Thursday, June 5, 2014

Kids of all RacesWith the current obesity crisis affecting at least 35% of Americans, the Food and Drug Administration (FDA) recently proposed changes to the Nutrition Facts Panel (NFP) to improve health literacy and food choices among the American population. The suggested changes highlight new nutrients of public health significance or concern and formatting changes to improve readability and comprehension of the label. While the NFP changes intend to increase consumer understanding of the health impacts of the products that they select to consume, these changes may also have unintended positive and negative side effects, including food fortification, nutrient modification, and consumer confusion.

The proposed update to the NFP comes after nearly 24 years without major renovation. The last major overhaul of the NFP occurred with the Nutrition Labeling and Education Act, established in 1990, which was issued to assist consumers in managing a healthy diet when selecting foods. Of course, most of the proposed revisions will fall upon the food industry to implement through updated food product labels. The new regulations may also set the stage for product development and changes.

One of the principal changes suggested is an emphasis on the amount of calories and servings per container on the NFP. The NFP would now highlight the calories and servings per container through a larger, bolded font. For smaller products, labels often currently state that the product contains more than one serving; yet in actuality, the product is frequently consumed at one sitting (e.g., a 20-ounce soda or “grab bag” of chips). The NFP will be changed to include dual column labeling, which will showcase the nutrition facts not only per serving but also for the entire package. This proposal may discourage consumers from consuming the entire package when they previously may have, without fully understanding how the calorie amount shown related to the serving size. Increasing the font and providing calorie amounts for products frequently consumed in one sitting may increase consumer understanding of total calories consumed and dissuade overconsumption. However, there is concern that highlighting calories and servings per container without also emphasizing serving size per container will not allow consumers to connect the dots between serving size and calories per serving. Serving size is especially important as it is frequently the most misunderstood component of the food label.1,2 Ensuring consumer literacy of serving size in relation to the amount of calories is essential to promote appropriate consumption of many food products.

Another major proposed change is the incorporation of added sugars on the label. The Institute of Medicine report Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002) notes that added sugars are not chemically different from naturally occurring sugars, meaning that they are no more likely to contribute to weight gain than any other source of calories. However, they may increase dilution of micronutrient content and therefore, increase overall caloric density.3 Therefore, the revised food label would include added sugars to highlight the amount of sugars that have been added to a product during processing. One of the primary sources of added sugar in the diet is sugar-sweetened beverages.4 Scientific evidence shows a relationship between sugar-sweetened beverages and obesity, type II diabetes, and cardiovascular disease, so the premise is that making added sugars a component of the NFP may discourage consumers from purchasing products high in added sugar and therefore, decrease the risk of some diet-related chronic diseases. If incorporated into the food label, the added sugars declaration may also encourage food manufacturers to create products that will be lower in added sugars. However, palatability will have to be accounted for and reliability on taste enhancers such as noncaloric artificial sweeteners may be increased. Research has shown that artificial sweeteners are generally safe in limited quantities, although their safety continues to be scrutinized in the scientific literature. Research has not yet confirmed a safe daily dosage of artificial sweeteners.5 In addition, there is currently no analytical method to analyze added sugar versus sugars found naturally in foods. Manufacturers may encounter difficulties in accurately declaring the specific amount of added sugar. False reporting is unfortunately also a possibility, leading to consumption of underreported added sugar.

The proposed changes to the NFP seek to improve consumer literacy and, in the long run, improve public health. It is commendable that the Administration, the FDA and partnering agencies have taken this important stride in nutrition policy in an effort to improve the nation’s health. It is hoped that public policy transformations such as this will be integral toward improving public health and decreasing obesity prevalence. However, with the highly variable, ever-changing food environment in the United States, these changes may not yield their intended benefit. However, consumers are unlikely to see these proposed changes to the food label take place in the market for several years, as a final rule and comment period are still needed. The evaluation period to determine the impact of these changes will also last long after market exposure.

1.         Cowburn G, Stockley L. Consumer understanding and use of nutrition labelling: a systematic review. Public Health Nutrition. 2005;8(01):21–28.

2.         Vanderlee L, Goodman S, Sae Yang W, Hammond D. Consumer understanding of calorie amounts and serving size: implications for nutritional labelling. Canadian Journal of Public Health. Sepember–October 2012;103(5):e327–331.

3.         Klurfeld DM. What do government agencies consider in the debate over added sugars? Advances in Nutrition (Bethesda, Md.). March 2013;4(2):257–261.

4.         Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity Reviews. August 2013;14(8):606–619.

5.         Gardner C, Wylie-Rosett J, Gidding SS, et al. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. July 24, 2012;126(4):509–519.

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