The Heart Check Symbol – one of the first front-of-pack nutrition labels – was created by the American Heart Association in 1995. The idea was to give people a quick visual cue as to foods that were low in saturated fat and cholesterol. Unfortunately, the sugar count was not considered. And thus, ridiculously sweet and unhealthy foods started to appear with the heart check symbol.

No more, says an AHA spokesperson:

The association advocates limiting the amount of discretionary calories in the diet which come from added sugars. Since desserts are a significant source of added sugars, we have elected to close the dessert category to further certification.”

What you need to know:

This is a good development.

Endorsements on food products by respected health organizations are a double edged sword. On one hand, the AHA wanted to promote healthier eating habits. But on the other hand it began to develop a tidy little revenue stream, charging companies thousands of dollars per product endorsement.

That creates an unnecessary tension that could potentially cause the criteria for heart healthy food to be lower than if no money was being paid. Not saying that this is what happens, but it could.

In general, nutrition labeling that is not regulated by the FDA is an opening for various tricks, shenanigans, and nutrition voodoo. Instead of contributing to healthier consumer choices, such labels may actually achieve the opposite.

What to do at the supermarket:

Your best bet is NOT to rely on front-of-pack labels or other health claims, and head straight to the ingredient list and nutrition facts panel. Granted, it’s more time consuming and requires effort, but if you need help – we’re here to provide advice.

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The American Heart Association wants you to be healthier. And in a new, online campaign, dubbed My Life Check, the organization is introducing 7 factors that will help you live longer:

1. Stop smoking
2. Get active
3. Lose weight
4. Eat better
5. Manage blood pressure
6. Control cholesterol
7. Reduce blood sugar

No big surprises in the list. Smoking is a killer that everyone acknowledges. Most of us live a sedentary lifestyle and would do better to get physical activity into the daily routine. Losing weight and eating better seem like the same thing at first, but are not necessarily so. To lose weight you just need to cut calories, but that does not mean you are eating healthfully. Case in point, the recent Taco Bell Drive Thru Diet, where a young lady lost 50 pounds by eating at a fast food establishment. Eating better means incorporating nutrient dense foods into the lowered number of calories you are consuming as part of your diet. Nutrient dense foods are fresh fruits and vegetables, whole grains, lean cuts of meat, legumes, and dairy products.

These first 4 activities can be handled by yourself, with help and advice from registered dietitians to create a weight loss plan that fits your personal needs.

The last 3 suggestions in the list require a visit to the doctor’s office for a checkup and some tests (blood pressure, cholesterol, blood sugar), something we should do once a year if we’re healthy and young, and more often if not.

The program is sponsored by the “Pharmaceutical Roundtable”, which in the AHA’s words is:

the first roundtable in the pharmaceutical industry and one of the most exciting developments in cardiovascular research in recent years. This innovative forum provides an opportunity for an ongoing exchange of ideas and information between our medical leaders and those from prestigious pharmaceutical companies.

All the big pharma companies are members and will be more than happy to provide you with pills, shots, and treatment plans to help you get better.

Other features of the program include an online quiz you can take to assess how you are faring in each of the seven steps to a healthier heart.

What to do at the supermarket:

It’s much cheaper for you, not to mention healthier, not to be in a position to need the help of the pharmaceutical industry. You don’t want to get to the stage where drugs are what keep your heart healthy. So start making smart food choices NOW, for yourself, and even more importantly, for your children.

Our usual basket of advice includes buying mostly unprocessed products and preparing meals and snacks at home. When you do buy prepared foods, a short ingredient list is usually a sign of a better product for you. Try to ignore front of package health claims and marketing speak, because in many cases they only present half the truth – a low fat product may be very high in sugar to compensate.

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This is a guest blog-post by  Professor Timothy D. Lytton

In my previous post, I suggested that regulation of front-of-package nutrition labels should begin with better enforcement of existing standards. Existing regulations, I argued, already provide adequate tools to clamp down on misleading labels. I focused on the three most common types of front-of-package nutrition labels: (1) those that provide simple quantitative statements, (2) those that rate individual nutrients, and (3) those that present seals of approval. In this post, I suggest how existing standards might be further developed to regulate a fourth type of front-of-package label.

