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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This month is seeing several religious fasting traditions – Muslims with the Rammadan, and Jews with Yom Kippur. The latter is a 25 hour fast beginning this evening at sunset. Rammadan, which ended last week, lasted an entire month! Luckily, followers of Islam are allowed to eat before sunrise and after sunset each day during the fasting month.

Historically, fasting has been tied to spiritual healing, a cleansing of the soul, and prophetic visions. In modern times, some people have opted for occasional fasts as a quick weight loss solution.

What you need to know:

While fasting once in a while is not going to kill a normally healthy person, it does pose  several risks:

Undernourishment and malnourishment – our body is an amazing machine that needs a host of nutrients to keep it running smoothly.

Muscle loss – When our body is undernourished and inactive – it tends to burn the pounds away in the form of muscle, not fat. Big bummer.

Going crazy – Perhaps the modern day interpretation of historical fasts leading to visions and prophecies is simply the fact that going too long without food leads to deteriorating mental capacities, sometimes inducing hallucinations and other psychological side effects.

Weight gain – Silly as it sounds, after the fast some people put more into their body than they would have given the opportunity to eat  regular meals.

To summarize, a better way to lose weight is to eat right rather than not eat at all.

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The hottest trend in the food industry lately is functional food. Although there is not formal definition for the term, its agreed that these are foods that can help reduce the risk of disease due to the presence of specific nutrients.

In general, the best functional foods are also the most unprocessed ones – fruits, vegetables and whole grains, as an example.

However, more and more processed foods are being fortified with nutrients in order to become “functional.” Manufacturers have realized that health sells, and usually commands a higher margin too.

And so we find calcium added to orange juice, vitamin C added to fruit snacks, and breakfast cereals fortified with pretty much the entire alphabet of minerals and vitamins.

OK. In the examples above, they’ve made decent products a bit healthier. But what can manufacturers do with products that at their core are not so healthy? Can a sugary / fatty / salty (take your pick) item  be miraculously transformed into something nutritious?

If we’re to judge by the sales of functional foods, sales are growing at a great clip, which means consumers have been convinced that the bag of cheese puffs fortified with omega-3 is really good for them.

An article in the Wall Street Journal recently tackled this topic:

Lillian Cheung, Ph.D, a nutrition professor at the Harvard School of Public Health, [...] points out that adding nutrients to a food can encourage people to perceive it as unequivocally healthy, whether it’s low-fat and fiber-rich oatmeal that’s been fortified or a similarly enhanced bag of potato chips packed with fat and bereft of any naturally occurring nutrients that the oatmeal has. “The fact that brands have gone to the trouble to add this stuff sends an implicit message that the finished product is desirable, and that’s just not always the case,” she says.

“Sports drinks are an example. The sugar they contain is so much worse than the added vitamins. But that information gets obscured.”

read more…

What you need to know:

The FDA does not recognize functional foods as a category. Which means it’s a wild west for marketers to sell us stories.

So if it’s too good to be true, it isn’t.

What to do at the supermarket:

Go for foods that are naturally functional. The less a food is processed, the most benefit you’ll reap. For example, get your omega-3 from fish, not a snack bar. If you’re still deficient in a certain nutrient, a fortified product is a good option, but only if at its base it is a nutritious product (non sugary cereals yes, soft drinks – NO).

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Meijer is rolling out what it hopes will be another helpful means for consumers to assess the nutritional quality of foods at the supermarket. NuVal assigns a score of 0-100 to food products based on a proprietary algorithm called ONQI (overall nutritional quality index) developed by top nutrition experts.

According to Dr. David Katz, the scientist behind ONQI / NuVal, the values of  30 nutrients in a food product are crunched in a formula that yields a final score. Nutrients to encourage, such as fiber and vitamin C, increase the score, while saturated fats and sugars reduce it.

As would be expected, vegetables and fruits score high, milk and meats lower, and most processed foods the lowest.

What you need to know:

We covered NuVal in detail when it launched several months ago,  commenting on both the positive and negative aspects of such a system.

On the bright side, the system provides a simple, intuative, front of label indication of a food’s health value.

On the other hand, there is an inherent conflict of interests between retailers and consumers. Most consumers, we assume, want to eat healthy. But retailers want to sell them as much as possible and at high margins. Unfortunately the most profitable products are processed foods (Soft drinks are a great example: water, colors and sugar – very profitable).The healthy foods, less processed, fruits vegetables, grains, and basics like milk and meats, do not carry a high profit margin. For a retailer, steering its customers to healthier products is then, essentially, like someone shooting himself in the foot.

Perhaps this is why NuVal, which hoped to have 15-20 retailers on board by now, can count Meijer only as its third partner, following limited launches at Hy-Vee and Price Chopper in January.

What to do at the supermarket:

Most Americans will have to wait till NuVal hits their local grocery store. So diligent shoppers will have to continue checking the ingredient lists and nutrition labels to make sure they know exactly what they are putting on their families’ plates.

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Have you ever wondered what’s inside that tasty TV dinner, instant pudding, or granola bar? How healthy, or not? Theoretically, we can learn a lot about a packaged food item just by reading its nutrition panel. Unfortunately for many of us, the nutrition information, ingredient list, and health claims on the package tend to confuse more than elucidate. As a result, consumers make misinformed purchase decisions. Several labeling initiatives have recently launched with a mission to simplify the nutrition information for consumers. (For some background, check our post about the history of food labels.)

