May 23, 2016

Why the New Nutrition Labels Won't Work

Richard Williams

Senior Affiliated Scholar
Summary

In 1993, nutrition labels seemed like a great idea. Now the evidence says we need a totally different approach.

The Food and Drug Administration’s Office of Nutrition has a tendency to cling to bad policies and reject any new ideas. So it was back in the 1990s, and so it is now—a couple of decades later.

The latest evidence came Friday when it released a long-awaited proposal to fix the nutrition label. The proposal received widespread praise, including by the first lady and the FDA commissioner who touted it as a “valuable resource.” Just one problem: The idea of a label makes much more sense on paper than it does in real life. Consumers don’t really use nutrition labels to eat healthier because it’s too complicated to try and combine all of the information into one decision. Perhaps even worse, what we know about the relationship between diet and disease is almost entirely based on data that come from people trying to remember what and how much they ate. Their memories are terrible, and subsequent study has shown that the data are flat wrong. The FDA needs to give up on this failed policy and try other ideas that help consumers make healthier choices.

How am I so sure that the nutrition facts panel has been a failure? Because I made all of the upbeat predictions about how helpful it would be when, in 1993, we implemented the Nutrition Labeling and Education Act of 1990. That law created, among other things, the Nutrition Facts Panel that you see on the back of packaged food. At the time, I was the chief economist at the Center for Food Safety and Applied Nutrition in the FDA and I asserted that people would see this information and use it to make wise, healthy choices, which would lead to better health outcomes for the nation. We thought we would see about 40,000 fewer cases of cancer and heart disease over the next 20 years and prevent 13,000 deaths.

Sadly, as nearly a quarter of a century of experience has revealed, pretty much none of that occurred. Today, fewer people read food labels, and most Americans think it’s easier to figure out their income taxes than to really understand how to eat healthy. After all, who knows how to trade off the different kinds of good fats and bad fats and good fiber and—in some cases, but not all—bad sodium and calories all together. If you don’t know, don’t feel bad; virtually no one does. The FDA suggests using its “5/20 rule,” which calls for limiting the bad characteristics of the food you buy to less than 5 percent and making sure the good ones exceed 20 percent. Unfortunately, the science doesn’t tell us whether this actually helps.

Part of the problem is that different people have different dietary needs. As scientific advances move toward allowing doctors to offer customized treatment plans for patients based on very specific needs, nutrition science continues to use a one-size-fits-all solution.

But even if everyone’s needs were uniform, research from the FDA’s sister agency, the Department of Agriculture, shows that the nutrition labeling law has no effect on consumption of total fat, saturated fat or cholesterol. Another study suggests that food labels may be actually misleading to consumers who are trying to make healthy choices.

Nutrition science also turns out to be much more uncertain than we thought. To estimate the effects of the label changes in the ’90s, we used nutrition science to link dietary fat to cancer, but now it appears that relationship doesn’t exist. We also linked high levels of LDL cholesterol to heart disease, but the age-adjusted decreases in coronary heart disease ceased to decline even as LDL continued to decline.

In its latest iteration, the FDA is updating two of the least understood parts of the nutrition label: the Daily Reference Values and Reference Daily Intakes. The former is the average percentage of a nutrient that a serving of a food provides in a day and the latter is the numerical quantities of the amounts of macronutrients that a person who consumes 2,000 calories per day needs. From a nutritionist’s perspective, those values may be useful information. But for most Americans, they are entirely meaningless and may serve only to discourage consumers from even looking at the label. One of the lead nutritionists at the FDA once told me that the problem was so complex, she would need to sit down with every American family for at least 15 minutes to explain the label.

If the nutrition label doesn’t work, how else can the government help consumers make more informed, healthier choices? For starters, the FDA should be more like the Defense Advanced Research Projects Agency, the people who created the Internet. Instead of just focusing on trying to fix the unfixable, the FDA could shift its focus toward thinking more creatively about viable solutions and give up on what isn’t working.

First, the FDA would need to honestly concede how little it knows about how different foods and food combinations actually affect individuals with distinct genetic and environmental factors, along with their personal preferences or capacity (or willingness) to exercise. The FDA would need to expand its base of knowledge and understanding within these areas and then consider how manufacturers and consumers would respond to any changes the FDA suggests as a result.

The FDA may need to think beyond labels or, at a minimum, think about something simpler like front-of-package signals that would convey the food’s nutrition information as a “healthier” or “less healthy” choice. Or maybe it’s time to start thinking even more outside the panel and consider using genetic modification to create foods that are healthier—as the researchers at the John Innes Centre did when they created a tomato packed with extra antioxidants meant to fight cancer.

Eventually, rather than consumers relying on poor memories of what they have eaten, we’ll have personal nutrition monitoring devices (including apps on cellphones) that can scan bar codes in grocery stores and input better data for actual meal intake. Rather than relying on faulty recall data, this could generate accurate data to establish diet-disease relationships—e.g., diets high in saturated fat leading to heart disease. The FDA can play a role in providing food labels that have more information in bar codes on packages or electronic tags within foods, which can provide more useful information to help with individual diets.

Whatever the FDA does, it should study, test and try pilot programs first—but it should not experiment on the entire American population without performing this due diligence. The health of 320 million people is far too important to leave to outdated policies and practices. The Nutrition Facts Panel is certainly not improving our health—and more and more tinkering is just poor policy.