By Susan Blumenthal, MD, MPA and Ella Cohen
On May 20, 2016, the Food and Drug Administration (FDA) issued new federal guidelines for nutrition labeling, announced by First Lady Michelle Obama at the Partnership for a Healthier America Summit. The new content requirements for the labels marked the first significant update since this nutrition information was required by law in 1990. The updated labels were enacted as part of the Federal government’s response to the rising rates of obesity and the associated chronic disease epidemic linked to poor nutrition. An estimated 68% of adults in the United States are overweight or obese, and rates have surged from 15% of American adults in 1990 to 34.9% today. Additionally, as many as 17% of American children and adolescents are obese.
The nutrition fact labels use a 2000 calorie daily diet to calculate the percent daily values for ingredients in the products. People should remember when reading the labels that the 2000 daily calorie count might not be right for them and may require adjustment depending on their height, weight, gender, age, physical activity level and other factors. Furthermore, it should be noted that the % Daily Values on the label does not add up vertically to 100%; rather the percentages refer to the daily recommended amount of a nutrient that is included in one serving of a food or beverage.
Why the new labels?
Nutrition plays an important role in overall health. Overweight and obesity have been linked to rising rates of chronic illnesses, including type 2 diabetes and heart disease. The new food and beverage product label requirements align with the recently updated Dietary Guidelines for Americans 2015-2016, and represent a component of the Federal government’s strategy to reverse obesity rates in the United States within a generation by helping consumers make more informed, healthier food and beverage choices.
The labels are designed to help people make more informed choices about what foods and beverages they are consuming. While the general format of the new nutrition label is similar to the original format, a few important changes have been made, including:
- Larger, bolded font for the calorie count
- Larger serving sizes that are more representative of how much people actually eat
- Inclusion of the grams of added sugar and the percent daily value
- Dual columns listing the nutritional content for packages that could reasonably be eaten in one sitting, comparing nutritional information for an individual serving with the contents of the entire package
- Revised percent daily value of nutrients like sodium, dietary fiber, and Vitamin D based on the new Dietary Guidelines for Americans
- Removal of “calories from fat” from the label
- Adding grams and percent daily value of Vitamin D, potassium, calcium and iron to the label
- Removing percent daily value of Vitamins A and C from the label
Below is a side-by-side comparison of the old and new labels for a hypothetical food product:
All calories count. As illustrated in the example of the new food product label shown above, the most noticeable change is that the calorie count is now presented in large, bold type, and is about three to four times bigger in size than any other number included on the label. This makes the calorie count easier to read, drawing greater attention to it, with the hopes of helping consumers become more aware of the amount that they are consuming.
This change, however, has been criticized by some experts for emphasizing the caloric content of food, rather than its nutritional value. Some foods, including avocados, nuts, and olive oil, are high in calories, but contain many essential nutrients and healthy monounsaturated fats that can help lower bad cholesterol (LDL) and promote overall health. The label’s emphasis on calorie count might lead some consumers to assume that these healthy foods are “unhealthy.”
Food companies can also manipulate the calorie count and nutritional value of their products by changing packages in order to meet a perceived acceptable calorie content. For example, smaller cans of soda and 100-calorie bags of chips and cookies have fewer calories than their full-sized counterparts, but they are still unhealthy foods in terms of their nutritional content. Additionally, “Fat Free” on a product does not mean that it is calorie free.
By increasing the serving sizes on packaged foods and beverages, the FDA is trying to more accurately reflect the actual amount of product that consumers eat at any one time. In this way, the new labels will provide people with a better understanding of the nutritional content of the food product they are consuming, including the amount of protein, fats, sugars, and vitamins. The Nutrition Labeling and Education Act of 1990 required that product serving sizes represent how much people actually eat, and not how much they should eat. Eating patterns in the United States have changed since this legislation was enacted over 25 years ago, and today people are generally consuming more now than they did then; therefore, the new labels were changed to reflect this trend of increasing serving sizes over time.
