Interpreting Health Claims on Food Packages

Can packaged foods

really

help to “reduce cholesterol,” “support immunity” or “maintain a healthy heart?” Considering that many boxed foods in grocery store aisles are heavily processed and have added sugar, these kinds of marketing statements may seem suspicious to nutrition-savvy fitness professionals.

Eye-catching labels on food packages will attract consumers who’ve been told to consume more fiber-rich or cholesterol-free foods, says Teri Mosey, a science and Eastern philosophies expert who holds advanced degrees in exercise physiology and holistic nutrition. However, labels can sometimes be deceptive. “It’s about marketing and profits, not about public health,” Mosey notes.

Under U.S. Food and Drug Admini-stration (FDA) regulations, companies can legally make all sorts of health claims on product packaging. In fact, companies operating well within the law can imply a product is healthy without necessarily being required to prove it. To make the best choices in the grocery store, fitness clients need to be aware of how these health-claim rules work.

Marketing by Implication

For example, FDA regulations allow sugar manufacturers to put the label “15 calories per serving” on a bag of sugar. After all, it’s a true statement that falls within FDA guidelines.

To the average shopper, “15 calories per serving” might imply a low-calorie—and perhaps healthy and nonfattening—food option. But as a fitness professional, you probably have more context on 15 calories of sugar. For example, these might be your first thoughts:

• A “serving” must be pretty small (it’s one level teaspoon of sugar, as it turns out) (Domino 2014).
• Most people probably eat more than one serving of sugar per sitting (in fact, most Americans consume roughly 13–26 teaspoons of sugar per day) (Ervin
  &
  Ogden 2013).
• Consuming sugar has many health implications beyond mere caloric intake.

Claims

implying

health—without actually promising it—have proliferated on food packages. This is health by association, and your clients need to understand why it’s a serious issue.

Types of Food Packaging “Claims”

Health claims usually describe the relationship between a substance (a food or food component) and a disease or health-related condition such as cancer or hypertension. These are the major FDA “claims” categories:

• 
  Nutrient content.
  
  These describe the level of a nutrient in a food with terms such as “free,” “high,” “low,” “more,” “reduced,” “lite” and noncomparative quantitative statements (“200 mg of sodium,” for example) (FDA 2013b).

  Regulations define when each qualifier may legally be used. For example, a “high” claim may be made only if food contains at least 20% of the daily value for that nutrient (FDA 2013a). Nutrient content claims typically apply to substances that have an established daily value, such as vitamins and minerals (Exponent 2010).

• 
  Health.
  
  These claims link a food substance or dietary ingredient to reduced risk of a disease or health-related condition (FDA 2013b). Examples include “Adequate calcium throughout life may reduce the risk of osteoporosis” (Silverglade
  &
  Heller 2010). Note that health claims are limited to statements about disease
  
  risk reduction
  
  , rather than treatment or prevention of disease (Schneeman 2007).
  Health claims have legal limits. For example, claims may be used only if a product does not exceed disqualifying levels for certain nutrients, vitamins, fiber and so on (Silverglade
  &
  Heller 2010). Health claims typically require premarket approval by the FDA and must meet the agency’s “standard of significant scientific agreement.” This mean that experts agree that scientific evidence supports the claim (Exponent 2010).
• 
  Structure-function.
  
  These claims address the role of a specific substance in maintaining normal healthy structures or functions of the body,
  
  without
  
  stating the nutrient’s role in the prevention of any disease. In essence, they suggest the product can help make you healthier in a relatively unspecified way (Nestle 2010). Examples include “Calcium builds strong bones” or a claim that a particular nutrient “helps maintain a healthy heart” (Silverglade
  &
  Heller 2010) or “supports immunity” (Nestle 2009).

  Structure-function claims were initially sanctioned in 1994 for use on dietary supplement labels, but they have proliferated on food labels—even under the guise of food manufacturers’ free-speech rights under the First Amendment (Nestle 2010).

  Like many experts, Mosey is concerned with structure-function statements. “These claims are quite misleading and not reviewed by an overseeing organization.” Indeed, unlike health claims, structure-function claims do
  
  not
  
  require FDA approval, which can take over a year to obtain (Silverglade
  &
  Heller 2010).

The Law . . . and Ways Around It

Despite extensive FDA regulations on food labeling, the deck is stacked against the consumer, says Yoni Freedhoff, a physician, author and weight loss specialist in Ottawa, Ontario. So just how do food marketers push the limits of the law and keep the FDA at bay?

• 
  Claims are not rigorously verified.
  
  While drugs have to undergo specific and randomized controlled trials, statements that link particular dietary components to improved health outcomes do not face similar scrutiny (Nestle
  &
  Ludwig 2010). Also, marketing claims may overstate findings or be based on weak science (Chandon
  &
  Wansink 2012).
• 
  Bad news is omitted.
  
  Drug advertisements must disclose potential adverse side effects of ingredients. But foods that contain ingredients with potential negative effects (such as sugar) have no such labeling requirement (Nestle
  &
  Ludwig 2010).

  Note that dietary supplements must carry a disclaimer stating that the claim has not been reviewed by the FDA, and that the product is not intended to diagnose, treat, cure or prevent any disease. Packaged foods have no such disclaimer requirement (FDA 2009).

• 
  Consumers misunderstand health claims.
  
  For example, consumers typically have a “more is better” approach to nutrients, when in reality nutrients have a point of diminishing returns. Plus, words can mislead. For example, “provides energy” can easily be misunderstood as “energizing” (Chandon
  &
  Wansink 2012).
• 
  Regulations are hard to enforce.
  
  Statements on food labels are not always reviewed by the FDA. And in practical terms, “there’s simply no way to enforce accuracy given the vast quantities of products on grocery store shelves,” says Freedhoff.
• 
  Food manufacturers are often focused on sales, not public health.
  
  “Our national dietary recommendations, along with the regulations involving food labeling, are crafted by government . . . and governments by definition need to also consider the impact of their recommendations on industry,” Freedhoff argues.

Giving Your Clients Context

How can you help your clients cut through the confusion of health claim labels? “My first recommendation for shoppers is to ignore all the ‘flair’ and turn the package around and look at the ingredients. That’s the most important aspect of the packaging. What’s in it?!” says Mosey.

Gary Collins, MS, is a former FDA special agent turned health advocate. What’s his take on health claims on food labels? “The best piece of advice I can give is that there is no perfect processed or packaged food. They are what they are, and some are worse than others. Use common sense. If something sounds too good to be true, it probably is.”

Democratic leadership recently introduced the Food Labeling Modernization Act of 2015 (H.R. 4061), which seeks to minimize what they describe as confusing and misleading information that consumers encounter on food packages.

This bill approaches food labeling reform in a comprehensive manner, addressing front-of-package labeling and misleading health claims, and requiring updates to the Nutrition Facts label and the ingredient list. The FDA has proposed revising the Nutrition Facts label to include information about “added sugars,” update serving size requirements, and make calorie and serving size information more prominent. The FDA also recently requested public comment on the use of “natural” on food products.

A section-by-section breakdown of the bill can be found at http://tinyurl.com/ot6wefy.