Rating Overall Nutritional Value: Guiding Stars & NuVal

The fourth type of front-of-package nutrition label rates the overall nutritional value of foods. For example, Hannaford Brothers’ Guiding Stars label rates foods on a scale of zero to three stars and the NuVal Nutritional Scoring System rates foods on a scale from one to one hundred.

The FDA could build on its existing regulations concerning the use of “healthy” claims to develop multiple threshold definitions for overall nutritional value, for example providing three threshold definitions that would create a four-point scale: (1) foods below the bottom threshold, (2) foods between the bottom and middle thresholds, (3) foods between the middle and top thresholds, (4) and foods above the top threshold. This could be accomplished by adding further gradation to the current FDA definition of “healthy,” as the agency has already done for some single nutrient claims (for example, “low sodium,” “very low sodium,” and “sodium free.”).

Thus, food ratings in a scheme like Hannaford Brothers’ Guiding Stars would have to meet the corresponding FDA threshold definitions—a food labeled with three stars would have to meet the FDA’s top threshold definition, a food labeled with two stars would have to meet the FDA’s middle threshold definition, and so on. For schemes with a higher level of gradation, like NuVal’s one to one-hundred ranking, the FDA could use the same four-point scale. Foods rated by NuVal in the top quartile (100-76) would have to meet the FDA’s top threshold definition, foods in the NuVal second quartile (75-51) would have to meet the FDAs middle threshold definition, and so on. Calibrating nutrient profile rating schemes to graduated FDA definitions of relative overall nutritional value, using the definition of “healthy” as a starting point, would provide consistency among schemes based on the federal government’s dietary guidelines and health recommendations.

This means of regulation would also allow for variation among schemes in terms of gradation and rankings. Those who design nutrient profile labeling schemes could experiment with greater and lesser levels of gradation, and rankings could vary so long as they met or exceeded minimum FDA threshold levels. The purpose of my proposal to formulate a four-tiered definition of “healthy” is not to create an FDA nutrient profile rating system to displace private-sector rating systems like Guiding Stars or NuVal. The purpose is merely to provide an easily understandable system of minimum thresholds to prevent abuse. Thresholds should be set in such a way as to prevent high ratings for foods of low nutritional value—like Froot Loops—while allowing for variation in different approaches that are consistent with these minimum thresholds. This regulatory approach does not interfere with private sector efforts to develop more complex nutrient rating schemes, so long as those schemes satisfy minimum standards that prevent ratings that are false or misleading.

In a subsequent post, I will discuss why FDA imposition of a uniform, mandatory front-of-package labeling system—as proposed by the Center for Science in the Public Interest—might not be the best regulatory approach.

Timothy D. Lytton is the Albert and Angela Distinguished Professor of Law at Albany Law School where he teaches regulatory law & policy, constitutional law, administrative law, and tort law. His article “Signs of Change or Clash of Symbols? FDA Regulation of Nutrient Profile Labeling” (forthcoming in Health Matrix, vol. 19, no. 2) is available online by clicking here. He is also working on an article about regulation of nutrition standards for school food. For more information, visit his Albany Law School faculty website.

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This is a guest blog-post by  Professor Timothy D. Lytton

At the top of the FDA’s agenda for 2010 is regulating front-of-package nutrition labels.

Proponents of symbols like the Heart Check mark and the Smart Choices logo and rating systems like Guiding Stars and NuVal argue that they offer a quick way to help consumers identify foods that contribute to a healthy diet. Critics allege that the labeling schemes are confusing and misleading and have called for stricter government regulation. The Center for Science and the Public Interest (CSPI) recently released a report advocating that the FDA to develop a uniform, mandatory front-of-package labeling system.

But before the FDA gets into the business of creating its own front-of-package labeling scheme, it should first consider how existing regulations could be used to clamp down on misleading front-of-package labeling information. Better use of existing regulations would be a prudent first step in reigning in the current front-of-package free-for-all.

The FDA has promulgated extensive regulations governing the use of nutrient content claims on food labels—claims describe the level of a nutrient in a food. FDA regulations distinguish several different categories of nutrient content claims, and most front-of-package nutrition labels fall into one of three categories.

1. Simple Quantitative Statements: The Nutrition Highlights Panel

Some front-of-package nutrition labels present nutrient information in the form of simple quantitative statements concerning the amount of one or more nutrients in the food. General Mills’ Nutrition Highlights panel is an example of this type of label.