A few days ago we reviewed the brand new Smart Choices Program. Today, a look at another front of package labeling system – NuVal (Nutritional Value Scoring System). NuVal was announced in late 2007 as ONQI (Overall Nutritional Quality Index). It is a scoring system that rates food on a scale of 1-100. The higher the score, the more nutritious the product.

The proprietary system consists of an algorithm that inputs values of over 30 different nutrients (i.e. protein, carbs, fats, vitamins, and minerals), and outputting a single score. The system looks at “nutrients to encourage”, such as fiber and omega-3 fatty acids, as well as “nutrients to avoid” such as saturated fat and sodium.

The NuVal score is displayed at the supermarket on shelf tags and aisle signage, but not on the product package itself. NuVal was supposed to launch earlier this summer with several grocery chains. After a slight delay, Hy-Vee, a midwestern chain out of Iowa, was recently announced as a partner. Price Chopper has joined in the North East. Both are limited launches though – only several stores and several product categories are offered now.

NuVal / ONQI is the brainchild of Dr. David Katz, a Professor of Public Health Practice, and a nationally recognized expert in the fields of weight control and nutrition. He was previously Director of Medical Studies in Public Health, at the Yale University School of Medicine. Dr. Katz assembled a top notch team of researchers to create the ONQI system, and it took them 2 years to do it. The grading algorithm itself has not been disclosed to the public.

NuVal LLC is  a joint venture of Yale university’s Griffin Hospital and Topco Associates, a privately held cooperative of food retailers and wholesalers. Unlike “Smart Choices”, food manufacturers are not part of this initiative, although the ONQI score requires additional information from manufacturers that is not found on food labels.

The good:

1. Simplicity. Everyone can relate to a numeric score of 1-100.

2. Uniformity. A single scoring system across all products enables consumers to compare apples to oranges, literally. (not that it would make any sense – both are nutritious and tasty).

3. Depth. A NuVal score of 1-100 provides more breadth to a product’s healthfulness than a Yes/No benchmark that appears only on selected items. Assuming all products in a supermarket will carry a NuVal score, consumers will readily compare between items in a category and choose the one with highest ranking.

4. Independence. Although not mentioned explicitly, it seems that food manufacturers were not directly involved in defining the NuVal scoring algorithm. Hopefully this sets a higher rating standard, more in favor of consumers than in the interests of manufacturers.

The not so good:

1. Mystery Scoring. NuVal is not disclosing its scoring mechanism. Smart Choices posted their criteria online, and those interested can understand exactly why one product is eligible for a check mark, and the other is not. According to NuVal, its algorithm is patent pending (which means it will be published by the US patent office once it is approved). If so, why not publish it now so consumers can be confident in their choices?

2. Manufacturer Buy In. Some of the nutrients used by the NuVal algorithm do not uniformly appear on food nutrition labels (i.e. omega-3, Total bioflavanoids, vitamin B12).  This means either the algorithm can’t calculate scores uniformly within a product category, or that all manufacturers need to provide additional nutrient information to NuVal, a third party. The chances for that happening are slim, especially for those already comitted to Smart Choices.

3. Retailer Buy In. What happens if best selling products in the supermarket get low scores? Will retailers willingly want to lose sales of soda pop and salty snacks because of their single digit score? Or are they betting that customers won’t care?

4. Placement. This may seem trivial, but in those supermarkets where price is displayed on the shelf instead of on the product, there are always mismatches. Put NuVal indicators on the shelves and you’ve added another level of complexity to bleary eyed associates stocking shelves at 4am. With Smart Choices, the approval seal is on the product package itself.

5. No personalization. This is an issue with Smart Choices as well. A middle aged diabetic has different dietary needs than a healthy teenager or a senior suffering from hypertension and trying to reduce sodium intake. How can a low-fat fruit yogurt have the same score for each of them? Ideally, a person would see a personalized score for each product.

Conclusion:

The teams behind NuVal and Smart Choices have made good headway in simplifying a very complex nutrition label and boiling it down to very simple indicator for consumer decision. Both systems sport some flaws, but having them at a supermarket seems to be better than not having them at all.

As the goal of both Smart Choices and NuVal is to become a nationwide standard, it will be interesting to see how the imminent competition between the two systems will play out. Also interesting to look for are the FDA’s actions. Will the FDA choose to create some sort of uniform benchmark like the UK’s Food Standard Agency Traffic Lights?

What do you think? Comments below.

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Flickr photo: Laurel Fan

This is the title of nutrition expert Marion Nestle’s article today in the San Francisco Chronicle:

Foods contain nutrients. If you eat foods, you get nutrients. Somehow, humanity, in all its amazing variation, has survived to the present and is doing pretty well without having to deal with computer printouts of nutrient intakes every day. If we have enough money to eat regularly and decently, we are likely to be living a lot longer and more healthfully than in the past.

But the operative word is “decently,” and that brings us to variety.

Read the full article

What to look for at the supermarket:

Choose minimally processed foods. Look for variety. Try new foods. Combine colors, Make sure you get plenty of fruits and vegetables (fresh or frozen)