Front-of-Package Nutrition Rating Systems and Symbols
Phase I Report
Ellen A. Wartella, Alice H. Lichtenstein, and Caitlin S. Boon, Editors
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. 200-2005-13434, Task Order 20, between the National Academy of Sciences and the Centers for Disease Control and Prevention and Contract No. HHSF22320810201, Task Order 12, between the National Academy of Sciences and the Food and Drug Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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Suggested citation: IOM (Institute of Medicine). 2010. Examination of Front-of-Package Nutrition Rating Systems and Symbols: Phase I Report. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
COMMITTEE ON EXAMINATION OF FRONT-OF-PACKAGE NUTRITION RATING SYSTEMS AND SYMBOLS
ELLEN A. WARTELLA (Chair), Professor,
Department of Communication Studies, Northwestern University, Evanston, IL
ALICE H. LICHTENSTEIN (Vice Chair),
Gershoff Professor, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
LINDSAY H. ALLEN, Center Director,
USDA, ARS Western Human Nutrition Research Center, Davis, CA
TRACY A. FOX, Nutrition Consultant and President, Food, Nutrition, & Policy Consultants,
LLC, Washington, DC
MATTHEW W. KREUTER, Professor,
Health Communication Research Laboratory, Washington University, St. Louis, MO
ANUSREE MITRA, Associate Professor,
Kogod School of Business, American University, Washington, DC
FRANCES H. SELIGSON, Consultant,
MARY T. STORY, Professor,
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
CAITLIN S. BOON, Study Director (through August 2010)
ROMY NATHAN, Senior Program Officer
JANET MULLIGAN, Research Associate
LAURA PILLSBURY, Research Associate
SAMANTHA ROBOTHAM, Senior Program Assistant
ANTON BANDY, Financial Officer
GERALDINE KENNEDO, Administrative Assistant
LINDA D. MEYERS, Director,
Food and Nutrition Board
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
KELLY BROWNELL, Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT
NANCY CHAPMAN, N. Chapman Associates, Inc., Washington, DC
JEANNE P. GOLDBERG, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
EDWARD GROTH III, Consultant, Groth Consulting Services, Pelham, NY
JANE E. HENNEY, College of Medicine, University of Cincinnati, OH
REGINA HILDWINE, Grocery Manufacturers Association, Washington, DC
LINDA VAN HORN, Feinberg School of Medicine, Northwestern University, Chicago, IL
CONNIE M. WEAVER, Department of Food and Nutrition, Purdue University, West Lafayette, IN
CHRISTINA ZARCADOOLAS, Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by ELENA O. NIGHTINGALE, Washington, DC, and DIANE FEICKERT BIRT, Iowa State University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
This country is experiencing the highest rates of overweight, obesity, and diet-related chronic diseases in its history, and there is a great emphasis on consumers making healthier food choices. Against the backdrop of a pressing public health crisis, Congress requested an Institute of Medicine study that would examine front-of-package nutrition systems and symbols and the effect that such systems and symbols could have on consumers choosing more nutritious foods.
The committee’s charge was to review front-of-package nutrition rating systems and symbols, identifying the systems developed by manufacturers, supermarkets, health organizations, and governments in the United States and abroad; evaluating the scientific basis of the underlying nutrient criteria; considering the strengths and limitations of various approaches; and planning a second phase of nutrition labeling to consider the consumer aspect of front-of-package systems. In 1990, passage of the Nutrition Labeling and Education Act (NLEA) standardized the way nutrition information is provided to the public by requiring the information to be displayed in the now iconic Nutrition Facts panel and setting criteria for nutrient claims and health claims. This study, undertaken 20 years after passage of NLEA, represents a new phase in the understanding and use of nutrition labeling.
Over a dozen systems have been developed over the years, so this was no small task, but in light of the potential public health benefit that could be achieved with front-of-package nutrition rating systems, it was a worthy one. We are pleased that the assembled committee had the individual expertise and experience as well as the collective will to serve the health of the public and had the willingness to meet the significant challenge of our charge. It was a privilege to be a part of this effort.
Over the course of the study, we met often and consulted many sources. Our first meeting set the tone as we heard from each of our study sponsors. A public workshop elicited needed input and was extremely useful to the committee’s deliberations. Invited speakers and panelists included Mark Andon, Claire Boville, Adam Drewnowski, Mark Kantor, David Katz, Joanne Lupton, Marion Nestle, Jacob Seidell, Kim Stitzel, and Kathy Wiemer. These individuals and others shared their data, perspectives, and experience with us on that day or afterward by input to the project website. Jim Crimmins, Brian Elbel, and Elizabeth Howlett provided valued service as unpaid consultants during the later part of the project as we developed plans for Phase II of the study. Neal H. Hooker resigned from the committee in April 2010; we are grateful for his contributions to our early work.
On behalf of the committee, we extend our deepest thanks to the able project staff: Caitlin Boon, study director (through August 2010); Romy Nathan, senior program officer; Janet Mulligan, research associate; Laura Pillsbury, research associate; and Samantha Robotham, senior program assistant. All gave generously of their talents and time. In addition, the committee would like to thank other members of the Food and Nutrition Board staff includ-
ing Linda Meyers, Food and Nutrition Board director; Anton Bandy, financial officer; Alice Vorosmarti, research associate; and Geraldine Kennedo, administrative assistant, who assisted at crucial times during the project.
The findings and conclusions in this report could not come at a better time. This year has been one of many events and new initiatives drawing even more attention to the current public health crisis of obesity, including First Lady Michelle Obama’s Let’s Move initiative, the anticipated release of the 2010 Dietary Guidelines for Americans, and billions of dollars of government and private investments provided to our local communities in an effort to reverse the epidemic of obesity. To this end, we are grateful to have been able to contribute through this Phase I report to the discussion about the important role of nutrition labeling in these endeavors.
Ellen A.Wartella, Chair
Alice H. Lichtenstein, Vice-Chair
Committee on Examination of Front-of-Package Nutrition Rating Systems and Symbols