While it is important for consumers to recognize how much food they are actually eating so they can make healthy choices, many people do not understand that serving sizes are standardized numbers representing current average consumption, and are not meant to provide recommendations about how much food should be eaten. As a result, some people may misinterpret “serving size” as “recommended serving size,” and try to eat the amount listed on the label. 400 calories per serving is generally regarded as high whereas 100 calories per serving is moderate. Consequently, there is some concern that the increased amount of a serving size on the new label might contribute to the obesity epidemic by inadvertently suggesting to some people that they should consume more food than they did before.
The new label also includes information about how much sugar is contained naturally in the product’s ingredients, and how much sugar is added, either as plain sugar, evaporated cane juice, beet sugar, high fructose corn syrup, honey, malt syrup, nectar, or any other type of sugar. Many experts have warned that food and beverage products with added sugars have contributed significantly to the escalating rates of obesity and associated chronic medical conditions. New dietary guidelines recommend that added sugars should account for only 10 percent of daily calories. In an average person’s diet, this would be about 50 grams (12 teaspoons) of added sugar, the amount found in a 16 ounce bottle of soda. The average American, however, consumes approximately 126 grams of sugar a day, which is equal to about 32 teaspoons of sugar, 22 teaspoons (88 grams) of which come from added sugars.
Although consuming more sugar than recommended by the Dietary Guidelines for Americans can increase the risk for obesity and many associated medical conditions, the inclusion of the amount of added sugars on the label is not sufficient by itself to address the problem of overconsumption. Some critics worry that manufacturers will include ingredients like fruit juices, which are naturally high in sugar, as sweeteners to avoid listing the actual amount of added sugar on their products’ labels.
More than 75% of dietary sodium comes from packaged or restaurant food so that consumption of this substance often exceeds recommended daily amounts. Foods that contain a lot of salt include savory snacks, deli foods, bread, cheese, pizza, soup, mixed pasta and meat dishes. Added sodium is present in baking soda and MSG as well.
The dual column mandate for the new food label is meant to make people more aware of the nutritional content of a single serving, as compared to the amount contained in an entire package. If it is likely that some people might consume the contents of the whole package in one sitting, then the new guidelines require manufacturers to include a dual column label. This dual label will have nutrition facts for one serving, as well as for the entire package listed next to each other to help people make more informed choices about their food and beverage consumption. Research has shown that this approach, comparing a single serving size of a food product that could reasonably be consumed in one sitting with the contents of the entire package, helps people make smarter food choices, and ultimately helps them eat less. Below is an example of this dual column nutrition label format:
Other Label Changes
Other changes to the new nutrition labels include the FDA’s removal of the “calories from fat” line in response to a general consensus among experts that the type of fat is more important than the calories from fat. Most experts also appear to accept the requirement changes for the listing of vitamins and minerals, as the majority of Americans consume enough Vitamins A and C, but many are deficient in Vitamin D, iron, calcium, and potassium.
While the FDA’s updated food label represents an important and long-overdue achievement, some experts warn that the changes still do not adequately address some of the key issues that make it difficult for consumers to make smart food choices. The labels remain complicated and difficult for many people to interpret. For this reason, some experts believe it would be better to rank foods based on their nutritional content instead in order to help simplify information presented on product labels. Several of these approaches already exist, including the color-based system that labels unhealthy foods as a gradient of red (“stop”), and healthy foods as a gradient of green (“go”), and the NuVal system, which gives foods a score, making it easier to compare the nutritional value of food product options.
In summary, while the FDA’s new food label presentation represents significant progress, there is still more work to be done. Hopefully the agency’s next update will further simplify the presentation of food and beverage labels, making them easier to understand and digest, so that Americans can make healthier and more informed choices for themselves and for their families in the years ahead.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is a Senior Fellow in Health Policy at New America and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the federal government in the Administrations of four U.S. presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women’s Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House advisor on health. She provided pioneering leadership in applying information technology to health, establishing one of the first health websites in the government (womenshealth.gov) and the“Missiles to Mammogram” Initiative that transferred CIA, DOD and NASA imaging technology to improve the early detection of breast and other cancers. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch, Head of the Suicide Research Unit, and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired many national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Dr. Rosalind Franklin Centennial Life in Discovery Award.
Ella Cohen is a junior at Brown University concentrating in Psychology. She currently serves as a Health Policy Intern at New America in Washington, DC.