July 2014 Issue

The Nutrition Facts Label
By David Yeager
Today’s Dietitian
Vol. 16 No. 7 P. 44

Dietitians speak out about the FDA’s proposed changes, what more should be done, and how the updates will impact public health.

Much has changed in nutrition science since the Nutrition Labeling and Education Act, signed into law in 1990, mandated that nutrition labels be placed on packaged foods. However, the labels themselves haven’t changed to reflect the science, with the exception of listing trans fat content beginning in 2006.

Later this year, however, the Nutrition Facts label will get a significant facelift. The FDA issued two proposed rules in March that were open for public comment until June 2. The final rules, which will revamp the labels and bring them more in line with the latest nutrition science and how people eat today, will take effect 60 days after they’re published in the Federal Register, and manufacturers will have two years to bring their labels into compliance.

Many dietitians believe it’s time to update the Nutrition Facts label. Although it was an improvement over previous labeling efforts, there were limitations. Janet Colson, PhD, RD, a professor in the nutrition and food science program at Middle Tennessee State University, says the proposed changes will provide more relevant information in an easier-to-understand format for average consumers. “For example, in the 1990s, most dietary advice focused on reducing total fat, saturated fat, and cholesterol, and the general consensus of the nutrition community was that all sugars are basically the same,” she says. “In fact, one of the leading nutrition textbooks [of that time] emphasized that the only problem with added sugar was that it causes cavities. After years of research, evidence on the effects of added sugars vs. natural sugars shows they have different effects on health. The public needs to be able to use the food label to determine the difference.”

What Lies Ahead
One of the most significant proposed changes to the Nutrition Facts label will be the inclusion of added sugars. The 2010 Dietary Guidelines for Americans state that the US population’s sugar intake is too high. In fact, the American Heart Association, the American Academy of Pediatrics, the Institute of Medicine, and the World Health Organization recommend people decrease their intake of added sugars, according to the FDA.

On average, Americans get 16% of their total calories from added sugars, and the major sources are soda, energy and sports drinks, sugar-sweetened fruit drinks, grain- and dairy-based desserts, and candy. There’s no specific recommendation for added sugar intake, but by listing added sugars separate from naturally occurring sugars on nutrition labels, the FDA hopes to make consumers aware of how much extra sugar they’re getting in a given food.

Removing the calories from fat line is another proposed change. Current research indicates that total fat is less important to overall health than the types of fat a person consumes. Moreover, FDA consumer research has found that calories from fat make no difference in a person’s ability to judge the relative healthfulness of a product. Values for total fat, saturated fat, and trans fat will remain on the label, though.

The new labels also will more prominently display the number of calories per serving and adjust serving sizes to reflect what people actually eat, which is required by law, rather than what they should eat, especially since Americans are eating larger portions today than they were 20 years ago. “For example, a typical serving size of ice cream is listed as 1/2 cup, and what’s being proposed is that they increase that to a full cup, which is a more realistic serving size,” says Liz Weinandy, MPH, RD, LD, an outpatient dietitian at The Ohio State University Wexner Medical Center. “The serving size is what’s listed on the label, and the portion size is what a person would eat. So they’re starting to get the portion size and the serving size to be closer to the same thing, which would make the labels much more realistic and easier to understand.”

Some food containers will list total calories depending on whether someone likely will eat or drink the entire package content in one sitting. Weinandy says this can be a useful tool for someone who drinks a 20-oz bottle of soda, for example, because labels on these products currently list multiple servings. If someone eats a whole bag of potato chips or a container of ice cream each week, it will be easier for them to see how many extra calories they’re consuming over time, she adds.

Vitamins and minerals such as calcium, vitamin D, potassium, and iron also may be added to the Nutrition Facts labels. These proposed revisions are based on data from the National Health and Nutrition Examination Survey and focus on nutrients that most Americans don’t adequately consume. Currently, vitamin D and potassium aren’t required on nutrition labels. Values for vitamins A and C would no longer be required because most Americans get plenty of these nutrients, although manufacturers can include them voluntarily.

Additionally, rather than listing the percent Daily Values a food provides, the labels will list the specific amounts of those nutrients in micrograms and milligrams. “When we talk to clients, we tell them how many grams or micrograms they need of that nutrient,” says Erin Winterhalter, MPH, RD, LDN, CDE, director of the MacDonald Center for Obesity Prevention and Education in Villanova University’s College of Nursing. “We don’t say, ‘You need three foods that have 20% of your Daily Value of vitamin D’; that doesn’t translate well for the consumer. The consumer is looking for the number of milligrams that they need each day. We tell them, ‘You need 1,000 mg of calcium per day, and this food’s going to give you 200 of that.’ So now we’ll be able to explain it in laymen’s terms for them with the help of the food label.”

Need for More Improvements
Although most dietitians agree that these changes are overdue, some have suggestions for further improving the labels. Colson would like to see folic acid values included, and Weinandy says larger print would be helpful for older consumers. And while serving sizes on approximately 17% of products would be updated, some say there’s still potential for confusion.

“These serving size changes aren’t harmonious across all food categories,” says Rene Ficek, RD, LDN, CDE, lead nutrition expert at Seattle Sutton’s Healthy Eating, a freshly prepared healthful meal service. “In fact, the new label changes could make this gap even bigger. For instance, serving sizes on packages should match with serving sizes listed in the Dietary Guidelines for Americans. However, food manufacturers differ widely [on how they list serving sizes].