Existing FDA regulations allow for simple quantitative statements provided that they are accurate.

2. Rating Individual Nutrients: The Traffic Light Label

A second type of front-of-package nutrition label rates the level of individual nutrients on a scale. The British Food Standards Agency (FSA) traffic light label provides an example.

Under FDA regulations, any label claim that employs descriptive terms to characterize the level of a nutrient, such as “low in sodium” or “high in fiber,” may be made only for nutrients for which FDA has established a Daily Value (DV), may be used only if the food meets specified threshold requirements for the nutrient, and may employ only descriptive terms approved by the FDA. For example, a tub of yoghurt labeled “high in calcium” must contain at least twenty percent of the DV of calcium per 225 grams of yoghurt. Any front-of-package label that rates individual nutrients must conform to these strict guidelines. (Note: A daily value for sugar has not been established by the FDA.)

3. Seals of Approval: The Heart Check Mark & The Smart Choices Logo

A third type of front-of-package nutrition label combines analysis of nutrients to suggest that a food satisfies some minimum standard of overall nutritional value, such that it contributes to a healthy diet. The American Heart Association (AHA) Heart Check mark is an example.

The AHA explains on its website that the underlying nutrient criteria for the label are based on the Association’s dietary recommendations which it explains are consistent with federal dietary guidelines and health recommendations. The mark is intended to convey that a food is of high nutritional value by these standards.

Symbols like the Heart Check mark are functionally equivalent to label claims that a food is “healthy.” Under FDA regulations, foods labeled “healthy,” or any derivative of the term such as “healthier” or “healthful,” must not exceed specific thresholds of fat, saturated fat, sodium, and cholesterol and must contain requisite amounts of other nutrients such as vitamin A, vitamin C, calcium, iron, protein, and fiber, depending upon the food. “[T]he purpose of the ‘healthy’ claim,” explains the FDA, “is to highlight those foods that, based on their nutrient levels, are particularly useful in constructing a diet that conforms to current dietary guidelines.” This is precisely what symbols like the Heart Check mark are intended to convey, and this is how consumers understand them. They should, therefore, be required to meet FDA standards for “healthy” claims.

Some front-of-package nutrition labels place symbols of approval on products within a food category that have comparatively better overall nutritional value, although they may be foods of low nutritional value. The symbol is meant to indicate not that a food is healthy in the absolute sense but merely healthier in a relative sense. For example, the Smart Choices logo has appeared on cereals such as Cocoa Krispies and Froot Loops based on their relatively lower sugar content when compared to other highly-sweetened children’s cereals.

FDA regulations prohibit this type of relative healthy claim, explaining that,

“[t]he usefulness of a food labeled ‘healthy’ is not based on how it compares to a similar food, but on how it contributes to achieving a total diet consistent with dietary recommendations.”

Foods that are healthy only in a relative sense do not contribute to a total diet consistent with dietary recommendations and are, therefore, misleading. Under existing FDA regulations, front-of-package labeling schemes that make this type of relative “healthier” claim should be prohibited.

In a subsequent post, I will address how the FDA could further develop its regulations governing the use of healthy claims to regulate more complex front-of-package labels that rate the overall nutritional value of foods.

Timothy D. Lytton is the Albert and Angela Distinguished Professor of Law at Albany Law School where he teaches regulatory law & policy, constitutional law, administrative law, and tort law. His article “Signs of Change or Clash of Symbols? FDA Regulation of Nutrient Profile Labeling” (forthcoming in Health Matrix, vol. 19, no. 2) is available online by clicking here. He is also working on an article about regulation of nutrition standards for school food. For more information, visit his Albany Law School faculty website.

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The American Heart Association has just published a report on sugar consumption [PDF] in its Circulation Journal. Not surprisingly, Americans are consuming way too many teaspoonfuls of ADDED SUGAR in our diet.

How much? 22 teaspoons worth on average!

If you think that’s not typical, just add up a  breakfast cereal (3 teaspoons),  lowfat strawberry yogurt (3 teaspoons), one can of soda pop (8 teaspoons), 3 teaspoons for three cups of coffee during the day, and a serving of ice cream for dessert (4 teaspoons). You’ll have reached a similar amount. And that’s not counting natural sugars.

