Snack Attack: The FDA Looks to Front-of-Package Labels

Location, location, location

There is no more valuable real estate in the retail world than the front of package, FOP. Like a penthouse, the upper third of the FOP is the most sought. In the past, the FDA redlined the Nutritional Facts label to the back of package (BOP); however, in a surprise move 20 years in the making, the FDA is exercising its rights of eminent domain and taking over much of the penthouse with a new, simplified, nutritional label. 

For those who study “reductive” nutrition, poor diets, characterized by excessive intake of saturated fats, sugars, salt, and alcohol, drive the global rise in obesity and non-communicable diseases like cardiovascular disease, diabetes, and cancer. Despite a widespread desire to adopt healthier habits, sustaining these changes remains challenging. Physical environments significantly shape routine health behaviors, making environmental modifications like calorie and nutritional labeling an attractive intervention strategy.

A Regulation 20 years in the making

In 2006, the Center for Science in the Public Interest (CSPI) filed a citizen’s petition asking the FDA to require FOP nutrition labels, arguing that the current back of package Nutrition Facts was hidden, unclear, and needed a high level of nutritional knowledge to interpret.

In response, the FDA asked the Institute of Medicine to investigate FOP labeling. They recommended adopting mandatory labels, while the food industry, in response, introduced its voluntary system, Facts Up Front. However, critics claimed it was “difficult to interpret.”

In 2016, Chile became the first country to implement mandatory FOP warnings, a black, stop sign-shaped icon indicating high levels of sugar, salt, saturated fat, or calories. The results have been mixed, with some studies showing “companies reformulated products to adapt to the new regulation.” In contrast, others indicate little change in purchasing behavior for those most at risk for poor nutritional choices.

In August 2022, CSPI filed a new citizen petition asking the FDA to “mandate a standardized, easy-to-understand FOP labeling system,” focusing on calories, added sugars, sodium, and saturated fat. 

The battle lines are drawn

Industry raised their oft-repeated criticisms and fears:

“Labels should not raise unnecessary fear in consumers through health warnings and symbols, or otherwise promote the avoidance of food ingredients or additives that have been affirmed safe by federal regulatory bodies” - Consumer Brands Association

“The FDA’s proposed rule for front-of-package nutrition labeling appears to be based upon opaque methodology and disregard of industry input and collaboration,” - Sarah Gallo, senior vice president for product policy at the Consumer Brands Association 

And advocates voice their oft-repeated hopes and concerns:

Front-of-package labels are this huge opportunity to really level the playing field and make that information more accessible.” - Marissa G Hall, Professor of Health Behavior at UNC Gillings School of Global Public Health 

“Tobacco labels in the United States do not say, “High in tar, medium in nicotine, and low in carcinogens.” They say, “Cigarettes cause lung cancer, emphysema, and may complicate pregnancy.”

We need to put strong warning labels on unhealthy food and beverages that makes it clear that consuming these products could lead to serious illnesses.”- Senator Bernie Sanders, independent Vermont 

And would any public comments be complete without referencing the “playbook?”

 “The food industry is drawing heavily on the same playbook that the tobacco industry used to oppose regulation. And one of the things that they love to do is propose self-regulation. It’s their way of getting a labeling system without having any meaningful consequences.” - Lindsey Smith Taillie, Professor of Nutrition at UNC Gillings School of Global Public Health. 

“The food industry playbook is predictable. Food companies criticize the science supporting front-of-package labeling, delay public consultation periods, push for their own confusing label designs and emphasize the possible harms of a mandatory labeling policy.” – The Hill

The FDA proposal

The proposed rule, if finalized, would put a Nutrition Info box on the front of the packaging, detailing the relative amount of saturated fat, sodium, and added sugars.

The FDA justified regulation after examining the scientific literature and consumer data on nutrition labeling, particularly the use and effectiveness of the BOP Nutrition Facts label, used by 80% of US consumers at least occasionally. 

The regulation aims to enhance visibility and facilitate informed choices by placing interpretive labels on the front of packages. The benefits of the rule were two-fold. A direct value “from the information provided,” and a more indirect value as “…manufacturers chose to reformulate products to maintain current nutrient content claims or move into a “Low” or “Med” interpretive description,” resulting in a healthier food supply.  Costs accrue to manufacturers, but there was no mention of how they might or would be passed to consumers.

