Former FDA, CDC officials: More food label changes needed to help people make healthy choices

Nutrition facts labels on food packages list ingredients and nutrient levels, but they don't tell consumers outright if a food is good for them.

Public health advocates say that information is necessary to help consumers make healthy choices at the supermarket. They'd like to see labels on the front of packages and a clearer statement of which ingredients are good and which should be avoided.

The Food and Drug Administration is working on a label overhaul and has proposed two different versions.

Writing separately in The New England Journal of Medicine on Wednesday, former FDA Commissioner David Kessler and former Centers for Disease Control and Prevention official William H. Dietz both say the FDA doesn't go far enough. Dietz, the CDC's former director of the Division of Nutrition, Physical Activity and Obesity, is now with George Washington University.

Five ways these experts, and others, say nutrition facts labels could be improved:

— INDICATE OVERALL NUTRITIONAL VALUE: The FDA proposed a nutrition facts overhaul in February that made a lot of improvements sought by the public health community. There was more emphasis on calories, revised serving sizes closer to what Americans really eat and a new line for added sugars. But Kessler says there is nothing in the new framework that "actively encourages consumers to purchase food rich in the fruits, vegetables and whole grains that are rightfully considered 'real food.'"

Both Kessler and Dietz say the panel's emphasis on specific nutrients gives food companies the ability to make claims on the fronts of their packages that can mislead consumers. For example, sugary or fatty foods can entice customers by adding fiber and promoting that. Diners often consume more of a food that is advertised as low in calories, whether it is healthy or not.

As Michael Jacobsen of the Center for Science in the Public Interest puts it: "It's a bunch of technical terms — saturated fat and cholesterol and dietary fiber. What do those mean? Are these numbers high or low, good or bad, what do you do with it?"

— MAKE INGREDIENT LISTS CLEARER: Shoppers may turn over a package of food and look for "sugar" on its ingredient list. What that consumer may not know is that "sugar" could be listed as maltose, dextrose, sucrose, corn syrup, brown rice syrup, maple syrup, high-fructose corn syrup, honey or a variety of fruit juice concentrates, among other ways.

"Tiny type, complex names, and confusing formats make many ingredient lists almost impossible to read or understand," Kessler says. He added, "If we instead defined all forms of sugar as a single ingredient, sugar might emerge near the top of many products' lists."

— CREATE A DAILY VALUE FOR SUGAR: Though public health specialists have overwhelmingly praised the FDA's proposed addition of an "added sugars" line that would distinguish from naturally occurring sugars, Kessler says the agency needs to include a line suggesting how much sugar people should eat daily.

The FDA has said they didn't include a line because there is no accepted recommendation for how much sugar should be consumed on a daily basis.

— PUT LABELS ON THE FRONT, TOO: The FDA said in 2009 that it was developing proposed nutritional standards that would have to be met before manufacturers place claims on the fronts of packages. That effort has since stalled as the industry has said it is working on its own standards, a move that has frustrated public health advocates.

Kessler proposes front-of-package labels that would list the top three ingredients, the calorie count and the number of additional ingredients in bold type.

FDA spokeswoman Theresa Eisenman says the agency is still working on a front-of-pack label, but is monitoring what industry is doing.

— GIVE THE LABELS SOME CONTEXT: At a recent public meeting, several experts told the FDA they would endorse a version of the nutrition facts label that would sort nutrients by "get enough" and "avoid too much." The FDA offered that version as a second option in February's proposal.

Dr. Frank Hu of the Harvard School of Public Health said sorting nutrients that way is easier for people to understand than reading the column that lists the percent of the daily recommended value of a nutrient.

Pepin Tuma of the Academy of Nutrition and Dietetics agreed, saying "nobody wants to do math."

The food industry protested. Telling shoppers what they should get enough of and what they should avoid "goes beyond just the facts," said Donna Garren of the American Frozen Food Institute.

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