Added sugar is found in refined and processed foods such as snacks, breakfast cereals and soft drinks. Sugar is also naturally found in fruits, vegetables, and dairy products. And though our body reacts to sugar pretty much the same way no matter the source, when we eat fruits we also get the benefits of vitamins, minerals, antioxidants, and fiber that helps us feel fuller, longer.

The by the AHA is interesting because traditionally the organization has endorsed some sugary foods as heart healthy. Companies have paid, and still pay, to get the AHA symbol on products that are low-fat, regardless of their sugar content. It’s good deal for both sides – the AHA gets much needed funds, and the companies get an “objective” approval of their product’s nutritional value.

Perhaps now the AHA will take a more holistic approach to is endorsements, and stop recommending foods that have taken out the fat but added sugar as compensation. Removing one “bad” nutrient and replacing it with another “bad” one has not done consumers any good. Just ask the 24 million diabetics and 1 million additions each year.

The nutrition panel on food products displays the total amount of sugar in a serving. Unfortunately it doesn’t tell us how much is naturally present and how much has been added. In some categories such as cereals, pastries, and sweet snacks, you can bet that most of the sugar, if not all, is not naturally present.

The FDA would do wisely to require added sugar to appear as a separate line in the nutrition panel. Until then, we’ll have to guess.

What to do at the supermarket:

The less processed a food, the less added sugars. Consuming sugars from natural sources such as fruits is excellent and tasty.

Most people, by just quitting soft drinks and drinking coffee straight, can drastically cut their refined sugar intake.

Leave the few teaspoons of added sugar to a nice scoop of ice cream over a fresh hot brownie.

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We recently wrote about the soup war raging between Campbell’s and Progresso. Could the following be another battle for consumer mindshare?

Campbell Soup Company has reformulated its product line specifically for schools, lowering salt and fat content to meet the nutrition standards of an alliance set up to fight childhood obesity. Campbell Soup Company announced this week that their Foodservice division will provide healthier reformulated soups and snacks to schools. Some soups got cheaper too. Here’s a rundown of the healthier products:

* lower-sodium Campbell’s Chicken & Stars soup
* lower-sodium versions of Campbell’s Vegetarian Vegetable Alphabet
* Campbell’s Mega Noodle soup
* four varieties of Campbell’s Healthy Request soups
* Goldfish Snack Crackers in Cheddar, Parmesan and Whole Grain Cheddar
* Flavor Blasted Goldfish Snack Crackers in Kickin’ Ranch and Hot and Spicy Cheddar
* Giant Goldfish Grahams in Chocolate and Cinnamon
* Goldfish Physedibles(R) Animal Crackers in Strawberry, Lemon and Vanilla

According to Campbell’s, The reformulation meets nutrition standards of the Alliance for a Healthier Generation – a partnership of the American Heart Association and The William J Clinton Foundation (President Clinton) – which is fighting childhood obesity. The soups have less than 480mg of sodium per serving (at the supermarket sodium levels can be twice as high). And of course, no MSG.

What to do at the supermarket:

Unfortunately these 50oz supersize soup packs are only sold to schools and organizations. Hopefully Campbell’s will expand their health drive to adults as well. At the supermarket, do look for low sodium alternatives when visiting the soup aisle. And if you can, try to make your own soup at home, where you control how much salt goes in.

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Updated: October  2009. Original version published in November 2008.

In the early 13th century, the king of England proclaimed the first food regulatory law, the Assize of Bread, which prohibited bakers from mixing ground peas and beans into bread dough. Ever since, it has been a cat and mouse game between the food industry and the public (fast forward to China 2008 – cheap poisonous melamine in milk powder). In the US, food regulation dates back to early colonial times. Here is a brief overview of the last 150 years of government and industry food regulation:

1862 President Lincoln launches the Department of Agriculture and the Bureau of Chemistry, the predecessor of the Food and Drug Administration.

1906 The original Food and Drugs Act is passed. It prohibits interstate commerce in mis-branded and adulterated foods, drinks and drugs.

1906 In the aftermath of “The Jungle” by Upton Sinclair, which detailed the horrendous sanitary and working conditions in the meatpacking industry, the Meat Inspection Act is passed.

