Added sugar and other changes to the back of the pack nutrition label

     I wrote this post on May 20 -21, 2016 after the FDA announced new labeling requirements for packaged food manufacturers. The manufacturers will be required to provide additional information and modified information on the Nutrition Facts Panel (NFP). This applies to all companies, but smaller ones have longer to comply. The FDA announced July 2018 as the official effective date, but we know from past FDA associated labeling initiatives that this date could change.
     The FDA press release - which you can access here - offers highlights of the changes, and many news sources have covered the story. What I want to do is put the changes in the context of my blog re: nutrition disclosures that help us consume fewer calories across venues.
     So does this change help? Probably - or to some extent. First, the revised labels have an increased 'reference serving size'. The noted serving size may merely be a declaration to allow the nutrient content to be calculated, because people rarely (if ever) dole out cups, ounces, or grams and even if they did, it would be more cups, ounces, or grams than the label suggests. The update, a slightly larger serving size, appears to be a compromise between what people are actually eating and what they are supposed to be eating. In other words, it is probably still not realistic.  One example of a serving size change involves ice cream. Instead of a 1/2 cup, a label will say 2/3 cup. I imagine most people scoop out more than 2/3 a cup of ice cream for themselves, therefore, if a person wanted to know the actual calories or sugar they consumed, they'd have to do the math (just as before). Also people may think that the label refers to an actual cup of some sort, not a measuring cup. 
     A similar issue with serving sizes is unchanged. They are not exactly uniform across similar products - the serving sizes may all be a 1/2 cup but the weight - the precise measurement - will vary. Boxes of cereal and cartons of ice cream, as opposed to say, a can of soda, are actually figured by weight, grams usually. So a serving size might be 2/3 cup on five cartons of ice cream but the weight of each 2/3 cup could be different. So to be frugal with our calories like we are with our dollars, we  need to know the calories per unit. You don't get to see an orange shelf tag with this information but you can do the math, e.g. calories per serving divided by grams in a serving gives you the calories/gram.
     Another change on the NFP is that sugar grams will come with a % DV. I've never been much of a fan of the % daily value disclosure on a label. It is based on a 2000 calorie/day diet and the majority of women, myself included, require less, say 1500 to 1800, so again, math is required. There is a trick that can make the percentages useful. If the item on the label is a nutrient of concern (meaning we get too much of it, like calories, sugar and sodium), look for a low %DV.  Low is 10% or less. There are very few nutrients that Americans lack, but for those, look for high %DV. For example, it would be great to have products with vitamin D and calcium at 20% or higher.
    Small packages, ones that people are likely to consume all at once even if they 'technically' contain 2 or 3 servings, will now have dual labels. There will be a column with the serving size nutrient information and a column with the whole package nutrient information. For items like a 20 ounce soda, where the expectation or custom is to drink the entire bottle in one 'sitting' the nutrient and calorie content will only be for the entire package (who drinks 8 ounces of a 20 ounce soda and saves the rest for tomorrow?). BTW, that is why I go for diet sodas in 12 ounce cans, I do not need 20 ounces, its too much; and for some diet sodas, the trace calories will become meaningful beyond 12 ounces.
    There are a couple more changes, which are not as relevant to the theme of my blog. You can review them by clicking on the above link.
    I'll end with two important things the new labels do not address. The information is still on the back of the package and the rule doesn't amend the new vending machine law to include sugar grams with the point of purchase calorie disclosure. Because the Nutrition Facts Panel is still on the back of the package the prospective buyer has to pick up and turn each product around (the new rule does not mandate or standardize front of pack labels and this is a disappointment). And consequently, this rule won't help us purchase low 'added sugar' snacks from vending machines because we can't see the back of the package at the time of purchase.

Learning how to maintain a healthy weight - from our pets

It is not a secret. We have obese cats and dogs, a good many of them. And I will gander a guess - an educated one, I've read research - that pets gain weight when we give them people food - in addition to their pet food.  I have also read that ad libitum feeding is better than intermittent feeding. Pets - maybe the study was on cats - eat less when the food is left for them all day (I'm sure it was cats, dogs are sort of dumb), than when the food is presented and taken away. Sound familiar?  Its a bit of a take on restriction and forbidden foods - if you think you wont' get to eat that again, you want to eat a lot of it when you have the chance, especially, it seems, if you are a cat.

Anyways, I recently adopted one, a cat, after not having one for several years. My cat will not get people food - ever. I did buy him some treats though - good for his teeth.  And imagine my surprise (delight even) at this label instruction:

As with any treat, always adjust amount of main meal to compensate for calories delivered by treats.

In addition, the label tells you how many calories per treat, and how many treats a day your cat should have based on his or her weight.  But the instruction to compensate is priceless and relevant: you can't just keep adding calories - even good ones - and not expect to gain weight.

If its important for a cat, isn't it important for you?  Sure - have a glass of wine, but those 150 to 200 calories COUNT towards your daily total, they are not supposed to be 'add ons' - you must compensate... pretend you're a cat.

I am referencing Feline Greenies, BTW, and my cat likes them - in moderation!

What's the story behind the calories + activity labels for soda?

Another study meant to test the effect of providing nutrition information at the point of sale has been published in a respected peer reviewed journal.  In addition, the results of the study are reported in the popular press and as often occurs, the popular press is reporting selectively.  It’s unfortunate that reporters would be selective or misrepresentative because the actual findings are impressive without embellishment or obfuscation. 

