Disclosing Nutritional Information to Reduce Chronic Diseases
The Nutrition Labeling and Education Act of 1990 (NLEA) required food processors to label products with amounts of key nutrients as a public health measure. Chronic diseases such as heart ailments, cancer, and diabetes were the largest causes of preventable deaths in the United States, killing more than 1.5 million people each year. Scientists agreed that the single most important factor in preventing and minimizing the effects of such diseases was improved diet. Before Congress acted, however, consumers had no way to assess the healthfulness of most packaged foods. Supporters of the law hoped that it would create new incentives for Americans to eat healthier foods and for manufacturers to improve their products.
Consumer groups combined with organizations such as the American Cancer Society and the American Heart Association to promote nutritional labeling as a public health measure rather than simply a right-to-know cause. Entrepreneurial members of Congress, led by Representative Henry Waxman (D-Calif.) and Senator Howard Metzenbaum (D-Ohio), pressed for the new labeling law. The food industry supported disclosure both as preferable to conflicting state requirements and as a means to reap profits from marketing healthy products.
The new law required food processors to label in standardized formats amounts in each serving of total fat, saturated fat, cholesterol, sodium, total carbohydrates, complex carbohydrates, sugars, dietary fiber, and total protein, in the context of amounts recommended for consumption as part of a daily diet. Companies also had to list total calories and calories from fat in each serving. Serving sizes were standardized to conform to amounts customarily consumed. Products that were not labeled accurately and completely could be deemed misbranded by the federal Food and Drug Administration (FDA) and removed from the market. In 1994, when the law took effect, interested shoppers could compare nutrients in virtually every can, bottle, or package of processed food for the first time. The law was appropriately heralded as the most important change in national food policy in fifty years.
However, Congress also gerrymandered the labeling requirement to satisfy powerful interests, exempting nearly half of consumers’ food purchases. Fast-food outlets, full service restaurants, fresh meats and seafood, deli items, and dietary supplements all escaped labeling.
Nutritional labeling did improve over time—but only slowly and sporadically. Often labeling failed to keep pace with new science. Scientists had known since the 1970s that trans fatty acids were the most health-threatening fats, for example. The FDA, however, did not require their listing on food labels until 2006. Major food allergens (from tree nuts to shellfish) were not clearly labeled until 2006. And labels continued to group together all carbohydrates despite evidence that complex carbohydrates were healthier than simple carbohydrates. The risks and benefits of dietary supplements remained largely undisclosed. In the late 2000s several industry groups launched private front-of-package labels, some of which were flagged by the FDA for being misleading and unfounded.
In 2012, the Department of Agriculture introduced mandatory labeling for single-ingredient major cuts of meat and poultry and for ground and chopped meat products. In early 2014 the FDA proposed sweeping changes to labels for conventional foods and dietary supplements. The FDA also proposed a new line listing "added sugars" separately, to alert consumers of sugars that do not originate from a food's ingredients but are added by manufacturers to enhance taste. The industry strongly opposed singling out added sugars claiming that "sugar is sugar," whether natural or added, and that the science behind added sugars labeling was misleading. The new nutrition fact labels were finalized in May 2016. The new labels present calorie information and serving size in larger and bolder types, to make it easier for consumers to find this information. Serving sizes have also been updated to reflect actual consumption patterns. A pint of ice cream, for example, will now have to list three servings, instead of four, which will increase the number of calories associated with a serving. For items that can be consumed in one sitting or in multiple sittings, manufacturers will have to provide a dual column label, where they list calories and nutrients per serving and per container. Added sugars are reported in grams and as percent daily value in a separate line. Some groups, like the Center for Science in the Public Interest, had advocated listing added sugar amounts in teaspoon, but the industry argued that would be too complicated for certain foods. Under the new labels information on Vitamin A and C will be voluntary, because deficiencies of these vitamins are rare, but information on Vitamin D and Potassium will become mandatory because these nutrients are lacking in American diets. The new labels should appear on food packages in July 2018, but a group of industry leaders requested an extension to 2021 citing high compliance costs and the need to wait for USDA's final rules on GMO labeling.
In an effort to curb obesity and related chronic illnesses, several states and local governments started mandating that chain restaurants report calorie information on their menus. In 2010 the Affordable Care Act made the scope of restaurant transparency national by introducing mandatory disclosure of calorie information for restaurants with 20 or more locations that offer standardized products. In November 2014, the FDA issued the rules that would finalize the national transparency requirements. Compliance was delayed from December 2015 to May 2017. Restaurant chains welcomed the new rule because it set a single national standard, which they viewed as preferable to complying with a patchwork of local regulations. Several chain restaurants have already started listing calorie information on their menus voluntarily and adding low calorie options anticipating the transparency requirements.
Updated April 2017
This case study is drawn from Full Disclosure, Fung, Graham and Weil, 2007.
A longer version of this case study appeared in Democracy by Disclosure, Graham, 2002.