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From HealthyFoodAmerica.org (Reprinted with Permission)

National Warning Labels for Added Sugar – It was lunchtime and we noticed that one of our staff loves Mountain Dew. They usually drink the diet version but today they had the regular. We looked at the label and it says “Includes 46g of Added Sugars which is 92% of the Daily Value”.
You see that is the crux of the situation. That soda does taste great and so do most sodas in general. But, when your whole food and beverage day is now going to try to compete for the last few percentage points to keep it balanced then we have a huge hole to get out of. Now multiply that figure by a week, then by a month, then by a year. All of a sudden just this one habit could add 10-25 lbs of weight on the average size body. It is very dangerous indeed.

It is known that multiple interventions are necessary to combat the obesity pandemic. We believe that a major intervention to discourage consumption would be to place a warning label on foods that have added sugar. Obviously this would be a major implication for the food industry but personal responsibility can’t be seen as a viable solution. Currently most food products have some form of warning label so labels are not that unusual. Some that you will recognize are the health warning labels on cigarettes and the allergy warning labels on food products that may contain certain nuts. These labels have been affective in both reducing potentially dangerous products like cigarettes to serious allergic reactions for someone with nut allergies. They also cut demand.

From HealthyFoodAmerica.org

          Added sugars, as opposed to naturally-occurring sugars, in processed foods are a primary driver of the obesity epidemic and have direct metabolic effects that raise the risk of type 2 diabetes, hypertension, and heart and liver diseases. They also promote dental disease.

Health Impacts of Sugar

Heart disease. Eating 12–30 teaspoons of added sugar per day increases the risk of dying from heart disease by nearly one-third over those who eat less. Eating more than 30 teaspoons increases the risk nearly three-fold. Sugary drinks contribute to more than 52,000 deaths from cardiovascular disease every year in the US.

Diabetes. Drinking just one to two 12-oz sodas per day can increase your risk of developing type 2 diabetes by 26% and the risk of developing hypertension by 12%. More than 1 in 3 US adults has pre-diabetes, and 40 percent of all children are predicted to develop diabetes in their lifetime.

Dental decay. Regular soda consumption is associated with nearly twice the risk of dental decay in children. Adults who drink 1-2 sugary drinks per day have 30% more dental disease compared with adults who consume no sugary drinks.

Types of Added Sugars* found in Packaged Foods

  • brown sugar
  • confectioner’s powdered sugar
  • corn syrup, corn syrup solids
  • dextrose, fructose, lactose, maltose, sucrose
  • high-fructose corn syrup (HFCS)
  • honey
  • invert sugar
  • malt syrup
  • maple syrup
  • molasses
  • nectars (e.g., peach or pear nectar)
  • raw sugar
  • white table (granulated) sugar
  • and others

Check out Sugar Science for more information on added sugars in packaged foods.

*Added sugars are sugars and syrups that are added to foods or beverages when they are processed or prepared. They don’t include naturally occurring sugars such as those in milk and fruit.

Sugar is added to three out of four of the products found on grocery shelves, making it nearly impossible to avoid. The typical American consumes about 17 teaspoons of added sugars per day, roughly 50 percent more than is recommended by the Dietary Guidelines for Americans (DGA) and the World Health Organization (WHO). To prevent chronic diseases and save lives, we must change the makeup and marketing of packaged foods to make it easier for Americans to reduce sugar intake to recommended levels, and to increase our consumption of healthful food.

Why take on sugar now? After years of research, we have a strong (and growing) body of scientific evidence that demonstrates the harm caused by added sugars. The media are sounding the alarm as well, helping Americans to get the message that excessive sugar is unhealthy and we should cut back. Overall, sugar consumption in America is declining, but it is still too high, and it varies by age, gender, race, and income. As a result, we continue to see the health impacts and inequities associated with overconsumption.

The U.S. consumes too much sugar!

The United States leads the world in consumption of added sugars and ranks third in the world in sales of sugary drinks. All of this sugar has consequences – the U.S. has one of the highest overall obesity rates in the world, and the highest rate of childhood obesityi. Over 35 million Americans have diabetes, and another 84 million are at risk of developing diabetesii.

