First, there were nutrition labels. Then came nutrition claims, which point to a food's particular nutrition property.1 Now, in an attempt to simplify food products' nutritional qualities even more for consumers, a variety of nutrition symbols and nutrition labeling systems are being developed by health experts, grocery stores, and food manufacturers. This article reviews these nutrition labeling systems to help diabetes dietitians and other health care providers help their clients maximize their use of these systems to make healthier food choices.
Nutrition labeling is based on the premise that providing consumers more information can help them understand the nutrient content of foods, which will lead them to improve their purchase decisions and eat a healthier diet.2-5 Consumers prefer nutrition labeling that is easy to interpret and use.6
Although the appearance of calories and number of servings on a food label may seem straightforward to the average consumer, it is still complex; consumers struggle to make sense of calories in the context of individual differences of energy expenditure6 and number of calories in a portion.7 Nutrition information can also be confusing when it comes to specific nutrients, as is the case with fats. Although knowledge about trans fats has reached a similar level as knowledge about saturated fat and resulted in improved self-reported behaviors related to grocery shopping, consumers still struggle to properly identify food sources of trans fats.8
As a result of consumer confusion, organizations are trying to create new ways to help consumers weave through the maze of nutrition information at the grocery store. Although the expectation is that these new labeling systems will help consumers purchase and eat more nutritious foods, there is no clear evidence to date of their positive effect on the improvement of dietary patterns.5 Table 1 (starting on p. 60) summarizes current nutrition labeling systems.
Nutrition Labeling Systems
Currently, no nutrition labeling system has been approved or endorsed by the U.S. Food and Drug Administration (FDA) or any other government agency. The FDA has taken a watch-and-wait stance on this topic. Basically, there are two types of systems that have been developed—fact-based and criteria-based. Each will be briefly described here.
The fact-based nutrition labeling systems are the ones that restate some of the facts listed on the nutrition label, such as amount of calories, protein, and carbohydrates and their respective percentage of daily value per serving. Manufacturers such as General Mills and Kellogg's have used front-of-pack nutrition labeling programs in recent years.
The criteria-based nutrition labeling systems categorize foods into their own chosen criteria, which can be as simple as “low calorie” or “good source of fiber” or as complex as an algorithm that takes into consideration a variety of nutrients at the same time to generate one score for each food. For example, each item may be given a score of 1-100.
Most likely, consumers do not understand the difference between these fact- or criteria-based nutrition labeling systems. And to make the situation even a bit more confusing for consumers, grocery stores such as Hy-Vee (Midwest), Price Chopper (Northeast), and Supervalu are adopting their own variations of the criteria-based scoring system on their shelves (Table 1). Although some criteria-based nutrition scoring systems are very transparent regarding the criteria used, others are not, and this makes it hard for consumers and even food manufacturers to know how to interpret the criteria.
Because “foods can no longer be evaluated only in terms of macronutrient and micronutrient content alone,”9 the question remains: are all these nutrition labeling systems evidence-based and efficient enough to properly guide consumers in search of health?
Developers of the Guiding Stars nutrition labeling system (Table 1) used at Hannaford Bros., Bloom, Food Lion, and Sweetbay stores report that customer recognition of their program has surpassed 80% in many markets, and sales of items awarded stars were outselling nonstarred items in most areas of the stores.10 However, the efficiency of these new labeling systems in improving people's purchasing and eating behaviors has not yet been studied.
Consolidation of manufacturer symbols
Some nutrition symbols and systems currently seen in the grocery store will no longer exist; Unilever's Choice Program, Sensible Solution, and PepsiCo's Smart Choices Made Easy are being consolidated into one new criteria-based nutrition labeling system called the Smart Choices Program. This program is part of a coalition composed of large food companies, retailers, health organizations, trade groups, and other industry organizations, as well as government agencies and other organizations such as universities, and coordinated by the Keystone Center, a nonprofit organization specializing in coalition-based public health solutions. Unilever's Choices Program had already been created with nutrition criteria developed by scientific committees and is scheduled to be reviewed every 2 years.11 The same approach is being used for the new consolidated Smart Choices Program.
Smart Choices Program. The Smart Choices Program is a new front-of-pack nutrition labeling system introduced in the summer of 2009. The program started on a limited number of products and will expand to a larger number of products from a variety of food manufacturers in the fall of 2009. Front package panels of participating products bear a symbol that looks like a green checkmark and the words “Smart Choices Program—Guiding Food Choices,” as well as the number of calories per serving and number of servings per container.
