The prevalence of chronic health conditions such as diabetes, heart disease and obesity have dramatically increased over the last decade, which in turn has increased health care costs. During the same time, studies revealed that the true culprit of these chronic conditions were not fats, as originally thought in the 1980s, but rather sugar. In 2004, a study published in the Journal of American Medical Association (JAMA), found that the risk of developing Type 2 diabetes rose with the consumption of sugar-sweetened beverages. A 2010 study also published in JAMA found that sugar significantly raised the risk for cardiovascular disease mortality. These studies were among many that demonstrated the negative impact of sugar on health. Yet there was little response from the food industry and the U.S. Food and Drug Administration (FDA). Perhaps the slow response was due to the misstep in placing the blame on fats, or maybe because added sugar is such an integral part of the American diet that officials worried about public backlash or decreased profits in the food industry.
Regardless, the FDA has finally taken a step toward decreasing the amount of sugar intake in the American diet by revising the nutrition labels. The first phase in behavior change theory is knowledge, and research suggests that at least 50 percent of illnesses can be attributed to personal behaviors. The revised nutrition labels will now give the public the information needed to make informed food choices, i.e., to change the behaviors that negatively impact their health. Among other things, the revised nutrition labels will now denote calories in larger, bold print; adjust the serving sizes to reflect the amount Americans normally eat; and list the amount of added sugars, along with the percentage the listed sugar amount makes up of the recommended daily diet. These changes reflect current dietary guidelines, scientific evidence and position statements by several medical organizations, including the American Academy of Pediatrics.
Yet will people actually read the labels? There is evidence to suggest that most people do not read the current nutrition labels, and those that read them don’t understand them. While the changes may increase comprehension, will they also make people want to read them? Likely not. There must be buy-in from the public that this information is important — that measuring and therefore limiting sugar intake and calories will directly impact their health, more than any magic pill.
Obtaining buy-in from the public on the importance of changing personal behaviors to improve health is vital to decreasing the amount our nation spends on health care. According to the Centers for Medicare & Medicaid Services, $3 trillion was spent on health care in 2013. In 2010, chronic diseases made up approximately 86 percent of health care costs, according to the Centers for Disease Control and Prevention, and that number has likely increased since then. While access to care, innovative treatments and technologies and end of life care are all important policy issues, helping the public understand, and then adopt, healthy eating behaviors could save billions of dollars.
The FDA responded to solid research demonstrating that sugar increases the risk of developing chronic conditions, such as diabetes and heart disease, which is the first step to creating good health policy. Yet the work cannot stop there. Policy changes based on sound research must occur at every level, with the ultimate goal of changing health behaviors. There is much debate about whether food behavior policies should be prohibitive, or create disincentives for sugary foods or incentives for consuming healthier foods. More research on the effectiveness of these policies is needed to determine the best approach. Moreover, the public needs to be engaged in these discussions. Effective policy cannot be created in a vacuum — those who are most affected by these policies need to be engaged in the research and decision-making process, not just through open comment on a federal website, but through real, active engagement with communities, from the least educated to the most. With buy-in from the community, more people will likely use the nutritional information provided to change their health behaviors. The changes to the nutrition label do not take effect until 2018, but we can start now by actively engaging the general public in policy discussions surrounding the impact of food on health.
Quianta Moore is the Baker Institute Scholar in Health Policy. Her research focuses on developing empirically informed policies to advance the health of children as well as access to care in vulnerable populations through school-based clinics, telehealth and health education.