Here it is in a nutshell.  In 2012/2013, Sara Bleich and colleagues Barry, Gary-Webb and Herring conducted a study in Baltimore, MD. They introduced 4 beverage related nutrition disclosures (or treatments) to a small sample (n=6) of corner stores that were in walking distance to nearby middle and high schools. All 6 stores received each of the 4 nutrition treatments for about two weeks– but in random order.  The nutrition disclosures, which were placed on signs on beverage cases were 1) Did you know that a bottle of soda or fruit juice has about 250 calories? Or 2) Did you know that a bottle of soda or fruit juice has about 16 teaspoons of sugar? Or 3) Did you know that working off a bottle of soda or fruit juice takes about 50 minutes of running? Or, 4) Did you know that working off a bottle of soda or fruit juice takes about 5 miles of walking?  [Note that the exercise examples are not equivalent, a flaw the researchers note in the limitations section of their paper.  Why does it matter?  People may not know how long it takes them to walk five miles, for me it would be more than 90 minutes.  In addition, the calorie expenditure data was based on a male or female adolescent weighing about 110 pounds.  The individualistic nature of calorie expenditure is one of the reasons I prefer multiple traffic light labels over exercise equivalents for an informative information disclosure.]  While the nutrition treatments were in place (i.e., the randomly selected sign was posted) research assistants collected sales receipts from a random sample of purchases at each store.  To be included in the random sample, the sales receipt had to be associated with someone who appeared to be between the ages of 12 and 18 and black.  This is important because the results of the study are generalizable to black adolescents in a Northeastern US city – not other kids, not adults, not other types of locations(e.g., a rural town).  The headlines in popular press do not make this distinction and only focus on one thing.  The headlines promulgate the findings that telling a person how much activity they will have to do to burn the calories in a soda or fruit juice leads to a change in the number of sugar sweetened beverages purchased, the size of sugar sweetened beverages purchased, and the average number of calories purchased. 

In the study, (see table 1 if you can access it) the average beverage calories sold when no information was posted was 207; the average calories sold during the calorie only treatment was 185; the teaspoons of sugar treatment, 188; the minutes of running treatment, 193; the minutes of walking treatment, 187.  In this analysis, for this outcome, the best treatment was the calorie only disclosure.  The average percent of sugar sweetened beverages purchased when no information was posted was 97%; for all of the different treatments the percent of sugar sweetened beverages purchased was between 88.3% and 89.1% - more than a 10% drop from the no information treatment, but similar across information types.  The purchase of sugar sweetened beverages greater than 16 ounces (recallthis post about the portion size cap) was around 53% when no information was posted and a much lower 38% with the calorie only treatment, 42.7% with the teaspoons of sugar treatment and 46.7% and 47.9% with the running and walking treatments, respectively.  As you can see, there is no earth shattering headline about exercise equivalents in the overall results of this study and in fact, the results are an exception to previous findings that calorie disclosures alone did not work.  However, in the analysis I just described, the types of disclosure or treatments were not directly compared to each other. 

In a sub analyses (with adjustment), the researchers did compare the treatments and found a significant (real) but modest (about 6 calories) superiority for the treatment that listed the number of miles it would take to walk off a bottle of soda or juice compared to the average across all treatment conditions.  For example, in the analysis of all the beverage sales,  the average calories sold for any information treatment was 184 (compared to 203 without information), but the average calories sold in the walking 5 miles treatment was 179.

During the last week of information disclosure, the researchers conducted exit surveys with a small group of randomly selected beverage customers (who were black adolescents). The surveys explored whether or not the youth saw, understood, believed and considered the information.  Please see the full article to read about the findings.¹

Lastly, and importantly, the researchers continued to track sales for 6 weeks after removing all of the nutrition signs.  They did this to test lasting effects and indeed all of the outcomes, though attenuated, remained in effect.

I am a researcher in this same area – though my focus is on nutrition labeling law. I understand that calorie only disclosures are not always effective or as effective as public health advocates would like them to be and I find the literature on multiple traffic light labeling more promising.  Others find the literature on exercise equivalents, to which the Bleich et al study belongs, to be equally or more promising.  So, I think that is what the press is capitalizing on – exercise equivalents did change behavior in this study, but the press isn’t doing a good job of telling the rest of the story.  In this sample of black youth, who as a population have a disproportionate prevalence of obesity and soda consumption, just providing a calorie disclosure at the point of sale led to positive changes in all outcomes.  That is GREAT news!   As the federal law now stands, the only disclosure mandated is calories and Bleich et al give us hope that even if we can’t modify the law's directive, nutrition labeling could still positively impact a high risk group.

¹Am J Public Health. Published online ahead of print October 16, 2014: e1–e8. doi:10.2105/AJPH.2014.302150

More Claims Face Sanction

It isn’t just herbal supplements that claim health benefits that are false, the FDA and FTC have also questioned Kellogg and General Mills on claims that they put on cereal boxes. To be certain, Cheerios are not an effective cholesterol lowering food and Rice Krispies do not improve children’s immune systems. Both companies have recently or in the past been admonished and sometimes fined for such falsehoods.

I can’t help but wonder why the NutriSystem company hasn’t been called out. The claims that companies make have to be backed by science and can not be misleading. I feel strongly that NutriSystem ads mislead people, especially when they promote a meal plan for diabetics that states it is “based on clinical studies” – what does that mean?

What you should be more inclined to believe is this – food in its natural form – fruits, whole grains, vegetables, legumes, some seafood – THEY are antioxidant rich and a diet that is based on them is better for you than one that contains a lot of processed foods. I do not CARE what they ADD to the box it is still food in a box and that means it is processed.

Remember, maybe it was last Sunday, the odds and ends note about those vegetables – immune, vision and digestive health – I wonder if the FDA/FTC is going to check on that one. I haven’t read the rest of the label though – if the name of it is the only leading thing I bet it passes by – but if it claims to improve those things – then it is apparently suggesting that it has medicinal properties and the FDA has to approve medicines and their outcomes – which must be proven in clinical trials!