The specific qualifying nutrition criteria developed for 19 different product categories is based on the Dietary Guidelines for Americans, FDA standards, reports from the Institute of Medicine, and other sources of dietary guidance consensus. The nutrition criteria used are designed to be flexible and adaptable to allow for updates according to emerging scientific information.
For the benefit of consumers, this program aims to provide a simple, uniform, and recognizable means of determining products' calorie information and number of servings per package. It may assist consumers in identifying more nutritious choices within food categories, according to consumer tests. However, studies have not been conducted on how well consumers will understand this program or how it will ultimately affect consumer's food consumption.
Currently participating food companies and retailers who intend to use the program include Coca-Cola (U.S.), ConAgra Foods, General Mills, Kellogg Company (U.S.), Kraft Foods, PepsiCo (U.S.), Unilever (U.S.), Wegmans, and WalMart. Other companies may be joining soon. These companies are pleased that their dedicated work toward building a consensus for a symbol and nutrition criteria is finished and has resulted in a uniform system that will be used across many of their products. The system replaces several earlier programs, including Sensible Solutions (Kraft), Smart Spot (PepsiCo), Nutrition at a Glance (Kellogg's), Nutrition Highlights (General Mills), and Eat Smart, Drink Smart (Unilever).
NuVal (previously named Overall Nutritional Quality Index). The NuVal system was created by a team of recognized medical and nutrition experts led by David Katz, MD. This criteria-based system gives foods a score on a scale of 1-100 (the higher the score, the higher the nutritional value), allowing food products to be compared within and across food categories. The score is based on an algorithm that considers 30 nutrients, looking at “nutrients to encourage” (such as fiber and omega-3 fatty acids) and “nutrients to avoid,” such as saturated fat and sodium. The NuVal score is currently being implemented by two grocery store chains, Hy-Vee and Price Chopper, only at selected stores and on selected product categories in 2009.
Nutrition IQ program. The Nutrition IQ program was designed by the Supervalu grocery store chain with experts from the Joslin Diabetes Center. It will be available nation-wide at Supervalu's grocery stores, which include Acme, Albertsons, Bigg's, Cub Foods, Farm Fresh, Hornbacher's, Jewel-Osco, Lucky, Shaw's/Star Market, Shop'n Save, and Shoppers Food & Pharmacy.
This program uses nutrient content claims filed with the FDA as a framework to determine whether a product meets the threshold criteria and which shelf tag the product can receive, according to the products' top one or two nutritional benefits. The threshold criteria are as follows: limited amount of sodium, saturated fat, and, in some categories, sugar. For this reason, the following categories are excluded: bottled water and soft drinks, candy/gum/mints, coffee and tea, cookies, dietetic foods, ice, ice cream, salts and spices, shelf-stable juice, shortenings and oils, soft drink mixers, syrups, molasses, and baby foods.
Other programs. Other labeling systems, including Guiding Stars, Healthy Ideas, Whole Grain Council Stamp, Heart Check Symbol, Mars International's Guideline Daily Amounts (GDA) labeling, Sara Lee's Nutritional Spotlight GDA labeling, and United Supermarket's Nutritional Tag Program, also exist and are described in Table 1.
Marketing or Health Promotion?
The debate continues about whether these programs are merely self-promoting strategies for the food companies and retailers involved in them or will actually increase nutrition knowledge and ultimately improve the eating behaviors of the general population. Health professionals on all sides of this debate will be watching how consumers react to and use these programs and whether they eventually change their purchasing and eating habits as a result of them.
For now, health professionals need more guidance and resources to effectively educate consumers about how best to use these programs to improve their purchasing and eating habits. Eventually, evidence will be required about the ability of these nutrition labeling initiatives to positively influence consumers' eating behavior.
Editor's Note: In October 2009, the Food and Drug Administration (FDA) issued a statement to industry on nutrition-related front-of-package and shelf labeling, indicating that these systems are subject to FDA regulations (i.e., the U.S. Food, Drug, and Cosmetic Act and regulatory criteria for nutrient content claims). The FDA also noted that it is forming a committee to evaluate current systems and make recommendations for companies using these systems. After the FDA statement, the Smart Choices Program announced that it would voluntarily postpone active operations and not encourage wider use of the logo at this time by either new or currently enrolled companies. No other companies had issued similar statements at the time of this publication.
Editor's Note: Table 1 for this article begins on p. 60.
