A big upcoming change in food is not actually in food. It's on it. On Friday, First Lady Michelle Obama and the U.S. Food and Drug Administration (FDA) formally unveiled the FDA’s new required nutritional information label for packaged foods, the label's first significant makeover in over 20 years. The FDA will require most food manufacturers to use the new label by July 26, 2018, but grant smaller food manufacturers (less than $10 million in annual food sales) an extra year to comply. Over the past twenty years, many things have changed. The prevalence of obesity has increased substantially. The types of food available have also changed. So, what took so long and do the changes go far enough?
Well, since the label has long been a battleground, making changes is no small feat. Over the years, various consumer and health advocates have pushed for adding more information and making included information clearer and more up-to-date. Conversely, many food manufacturers have resisted changes to the label, arguing that new information may “mislead” or “confuse” consumers. The intensity of such ongoing battles confirms that what's on the labels does matter and may affect what people purchase and eat.
Here are the major additions to the nutrition information label:
- Including for the first time the grams of “added sugars” as well as the percentage of recommended daily limit that this amount comprises.
- Making the serving size more closely reflect the actual amount that people typically currently eat.
- Updating the daily recommended limits for sodium and the recommended daily values for dietary fiber and vitamin D so that they are consistent with Institute of Medicine recommendations and the 2015-2020 Dietary Guidelines for Americans.
- Making "calories" and "serving size" larger and easier to see.
- Adding the amount and percentage daily value of vitamin D and potassium.
- Labeling packages that are between one and two servings as one serving because people will typically consume the entire package in one sitting (e.g., a 20-ounce soda).
- For certain foods that can be eaten in one sitting (such as a pint of ice cream), include both “per serving” and “per package” calorie and nutrition information.
Also, here are the major things that have been removed:
- No longer requiring "calories from fat" since the type of fat may be more important than the amount.
- No longer requiring vitamin A and vitamin C percentages since deficiencies of these vitamins are rare.
So how substantial are these changes? Well, one of the biggest changes is adding the "added sugars" category. Prior to this addition, you had no way of telling how much of the sugar in a packaged food was a natural part of the main ingredient (e.g., a piece of fruit will naturally have sugar) and how much was introduced via processing (e.g., making the original ingredient more sweet). As reported last year by Evan Halper of the Los Angeles Times, members of the food and sugar industry fought this addition, claiming that there is a lack of science supporting the dangers of added sugars and including added sugar would distract you from other, more important nutritional information. For example, the director of regulatory affairs for the
These arguments against adding "added sugars" don't seem very sweet. First of all, "calories" on the label now is substantially larger, so the "taking...focus off calories" argument doesn't quite hold. And regardless of the importance of other nutritional information, wouldn't you want to know if someone dumped much more sugar on to the food that you are eating? Moreover, for the claims of "lack of science," exactly how much more science is needed? More and more studies have been linking excess sugar to bad health outcomes. The University of California Berkeley Wellness site provides a nice summary of some recent evidence. For instance, this JAMA Internal Medicine study led by Quanhe Yang from the Centers for Disease Control and Prevention (CDC) and Frank Hu from the Harvard T.H. Chan School of Public Health associated sugar intake with heart disease and death from heart disease. Susanna C. Larsson, Agneta Åkesson and Alicja Wolk of the Karolinska Institutet in Stockholm, Sweden, published in the Journal of Nutrition a study that followed over 68,000 people for a decade and found that drinking at least two cups of sugary beverages a day (versus rarely drinking such beverages) was associated with a 20% increased risk of stroke. A paper in the Mayo Clinic Proceedings by James J. DiNicolantonio, James H. O'Keefe and Sean C. Lucan used evidence from various studies to explain how added sugars (e.g., sucrose and high-fructose corn syrup) are a principle driver behind the global diabetes epidemic. Published in the journal Circulation, a study from the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE) associated with sugar-sweetened beverage consumption more than 180,000 annual obesity-related deaths. The Berkeley Wellness site goes on to cite evidence for links between sugar and early menarche (first menses), rheumatoid arthritis, hypertension and high cholesterol. There is also evidence that sugar can be quite addicting. A policy brief from the World Cancer Research Fund (WCRF) International explains how sugar can raise the risk of various cancers via obesity.
Another big change is making serving sizes much more realistic. Take a look at some of the current serving size listings. How many people will drink just half a bottle of iced tea or juice? Who eats just a quarter cup of granola? Or half a cup of ice cream? Or six potato chips? Or just two crackers? Comedian Brian Regan emphasizes that no one eats just two Fig Newtons and that the serving size instead should be two sleeves of Fig Newtons here:
Serving size can be very important and deceptive because everything on the label depends on the serving size. Anything can appear low-calorie, low-sugar and low-salt if the serving size is small enough. One molecule of pure lard probably won't look too bad.
The label serving sizes need to match observations that on average people are eating more than they did twenty years ago. Take a look at the United States
A third major change, updating the daily recommended limits and values of different food components such as salt, acknowledges the fact that we actually know more about nutrition now compared to before. Yes, nutritional science is actually moving forward. Not updating the label would be analogous to saying that everyone should have continued to use telephone booths instead of cell phones.
What about removing things from the label such as vitamin C and fat from calories? It is true that scurvy (from vitamin C deficiency) doesn't seem like a major problem anymore. (It used to be a problem on pirate ships that would make long voyages.) Studies have suggested that the type of fat matters more than the pure amount of fat in food. For example, the Women’s Health Initiative Dietary Modification Trial showed a relative lack of health benefit from low-fat diets. And over the past two decades, too much focus on the amount of fat did lead to a plethora of "low-fat" products that were not necessarily healthy and very high in sugar, salt and other additives as well as low in nutritional value. Therefore, these removals are reasonable and help create more space for other information.
So, what's still missing from the nutritional information label? It is still difficult to discern how unnatural and processed some food products are. The amount of "added sugar" is a hint, and so is the amount of salt. However, this label update did not make significant changes to the ingredients list. Certainly, if the ingredient list contains a number of difficult to pronounce chemicals then you can figure what is in the package has not come directly from the ground or the ocean. But there are still items on the ingredient list that could be confusing or unclear such as "natural flavors" and various types of "gums." And when a food ingredient is listed, how much of the food is really that ingredient? For example, if fruit is near the top of the list, how much of what you are eating is really fruit?
Some have asked to include information on the use of genetically-modified organisms (GMOs) as well as pesticides and other chemicals that are not technically part of the food but potentially could remain on the food. While some of this information may already appear on some product packaging, this is quite different from appearing on the official required FDA nutrition label. What's on the label is more highly regulated and thus more accurate. The use of GMOs is an area of heavy debate and would consume an entire new piece to discuss. The same is true for other chemicals.
Another point of discussion is whether the public really understands what each nutritional information item means or if more clarification is needed. For example, a study led by Sara Bleich of the Global Obesity Prevention Center (GOPC) at Johns Hopkins University showed that telling people on restaurant menus how much exercise is needed to burn a calorie amount helped them put calorie content in better perspective. But of course, making nutritional information more understandable for everyone is not easy when populations are so diverse, space on the label is limited and labels need to remain relatively objective.
In general, the latest changes are welcome. With so much lobbying against changes in the labels, the FDA and the Obama Administration deserve credit for shepherding through the label makeover. However, discussions about future additions to the label should not end with this update. As long as the information is accurate, clear and reasonably objective, how, exactly, is more information worse? You can always choose to ignore information on a label. The label does not take the doughnut out of your hand or mouth. The label does not call you or the food names. When manufacturers or anyone wants you to know less information about food, the obvious question is: What is being hidden in food?
