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Sugar Warning Labels Could Cause Food Companies to Make Healthier Food

My name is Lauren Benning, and I am a medical student conducting research at the Duke Diet and Fitness Center (DFC) to monitor the outcomes of the residential style weight loss program. I authored a policy concerning the labeling of packaged food items that was adopted by the American Medical Association (AMA), the foremost group of organized physicians in the United States. Dr. William Yancy, the Director of the Duke Diet and Fitness Center, asked me to write up this post explaining how changing front package food labels relates to obesity as a public health concern.

The policy I authored (termed “resolution” in AMA speak) called upon the Food and Drug Administration (FDA) to regulate the front-of-package labels on packaged foods that are high in added sugar.  In June of 2018, I proposed the resolution to the Medical Student Section at the Annual Meeting, where it was debated and adopted. In November of 2018, the policy was passed and put into action by the AMA physicians. I spoke at the November Meeting on behalf of the resolution during committee hearings, right after the FDA’s Senior Medical Reviewer spoke about what the FDA was currently doing to address added sugars on food labels.

I was inspired to write the proposal after noticing the numerous health claims placed on foods such as Pop Tarts (“8 essential vitamins and minerals”) and Lucky Charms cereal (“100% Whole Grain”). Other examples of “healthy” foods that often contain high amounts of sugar are flavored yogurts, instant oatmeal, and breakfast/granola/energy bars. Front package claims, which appear to make a statement about the nutrient content of the food item, can be generalized to make consumers think a food is healthy. The claims made on the front package must be technically true (e.g. high fiber), but the other components of the packaged food item (e.g. added sugar) could make it a poor source of whichever nutrient one is seeking. Since many packaged cereals and breakfast pastries are high in added sugar, food  companies’ front package labels could be seen as creating a deceptively healthy image of foods one would normally characterize as “junk.”

While debating the merits of this proposal within the Medical Student Section, I argued against people who thought that posting the grams of added sugar to the nutrition facts panel on the back of food products was adequate to inform consumers about sugar content, and that limiting front-of-package advertising claims violated our right to freedom of speech. My argument to refute those claims was that people who are younger or less educated than the average consumer are most influenced by front package labels since they are less likely to look at the nutrition facts panel on foods. Furthermore, the use of warning labels on cigarettes was allowed in the 1960s, and ended up being an effective strategy to curb smoking.

The resolution calls for the Food and Drug Administration (FDA) to develop front package warning labels for foods high in added sugar. Furthermore, it calls for a restriction on the types of health claims that can be placed on the front label of high sugar foods.A similar law calling for warning labels on packaged foods was passed in Chile. The chief proponent of it was a Chilean physician who observed how food companies used marketing strategies to influence consumers to purchase foods high in sugar, salt, fat, and calories, which the physician suspected was a factor in exacerbating the obesity epidemic in his country. He proposed a set of black stop signs as warning labels on packaged food products, which were adopted and put in place by the Chilean government in 2016. The warning labels on food products not only influenced consumers to choose fewer of the labeled foods, but also spurred food companies in Chile to reformulate over 2,000 of their food products to be lower in sugar, salt, fat, and calories.

In the United States, the FDA has already ordered food companies to post the amount of added sugar in the nutrition facts panel on the back of food products, a regulation that will be enforced by 2020. The front package warning label initiative would make the added sugar content of foods even more prominent. Ideally, such a labeling change would better empower consumers to make healthy choices.

When one is reading labels, it is important to scrutinize the claims made on the front of the packaged food item since these claims are used for marketing by the food companies. The important source of information is the nutrition facts panel on the back. Furthermore, whole foods—the ones without a label--are usually the best choice because they typically are nutrient dense and do not add extra sugar to your dietary intake.

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