The Science Behind Front-Of-Package Food Labels

In April, the FDA released its meta-analysis on the science supporting front of package (FOP) nutrition labeling 

“…providing consumers with interpretive nutrition information that can help them quickly and easily identify, at the point of decision-making, how foods can be part of a healthy diet—including by allowing them to compare nutrition information across foods.”

The work combined an extensive literature review with focus group testing nutrition labeling schemes, including different combinations of colors, interpretive descriptions, and quantitative nutrient data. The focus group information led to experimental studies with a range of consumers over two feedback cycles. 

Among their findings:

• FOP labels catch consumers’ attention, but understanding varies
• “Simplified, summary, colorful FOP schemes can encourage healthier purchases in supermarkets, but that more research is needed to demonstrate the ability of FOP schemes with regard to overall health and diet-related chronic disease outcomes. [emphasis added]
• “The updated literature review confirms earlier findings and demonstrates that since most FOP labels help consumers understand nutrition quality of a food, the adoption and implementation of a uniform FOP labeling system could be beneficial to consumers.” [emphasis added]
• The focus groups and scientific literature found interpretive FOP nutrition information benefited all consumers, regardless of education or health literacy.
• The focus would be on three key nutrients: saturated fat, sodium, and added sugars, streamlining the required information and packaging space to ensure consumers receive clear, concise, and useful nutritional guidance at the point of purchase. Each is limited based on current nutrition science and the Federal 2020-2025 Dietary Guidelines, which support a nutrient-dense diet within calorie limits
• Interpretive descriptions like "Low," "Med," and "High" help consumers quickly assess nutrient levels. A nutrient is considered "Low" if it constitutes 5% or less of the daily value (DV) per serving. A nutrient is classified as "High" when it makes up 20% or more of the DV per serving. The “Med” designation has no legal definition but lies between Low and High, offering consumers an intermediate reference point.

While the FDA does consider the science of labels and, to a degree, the content and context of the nutrients, it fails to consider a fundamental question that lies at the heart of these reductive approaches to nutrition. Can complex nutritional information be effectively distilled into a simple format?

Do Labels Matter?

“Research is relatively clear that having very simplistic front of packaging labeling does catch people’s attention, but the second step to that is whether or not it changes purchasing behaviors. We really don’t know if it’s going to fully impact people’s purchasing habits.” 

- Colleen Tewksbury, Assistant Professor of Nutrition Science at the University of Pennsylvania

A newly released Cochrane meta-analysis considered the impact of FOP nutritional guidance on food selection and consumption and found that calorie labeling results in a small but meaningful reduction in energy intake. [1]

Based on their review, the researchers found with “certainty” a reduction in “energy purchased” of 1.8%, or 11 calories for a 600 kilocalorie meal. There was, with “uncertainty,” a 5.9% reduction, or 35 calories for consumption. When stratified by socioeconomic groups, higher status results in fewer calories ingested, missing the presumptive target population. 

They concluded that,

“… if estimated effects were realized at scale, then calorie labeling would have the potential to contribute to reductions in the energy intake from food, and therefore to lead to small but meaningful benefits to population health, through attenuation of weight gain or reductions in bodyweight.” [emphasis added]

You may interpret potential and meaningful. Senior author Dr Gareth Hollands is a bit more cautious in his remarks.

“However, we should not expect miracles, and any implementation of calorie labeling must balance the many potential positive and negative impacts of such policies.” 

Ultimately, front-of-package labeling is not the silver bullet to solve our collective dietary woes, nor is it an invaluable public health tool. While the food industry wrings its hands over potential sales dips and regulatory overreach, and advocates champion the labels as a game-changer, the reality likely falls somewhere in between—a small, perhaps meaningful step toward better-informed choices. Labeling will continue to distract from the more significant issue of creating a more educated public and a food chain that promotes what science, with certainty, recommends. 

[1] The meta-analysis examined 18 randomized controlled trials out of 25 studies, analyzing calorie labeling interventions compared to no-label conditions across 49 reports. The studies were conducted mainly in high-income countries, with over half in the US, and focused on consumer food choices in restaurants, supermarkets, and vending machines. Participants included adults and children, with labels clearly displayed at points of selection or consumption. Most studies targeted higher-income populations and lasted between 2 to 13 weeks, primarily assessing the influence of labels on purchasing behavior and, to a lesser extent, actual food consumption.

Source: Cochrane Library Calorie (energy) labelling for changing selection and consumption of food or alcohol