“We need to ask ourselves, ‘What is an actual serving for Americans, and what should it be?’” she continues. “Some people eat a pint of ice cream by themselves. If the FDA stated that an entire pint of ice cream was the actual serving size, it could encourage overeating, which is exactly what the labels are aiming to avoid. It would be ideal if the USDA and FDA could work together to present one seamless, clear message to consumers, but unfortunately the new labels don’t go far enough in this category.”

Another common criticism of the proposed changes is that the labels rely on a 2,000-kcal diet to derive the percent Daily Values. Many dietitians interviewed for this article say that, because nutritional needs vary widely among individuals, the percent Daily Values aren’t particularly helpful, and they don’t refer to them when educating clients. What would be helpful, they say, is more guidance about how the amount of nutrients relate to diet.

“Identifiable colors on the label—like our red, yellow, and green stoplight system—may work here,” Winterhalter says. “If the product is low in sodium, let’s highlight that and mark it in green. If it’s a high-sodium food, the label could reflect this information in red. By adding color or images, like a thumbs up or thumbs down symbol, you lower the literacy level required to read the label, and it instantly becomes easier for all consumers to understand.”

Dietitians also hope for more transparency about food ingredients. Blanket statements such as “natural flavors” are of little value to consumers. Although known allergens must be stated on the label, other ingredients that may affect health can be hidden.

“I’d like to see caffeine content listed,” Weinandy says. “I think this is really important. Right now, a lot of products don’t have to disclose the amount of caffeine that’s in them. In general, energy drinks are the main culprit. When you see a product that says ‘high energy’ or ‘gives you energy,’ it may say something like ‘with added B vitamins’ or ‘with ginseng’ on the front label, and people think that they’re getting energy because of added vitamins or herbs. But what a lot of companies are doing is they’re actually adding caffeine and, of course, we don’t have any idea how much. Sometimes, even if you call them, they won’t provide that information. The energy drinks are really a concern, especially for adolescents who might drink them frequently or people with cardiac problems.”

New Label’s Impact
How much of an effect can a simple food label have on public health? Although it may not be a bombshell, over time its influence could be substantial.

For example, the proposed changes could help make a dent in the obesity epidemic by putting pressure on manufacturers to reduce the added sugar content in their products. “Hopefully, it will affect the manufacturers in the same way as when trans fats were separated out on the label,” says Christine Santori, RDN, CDN, program manager of the Center for Weight Management at Syosset Hospital in New York, part of the North Shore-LIJ Health System. “It pushed many manufacturers to either not add [trans fat] in their food products or change their formulations a bit, so I’m hoping that may be the case as well when it comes to added sugars, that manufacturers will start reducing the amount of added sugars they put in products.”

For the most part, many dietitians believe the proposed changes will make nutrition labels more useful and help them educate consumers. The changes include areas that many of them emphasize, such as essential vitamins and minerals, good vs. bad carbohydrates, and appropriate calorie, sodium, and fiber intake.

“The new labels will be a valuable resource in working with obese, diabetic, or hypertensive patients as well as counseling clients who simply want to plan healthier diets,” Colson says. “Obesity and diabetes are at an all-time high. If we, as dietitians, educate the public on the need for healthful eating and convey simple messages—such as, try to limit sodium to 1,500 mg a day; aim for about 100 kcal per snack or 500 kcal per meal; eat at least 25 g of fiber each day to avoid constipation; or teens need 1,300 mg of calcium each day and adults need 1,000 mg—the public can use information on food labels to improve their diets.”

Ultimately, though, it’s up to consumers to take advantage of the tools at their disposal. For those who already eat a nutritious, well-balanced diet, the new labels probably won’t change their buying habits, Ficek says, but for those who eat a lot of processed foods, the proposed changes may encourage them to give calories, serving sizes, and added sugars a second thought.

Easier-to-understand labels are a step in the right direction, but much of the responsibility for public health falls on the public, dietitians say. To make a significant dent in obesity and the conditions associated with it, continued public outreach is essential. “Certainly, the label changes would be helpful for the people who are reading them, but somehow we have to get the people who aren’t turning the package over to look at the label,” Santori says. “If we can affect those folks and have them care a little bit more about what’s in the package, that would possibly alter the obesity epidemic.”

One piece of good news is that more people than ever are reading nutrition labels. Weinandy says more than one-half of consumers read labels, and that number has been increasing. Dietitians hope that eventually the labels will have a trickle-down effect on Americans’ health.

But while more people are paying attention to what they eat, there’s still more to be done. After more than 20 years, it will take some time for people to get used to the new labels. “As with any change, there will be an adjustment time for consumers,” Ficek says. “Any changes to the Nutrition Facts panel need to be part of an overall education effort. If no one understands his or her calorie needs for the day, none of this will make sense for consumers. Dietitians will be an integral part of this education to help consumers in the long run by translating nutrition information to the public. I believe many consumers will find the changes both important and relevant to their personal needs.”

— David Yeager is a freelance writer and editor in Royersford, Pennsylvania.

• Overview of label changes: www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm

• Fact sheet on proposed changes: www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm387533.htm

• Proposed rule for revising food labels: www.federalregister.gov/articles/2014/03/03/2014-04387/food-labeling-revision-of-the-nutrition-and-supplement-facts-labels

• Proposed rule to adjust serving sizes on food labels: www.federalregister.gov/articles/2014/03/03/2014-04385/food-labeling-serving-sizes-of-foods-that-can-reasonably-be-consumed-at-one-eating-occasion