1924 The Supreme Court rules that the Food and Drugs Act condemns every statement, design, or device on a product’s label that may mislead or deceive, even if technically true.

1938 A revised and expanded Federal Food, Drug, and Cosmetic (FDC) Act of 1938 is passed. Highlights include: safe tolerances to be set for unavoidable poisonous substances, standards of identity, quality, and fill-of-container to be set for foods, and authorization of factory inspections.

1939 First Food Standards issued (for canned tomatoes, tomato purée, and tomato paste).

1949 FDA publishes guidance to industry for the first time, called “Procedures for the Appraisal of the Toxicity of Chemicals in Food,” (aka the “black book”)

1950 Oleomargarine Act requires prominent labeling of colored oleomargarine, to distinguish it from butter. (Yes, swindlers tried to sell folks cheap margarine in the guise of butter.)

1958 Food Additives Amendment enacted, requiring manufacturers of new food additives to establish safety. Going forward, manufacturers were required to declare all additives in a product.

1958 FDA publishes the first list of food substances generally recognized as safe (GRAS).

1962 President Kennedy proclaims the Consumer Bill of Rights. Included are the right to safety, the right to be informed, the right to choose, and the right to be heard.

1965 Fair Packaging and Labeling Act requires all consumer products in interstate commerce to be honestly and informatively labeled, including food.

1971 Artificial sweetener saccharin, included in FDA’s original GRAS (generally recognized as safe) list, is removed from the list pending new scientific study.

1973 California Certified Organic Farmers (CCOF) is formed. Begins with 54 farmers mutually certifying each other’s adherence to its own published, publicly available standards for defining organic produce.

1977 Bowing to industry pressure, the Saccharin Study and Labeling Act is passed by Congress to stop the FDA from banning the chemical sweetener. The act does require a label warning that saccharin has been found to cause cancer in laboratory animals.

1980 Infant Formula Act establishes special FDA controls to ensure necessary nutritional content and safety.

1980 The USDA Food and Nutrition Information Center (FNIC) publishes the 1980 Dietary Guidelines for Americans. The guidelines are to be updated every 5 years. In 1980 there were 7 relatively simple guidelines. In the 2005 Dietary Guidelines for Americans, there were 41 recommendations in a 71 page booklet!!!

1982 FDA publishes first “red book” (successor to 1949 “black book”), officially known as “Toxicological Principles for the Safety Assessment of Direct Food Additives and Color Additives Used in Food”.

1990 Nutrition Labeling and Education Act (NLEA) is passed.  It requires all packaged foods to bear nutrition labeling and all health claims for foods to be consistent with terms defined by the Secretary of Health and Human Services. As a concession to food manufacturers, the FDA authorizes some health claims for foods. The food ingredient panel, serving sizes, and terms such as “low fat” and “light” are standardized. This is pretty much the nutrition label as we know it today.

1991 Nutrition facts, basic per-serving nutritional information, are required on foods under the Nutrition Labeling and Education Act of 1990. Food labels are to list the most important nutrients in an easy-to-follow format.

1995 Saccharin Notice Repeal Act repeals the saccharin notice requirements of 1977. People can get their saccharin without having to read about its risks.

1995 American Heart Association initiates a food certification program including AHA’s Heart Check Symbol to appear on certain foods.  Criteria is simple – low in saturated fat and cholesterol for healthy people over age 2. Oh and also, a certification payment to AHA by the food manufacturer. Now you know why sugary cereal is Heart Checked.

1998 Transfair, the US Fair Trade organization is established, with a mission “to build a more equitable and sustainable model of international trade that benefits producers, consumers, industry and the earth”.

2002 The 2002 Farm Bill requires retailers provide country-of-origin (COOL) labeling for fresh beef, pork, and lamb. After repeated debilitation and stakeholder pressures, the law would finally go into effect only 6 years later, on Oct 1, 2008, and even then with many loopholes.

2002 The National Organic Program (NOP),  enacted. It restricts the use of the term “organic” to certified organic producers. Certification is handled by state, non-profit and private agencies that have been approved by the US Department of Agriculture (USDA).

2003 Announcement made that FDA will require food labels to include trans fat content. Labeling went into effect in 2006.