SUGARY DRINKS CONTRIBUTE TO MORE THAN 52,000 DEATHS FROM CARDIOVASCULAR DISEASE EVERY YEAR IN THE USIII

calories-sold-per-person1
calories-consumed-per-person1
 While U.S. sugar consumption has begun to decline since 2000, it is still extremely high

          Sugar consumption in the US has risen steeply and steadily over the past two centuries. The rise in sugar consumption has corresponded with higher rates of obesity and diabetes – sugar consumption accelerated around 1980, when the obesity epidemic started, and the diabetes epidemic started a decade later, in the 1990s. Sugar consumption peaked in 1999 at about 425 calories per day, and then began to decline. However, the decline has plateaued since 2010.

us-consumption

The Dietary Guidelines for Americans 2015–2020 recommends limiting added sugars to less than 10 percent of our daily calories–about 12 teaspoons of added sugars per day. The American Heart Association sets an even lower limit, and makes recommendations based on age and gender.

american-heart-association1

On average, Americans of all ages are consuming more added sugar than recommended by the American Heart Association, the 2015 Dietary Guidelines for Americans, and the World Health Organization.

average sugar

The charts above show how added sugar intake differs substantially by age and gender. The chart below shows that intake also varies by race and income. Overall, adolescents and young adults, Blacks, low income people, and men consume the most added sugar.

daily added sugar intake by race and income

But average intake doesn’t tell the whole story. More than half of Americans (58 percent) exceed the Dietary Guidelines for Americans recommendation to limit added sugar intake to less than 10% of total calories. They are eating, on average, over 25 teaspoons of sugar a day, or nearly 20 percent of their total calories. Those who eat too much sugar also tend to eat more total calories and fewer healthy foods such as fruit, vegetables, and whole grains.

People who meet the DGA recommendation to eat less than 10% of calories from added sugar eat less total calories on average, and only about 6% of calories are from added sugar, compared to about 20% of calories from added sugar among the majority of Americans who do not meet the DGA recommendation. Additionally, those eating less than 10% of their calories from added sugar also tend to eat more vegetables, fruit, and whole grains, indicating that high sugar intake is associated with an overall lower quality diet.

Source: Bowman SA, Clemens JC, Martin CL, et al. Added Sugars Intake of Americans: What We Eat in America, NHANES 2013-2014. USDA Food Surveys Research Group. Dietary Date Brief No. 18. May 2017

Key points:
  • Consuming added sugars raises the risk of developing type 2 diabetes, obesity, hypertension, heart and liver diseases, and tooth decay.
  • Americans consume more sugar than people in any other country in the world.
  • Over two-thirds of children and adolescents, and more than half of adults consume more added sugars than is recommended by the Dietary Guidelines for Americans and the World Health Organization.
  • Added sugar intake varies by age, gender, race, and income – adolescents and young adults, Blacks, low income people, and men consume more added sugar than average.
  • People who eat too much added sugar tend to have a poor overall diet that is higher in calories and lower in fruits, vegetables, and whole grains.
Where are we getting all this sugar?

Sugary drinks account for nearly half (46%) of the added sugars in the American diet and are the largest source of added sugars for all age groups; they are far and away the largest contributor to sugar intake among people ages 12–50 years.

sugary drinks

Snacks and sweets are the second largest source, contributing 31 percent of added sugars. The chart below breaks this category down further to show that grain-based deserts are a major contributor of added sugar, especially among older adults. Candy and breakfast cereals contribute relatively high proportions of added sugars among children ages six to eleven.

added sugar intake by source
Where do we get most of these foods and beverages?

          These days, sugary foods and drinks are available almost everywhere. We buy them in the obvious places such as supermarkets, groceries, and fast food restaurants. They’re readily available in our workplaces and schools, in government buildings, sports arenas, and movie theaters. But we can also easily find them in more unlikely places: gas stations, city parks, museums, sports stores, office supply and home improvement stores, even craft and hobby stores.

          As you can see from the pie charts below, store-bought added sugars account for 65-70 percent of what we consume (depending on age). The total amount of added sugars from meals and beverages from restaurants, school cafeterias, and other sources is considerably lower. For example, the amount of added sugars contributed by school meals among the 12- to 19-year-old age group is 0.9 teaspoons/day, or about 15 calories per day.

added sugar intake

Great sources for local data on health impacts

To find out about the rates of diabetes, obesity, heart disease, and other conditions associated with added sugar consumption, in your state, county, or city, check out these data sources from the Centers for Disease Control (CDC).

