FDA proposes front-of-package requirement to curb unhealthy diets causing chronic diseases

The US FDA is proposing a mandatory front-of-package (FOP) labeling system to provide consumers with clear and accessible nutrition information and prevent diet-related chronic diseases. Nutrition Insight speaks to the Center for Science in the Public Interest (CPSI), which lauds the agency’s effort but advocates for more impactful “high in” warnings used internationally.

The FDA says the Nutrition Info box will inform consumers whether packaged foods contain low, medium or high saturated fat, sodium and added sugars. Americans overconsume these components, which have been linked to conditions such as heart disease and type 2 diabetes.

“The science on saturated fat, sodium and added sugars is clear,” says FDA Commissioner Robert Califf, M.D. “Nearly everyone knows or cares for someone with a chronic disease that is due, in part, to the food we eat.”

“It is time we make it easier for consumers to glance, grab and go. Adding FOP nutrition labeling to most packaged foods would do that. We are fully committed to pulling all the levers available to the FDA to make nutrition information readily accessible as part of our efforts to promote public health.”

However, the National Fisheries Institute (NFI) is asking the Trump administration to change FDA FOP requirements.

“By focusing on negative saturated fats, the FDA misses the point and misleads label readers. Fish, such as salmon, contain almost entirely unsaturated essential omega-3s, the healthiest fatty acids found in any protein,” protests NFI CEO Lisa Wallenda Picard in a statement.

“Meanwhile, the planned labeling provides no way to highlight nutritious components of the product, including for fish, the unsaturated fats associated with brain and heart health.”

Reshaping consumer habits

Chronic diseases are the leading cause of disability and death in the US, with 60% of Americans having at least one chronic disease.

Sixty percent of Americans have at least one chronic disease.“In addition to our goal of providing information to consumers, it’s possible we’ll see manufacturers reformulate products to be healthier in response to FOP nutrition labeling. Together, we hope the FDA’s efforts, alongside those of our federal partners, will start stemming the tide of the chronic disease crisis in our country,” says FDA deputy commissioner for Human Food, Jim Jones.

According to FDA research, including a 2023 study involving nearly 10,000 adults, black-and-white labels with the percent Daily Value helped consumers make faster and healthier food choices.

However, Aviva Musicus, ScD Science director of public health at CPSI, tells us that including symbols, such as exclamation marks, can enhance visibility.

The policy could reshape consumer habits and incentivize healthier food formulations if finalized. Musicus meets with us to discuss label design for consumer awareness and what needs to happen before the proposal can be implemented.

Why does CSPI think “high in” labels work better than “traffic light” labels for avoiding unhealthy foods?
Musicus: The FDA’s proposed FOP labeling system is a real step forward in better informing consumers, and it has great potential to help people make healthier choices and cut back on salt, added sugar and saturated fat. Ideally, however, the administration would have selected a “high in” nutrient warning format that aligns more with labels driving positive change in other countries. “High in” and “traffic light” labels have been tested in extensive experimental research and implemented in different countries. A 2021 systematic review and meta-analysis of experimental studies comparing “high in” nutrient warnings and traffic light labels found that nutrient warnings were more effective for most outcomes related to improved nutritional quality of food purchases. Real-world evidence confirms that nutritional warnings lead to healthier food purchases, whereas traffic light labels have shown less promise.

The new labels are black and white, not color-coded like systems in other countries. Will this make them less clear or effective?
Musicus: Other countries like Chile require black-and-white FOP nutrient labels that tend to use attention-grabbing symbols, like stop signs. These labels have been successful at helping consumers choose healthier foods and encouraging the food industry to provide consumers with healthier options. FDA’s proposed label does not have any icons or symbols, but an exclamation mark icon or something similar could help shoppers pay attention to these labels when selecting food.

Will this proposal push companies to make healthier products? How do you expect new labels to fix the health crisis?
Musicus: Evidence from experimental studies and real-world evaluations have shown that FOP labels can encourage the food industry to provide consumers with healthier products.

Black-and-white labels with the percent Daily Value helped consumers make faster and healthier food choices, finds the FDA.FOP labeling is just one of the many tools we need to employ to address our country’s chronic disease crisis. Still, transparency is an important first step for equipping consumers with the information they need. 

What needs to happen to ensure this rule gets approved and implemented, even if there is opposition?
Musicus: The FDA’s proposed rule will be open for comment for 120 days through May 16, 2025. To overcome industry opposition, the FDA needs to hear why this policy is important from consumer and public health groups, researchers, and consumers. We need strong FDA leaders who are committed to science and public health for a strong final rule on FOP labeling. 

Boosting nutrition security

The proposal is part of the White House National Strategy on Hunger, Nutrition, and Health, which aims to reduce diet-related diseases by 2030.

Last month, in a hearing before House and Senate Committees and Subcommittees, Califf and deputy commissioner for human foods, Jim Jones, testified on the FDA proposal for mandatory labels for diabetes and obesity on healthy F&B.

The agency suggested that FOP nutrition labeling complement the Nutrition Facts label to impact purchase-making decisions.

For the first time in 30 years, the FDA is overhauling the definition of “healthy” to align with current nutrition science. The FDA hopes this will help consumers identify nutritious foods through labels and motivate manufacturers to reformulate products. 

Meanwhile, the agency developed a “Long-Term National Strategy to Increase the Resiliency of the US Infant Formula Market” with action points and updated information for stakeholders. 

In research updates, a UK study suggests food calorie labeling could lead to “potentially meaningful impacts” on population health. After reviewing 25 randomized control trials, the team found that calorie labeling led to small reductions in calories selected (1.8%) and consumed (5.9%).