2003 The FDA announced plans to permit the manufacturers of food products sold in the United States to make health claims on food labels which are supported by less than conclusive evidence. From “significant scientific consensus” before a claim can be made, industry can now rely on “Some scientific evidence” or “Very limited and preliminary scientific research” to make a health claim. Opponents criticize it as opening the door to ill-founded claims. Advocates believe it will make more information available to the public.

2004 Passage of the Food Allergy Labeling and Consumer Protection Act. Requires labeling of any food that contains one or more of: peanuts, soybeans, cow’s milk, eggs, fish, crustacean shellfish, tree nuts, and wheat.

2004 PepsiCo launches Smartspot – designating the “more nutritious” of its products with an easy to spot symbol on the front of package. Baked Doritos in. Fried Doritos out.

2005 Kraft launches Sensible Solutions, a similar initiative for its gamut of products including sugar-free Jello, vitamin water, and Nabisco toasted chips.

2005 President’s Choice launches Blue Menu to designate its healthier products.

2006 Hannaford Brothers Supermarket Chain launches Guiding Stars intended to help customers choose healthy foods. Foods are ranked 0 to 3 stars, with three stars awarded to most nutritious foods. Only 20% of the supermarket stocked items are starred, but sales of these items increase by several percentage points.

Sept 2008 NuVal announced – The nutritional value (NuVal) System scores food on a scale of 1 to 100. The higher the NuVal Score, the higher the nutrition of a food product. The score is based on a complex and *top secret* Overall Nutritional Quality Index (ONQI) that takes into account 30 different nutrients in food. [update: read review]

Oct 2007 Kellogg’s Launches Nutrition at a Glance based on the European Guideline Daily Amounts (GDA) system. Front of Package information includes daily percentage values for 6 nutrients: calories, total fat, sodium, sugars, vitamin A, and vitamin C.

Oct 2008 Mars International launches GDA labeling of its foods and snacks in the US.

Oct 2008 Smart Choices launched – a pan industry effort to promote a standardized benchmark for front of package consumer information. Initial supporters include General Mills, Con-Agra, Coca-Cola, PepsiCo, and Unilever. [update: read review]

January 2009 Healthy Ideas launched at Giant Foods and  Stop & Shop supermarkets. Around 10% of the items qualify for this benchmark, developed by the grocers’ nutrition experts and based on FDA and USDA guidelines.

January 2009 Sara Lee introduces Nutritional Spotlight front of package labels for bread, bun, and bagel products. This move is in contrast to an industry wide attempt by manufacturers to create a unified Smart Choice label. This label is similar to Mars’ and Kelloggs’ recent efforts.

January 2009 SuperValu introduces nutritionIQ shelf signage at its Albertsons stores. The color-coded, easy-to-spot shelf tags, or cards, are supposed to aid shoppers in choosing low fat, high fiber and other good foods.

January 2009 Regional Grocery Chain, United Supermarkets, Introduces TAG Nutrition Labeling Program. Five color coded shelf labels point to Heart Healthy/Diabetes Management, Gluten-Free, Organic, Lean/Low-Fat for Meat and Dairy and Sugar-Free/Reduced Sugar products.

June 2009 – SuperValu introduces Healthy Elements program for its independent retail partners.

Summer 2009 – Smart Choices launches formally with several hundreds of products labeled with the green check mark. Froot Loops becomes the poster child for everything wrong with an industry backed nutrition rating system.

October 2009 – The FDA sends a “Dear Manufacturer” letter to boards of the Smart Choices Program and other Front of Pack nutrition rating systems, stating its concern with the potential to mislead consumers. A week later the Smart Choices program suspends itself.
What’s next for food labels? Consumers interest groups will continue to demand more visibility and more information from manufacturers. More data will become available, but translating the wealth of information to a decision at the supermarket shelf will not necessarily become easier for consumers. Programs such as Guiding Stars and NuVal may help consumers make better decisions, but with the FDA’s renewed interest and vigor, perhaps we shall see a uniform, standardized format on all products in the not too distant future.

Visionaries see a day where each ingredient of every product on a shelf can be connected directly to the farm, factory, and other stakeholders involved in its processing. Now how do you fit all that information on a pack of gum?

Sources: FDA, USDA, AHA, company and organization websites

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