Systems and Symbols
Promoting Healthier Choices
Committee on Examination of Front-of-Package Nutrition Rating Systems and Symbols (Phase II)
Food and Nutrition Board
Ellen A. Wartella, Alice H. Lichtenstein, Ann Yaktine, and Romy Nathan, Editors
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
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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 32, between the National Academy of Sciences and the Centers for Disease Control and Prevention, Contract No. HHSF22301021T, Task Order 23, between the National Academy of Sciences and the Food and Drug Administration, and Grant No. CNPP-IOM-11-0001 between the National Academy of Sciences and the U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. 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). 2012. Front-of-Package Nutrition Rating Systems and Symbols: Promoting Healthier Choices. Washington, DC: The National Academies Press.
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INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation, Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering and Medicine
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COMMITTEE ON EXAMINATION OF FRONT-OF-PACKAGE NUTRITION RATING SYSTEMS AND SYMBOLS (PHASE II)
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
JAMES CRIMMINS, Adjunct Professor and Marketing Consultant, Northwestern University, Chicago, IL
BRIAN ELBEL, Assistant Professor of Medicine and Health Policy, New York University School of Medicine and Wagner Graduate School of Public Service, New York, NY
TRACY A. FOX, Nutrition Consultant and President, Food, Nutrition, & Policy Consultants, LLC, Washington, DC
ELIZABETH HOWLETT, Professor of Marketing and Logistics, Sam M. Walton College of Business, University of Arkansas, Fayetteville, AR
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, Hershey, PA
MARY T. STORY, Professor, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
VIRGINIA WILKENING, Alexandria, VA (resigned from committee April 2011)
KELLY D. BROWNELL, Rudd Center, Yale University, New Haven, CT
CHRISTOPHER CASEY, Washington University, St. Louis, MO
LILA RUTTEN, SAIC, Inc., Frederick, MD
MARLENE B. SCHWARTZ, Rudd Center, Yale University, New Haven, CT
AMY SCOTT, UPBrand Collaborative, and Washington University, St. Louis, MO
VIRGINIA WILKENING, Alexandria, VA (as of May 2011)
ANN YAKTINE, Study Director
ROMY NATHAN, Senior Program Officer
JANET MULLIGAN, Senior Program Associate for Research
SAMANTHA ROBOTHAM, Senior Program Assistant
ANTON BANDY, Financial Officer
GERALDINE KENNEDO, Administrative Assistant
LINDA D. MEYERS, Director, Food and Nutrition Board
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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:
Nancy M. Childs, Department of Food Marketing, St. Joseph’s University, Philadelphia, PA
Karen Glanz, Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia
Jeanne P. Goldberg, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
Edward Groth III, Groth Consulting Services, Pelham, NY
Lisa Harnack, School of Public Health, University of Minnesota, Minneapolis
Suzanne Harris, International Life Sciences Institute, Washington, DC
Joanne R. Lupton, Texas A&M University, College Station
Suzanne Murphy, Cancer Research Center of Hawaii, University of Hawaii at Manoa, Honolulu
Marion Nestle, Department of Nutrition, Food Studies & Public Health, New York University, New York
Sarah Roller, Kelley Drye & Warren, LLP, Washington, DC
Bruce A. Silverglade, Washington, DC
Linda Van Horn, Feinberg School of Medicine, Northwestern University, Chicago, IL
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 Diana Birt, Iowa State University, and Elena O. Nightingale, Washington, DC. Appointed by the National Research Council and 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.
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American consumers today enjoy a wide array of food products from which to choose, but they also face a daunting challenge when trying to make healthful food choices. This challenge is exacerbated by the proliferation of front-of-package and shelf tag nutrition rating symbols and systems intended to communicate information about the healthfulness of the food. Not surprising, consumers trying to make choices in a short amount of time among packages cluttered with information and with different nutrition rating systems may have difficulty choosing more healthful products.
During Phase I of the study to examine front-of-package nutrition rating symbols and systems, the committee found that the health risks most strongly associated with diet and affecting the greatest number of Americans are obesity and its associated chronic diseases. The committee also found that Americans consume too many calories, saturated and trans fats, and added sugars, and too much sodium; leaving other important nutrients at risk for inadequacy. Given these findings, the Centers for Disease Control and Prevention (CDC) with additional support from the Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services and the Center for Nutrition Policy and Promotion (CNPP) of the U.S. Department of Agriculture asked the committee to carry out Phase II of the study to consider the benefits of a single, standardized front-label food guidance system; assess which icons or symbols would be most effective with consumers; and develop recommendations about the systems and icons that best promote health and ways to maximize their use.
The Phase II committee consisted of the Phase I committee members and three new members, Jim Crimmins, Brian Elbel, and Elizabeth Howlett. The committee conducted an extensive review of both peer-reviewed and non-reviewed evidence. It also conducted a public workshop to gather information from experts outside the committee and to hear from stakeholders. Invited speakers included Chung-Tung Jordan Lin and Alan Levy from the FDA; Kelly Brownell from the Yale University Rudd Center; Regina Hildwine from the Grocery Manufacturer’s Association and Marianne Smith-Edge from the International Food Information Council; Christina Zaradoolas from Mount Sinai School of Medicine; John Kozup from Villanova University; and Christine Johnson from the New York Department of Health. In addition, interviews with representatives from the food manufacturing industry were carried out, and the committee engaged several consultants. Kelly Brownell, Marlene Schwartz, and Lila Rutten served as unpaid consultants to assist the committee in interpreting the evidence. Christopher Casey and Amy Scott developed exemplar graphic representations of front-of-package symbol systems. The contributions of the workshop speakers, industry representatives, and the consultants were invaluable to the committee in guiding
its discussions and developing recommendations. On behalf of the committee, I would like to thank them for their excellent work.
I would also like to express my gratitude to the committee members, whose tireless efforts and determination made this report possible. The committee is also grateful to the Institute of Medicine study team: Ann Yaktine, study director; Romy Nathan, senior program officer; Janet Mulligan, Research Associate; Samantha Robotham, senior program assistant; Geraldine Kennedo, administrative assistant; and Anton Bandy, financial officer. I am especially grateful to Linda Meyers, director of the Food and Nutrition Board, who provided guidance to the committee throughout both study phases.
The committee’s findings about the current food package environment, together with evidence that consumer food choice behavior has not changed in spite of a myriad of front-of-package nutrition rating systems, clearly suggest that the time has come for a paradigm shift from information-based nutrition rating systems to one that encourages consumers to make more healthful food choices and purchasing decisions. The committee’s recommendations are presented as guidance to the study sponsors in developing a front-of-package symbol system that is easily understood and maximizes the opportunity to better inform and guide consumers’ toward more healthful food choices.
Ellen A. Wartella, Chair
Alice H. Lichtenstein, Vice-Chair
Committee on Examination of Front-of-Package
Nutrition Rating Systems and Symbols (Phase II)
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Boxes, Figures, and Tables