on Hunger, Nutrition and Health in 2022. Since then, it has literature review on front-of-pack labeling and focus groups to test label designs.

But the idea faces opposition from trade associations representing America’s food and beverage manufacturers, which created their own voluntary system to highlight certain nutrients on the front of packages more than a decade ago. And some of the label designs being considered by the FDA can be challenged on First Amendment grounds.

The U.S. interprets free speech much broader and more inclusive of corporate speech than any other country in the world, said Jennifer Pomeranz, an associate professor at New York University’s School of Global Public Health, who has researched First Amendment obstacles to mandate money. – the food labels of the packages.

Designs that are merely factual stating the number of grams of added sugars, for example, are more likely to be considered constitutional than interpretive designs that have shapes or colors that characterize a product as unhealthy, her research found.

It starts to get more boring when you move into subjectivity, Pomeranz said.

Among the many label options tested by the FDA, some used traffic light colors to indicate whether a food had a high (red), medium (yellow) or low (green) amount of saturated fat, sodium or added sugars. added; others stated whether a product was high in those nutrients, sometimes adding the percentage of the recommended daily value contained in a serving.

An FDA spokesman declined to tell NBC News which label design it will use and did not say exactly when the agency would publish its proposed rule, other than to say it is aiming for this summer, although earlier had set a deadline of this month. .

The Consumer Brands Association and the food industry association FMI, which created a voluntary labeling system for the food and drink industry called Facts up Front that was launched in 2011, have made it clear that they are against mandatory interpretive models. like the red light/green light system. . Interpretative labels will instill unnecessary fear in consumers based on a single limiting nutrient without providing meaningful information about how that food item might fit into overall healthy eating patterns, they wrote in a public comment to the FDA in 2022 .

They also say their voluntary system addresses consumer needs. Facts up Front uses up to four icons on the front of packages to highlight calories, saturated fat, sodium and added sugars per serving amount. Manufacturers may also include nutritional information for up to two nutrients to encourage, such as potassium or fiber. The Consumer Brands Association says hundreds of thousands of products carry facts on the front: 207,000 foods and beverages displayed them as of 2021, according to the most recent data available from the group.

“It really gives consumers a quick, consistent and comprehensive look at what the nutritional composition of whatever they’re buying is, and then helps those consumers make informed decisions,” said Sarah Gallo, the association’s vice president for policy. the product.

Advocates of mandatory front-of-package labeling disagree, arguing that the Facts up Front campaign is underutilized: In contrast, the federally mandated nutrition facts label is on the back or sides of packages appears in billions of products.

Front-of-pack labeling is only credible to consumers if it appears throughout the food supply, not just the products of a small number of producers who opt into a voluntary program, said Eva Greenthal, a senior policy scientist at the Food and Agriculture Organization of the United States. health. the advocacy group Center for Science in the Public Interest, which first petitioned the FDA in 2006 to enforce the first package labels.

She also said that Facts on the Front doesn’t provide enough context to be useful.

Facts up Front does not provide any additional tools to help the consumer interpret that information, she said. We need something like the high word.

Courtney Gaine, president and CEO for the Sugar Association, the trade association for the US sugar industry, said her group supports transparency but questions whether mandatory front-of-pack labeling will improve Americans’ diets.

It just doesn’t seem like there’s any evidence to show it’s going to make a difference, she said.

But Greenthal and other advocates say there is data from around the world to back it up. In Chile, which in 2016 became the first country to implement front-of-pack nutrition information, studies show that people have made healthier consumer purchases and are choosing healthier product reformulations.

I think it’s a very classic food industry, anti-regulatory tactic to deny science support for a new policy that may be difficult to implement but is beneficial to society, Greenthal said.

In its review of the scientific literature on front labels, FDA concluded that labels can help consumers identify healthy foods and appear useful to those with lower nutritional knowledge and busy shoppers.

The discussion comes as the percentage of Americans considered overweight or obese has increased, with obesity affecting about 42% of American adults. More than 1 million Americans die each year from diet-related diseases such as cardiovascular disease, diabetes and some cancers, according to the FDA.

The statistics don’t mean the nutrition facts box that became necessary on the back or sides of food packages three decades ago has been a failure, said Xaq Frohlich, an associate professor of history at Auburn University and author of From Label to Table. : Food Regulation in America in the Information Age.

Every time there has been a change in the label, the food industry has reformulated its foods, he said. So even if you’re not reading the label, food is changing and having that kind of impact.

Greenthal said there are many people who would benefit from more nutrition information on the front of packages: busy parents rushing to the supermarket, people with low levels of nutrition knowledge and anyone else with limited time and energy to invest. in their food choices.

Policies like front-of-package labeling can’t come soon enough, she said. Diet-related chronic diseases are one of the most important problems facing our country and hindering the health of our population.