  • Behavioral Risk Factor Surveillance System (BRFSS): all adult health outcomes. State, county, city levels. Also see the BRFSS Widget for obesity and diabetes. State level.
  • Diabetes Burden Toolkit: includes economic burden of diabetes. State level.
  • Diabetes data: includes prediabetes, diagnosed diabetes, risk factors for diagnosis, and risk factors for complications. National, state, and county levels.
  • 500 Cities Project: various health outcomes on maps. City level.
  • Heart disease and stroke data: by racial/ethnic group, with maps of social and environmental conditions and health services. National, state, territory, and county level.
  • Obesity and overweight data and statistics: adults, adolescents, and Women, Infants, and Children (WIC) two to four year-old participants. States, territories and some local levels.
  • Youth Online: data from the Youth Risk Behavior Surveillance System (YRBSS), 1999-2015, including obesity and soda consumption. State and local levels.

Other resources:

ENDNOTES

iGDB 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 years. NEJM. 2017; 377(1)

iiCenters for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2017.

iiiMicha R, Penalvo JL, Cudhea F, et al. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 2017;317(9)

REDUCING SUGAR EXPOSURE

How can we reduce our exposure to added sugars? Key policy approaches:

The policies and actions covered in this toolkit work by engaging one or more of the following key approaches for reducing the amount of sugar we confront in our diets.

1. Reduce added sugars in food and beverage products.

Reduce added sugars in food and beverage products

Reformulating products, particularly if done in a comprehensive manner, would be a highly effective way to reduce exposure to sugar. Reformulation has the potential to improve diet quality without requiring consumers to make a conscious choice to actively avoid added sugars. i Added sugar is present in 68 percent of all processed foods. It takes a lot of effort for us to cut down on sugar if we have to know how much sugar is in a product, figure out what proportion of the daily maximum intake this represents, and keep track of the sugar consumed across all food sources eaten that day. Reformulating products with less added sugar makes reducing sugar intake effortless for the consumer. And it can save lives. A French study estimated that deaths from nutrition-related diseases could be reduced by 5 percent—thousands of lives per year—with much greater benefits among low-income people.ii

Examples of this type of tactic could include:

2. Reduce the availability of sugary products.

Reduce the availability of sugary products

Over the last few decades, sugary drinks and snacks have become almost unavoidable, finding their way into schools, hospitals, childcare centers, gas stations, government buildings, recreation centers, and many more places. In the last few years, as evidence on sugar and health has accumulated, there has been a growing debate about whether these products are appropriate in many of these settings, particularly where kids are the target consumers, and in institutions, such as hospitals, where health is a focus.

Examples of this type of tactic could include:

  • Removing sugary products from schools.

  • Removing sugary drinks from hospitals and other healthcare settings.

  • Removing sugary drinks as the default beverage for kids’ meals in restaurants

3. Improve labeling and packaging of sugary products.

Improve labeling and packaging of sugary products

Labels with nutrition information, such as on the Nutrition Facts label, can help parents tell at a glance whether a “fruit drink” for young kids contains unhealthful amounts of added sugar. Health warning labels prominently placed on packages, or at the point of purchase for sugary products, can help consumers make decisions about which products to choose. Thanks to new federal requirements, consumers over the next two years will begin to see nutrition facts panels that disclose the amount of added sugars and the share of the recommended daily maximum it represents. However, advocates will need to help educate consumers on how to make use of label information and to alert people to more healthful options.

Examples of this type of tactic could include:

  • Requiring warning labels on sugary drink containers and/or on fountains and vending machines

  • Disclosing added sugars on nutrition labels, and educating the public on how to use this information to choose healthier products

5. Restrict advertising and promotion of sugary products.

Restrict advertising and promotion of sugary products

Our culture is saturated with advertising and other marketing strategies aimed at promoting foods and drinks with added sugars. Processed food makers spend $1.8 billion per year in the U.S. on marketing aimed just at young people, according to the UConn Rudd Center for Food Policy and Obesity. Black and Hispanic youth are especially targeted. In-store promotions take the insistent sales pitch even farther. Limiting some of that pitching, particularly to the most vulnerable consumers, can help to limit the appeal and, in some cases, the availability of products with excessive sugar.

Examples of this type of tactic could include:

  • Restrict advertising to children

  • Restrict point-of-sale advertising, special promotions

  • Implement “healthy” check-out aisles free of sugary products

6. Engage in counter-advertising and education.

Engage in counter-advertising and education

Overcoming the food and beverage industries’ multibillion dollar marketing megaphone is a tall order, but some creative and well-executed tactics have been able to make a start. San Francisco has moved to counter industry advertising by placing health warnings on outdoor advertising. Other places, such as New York City, have developed campaigns to reduce the appeal of sugary drinks through the use of a graphic public awareness campaign with slogans such as “Don’t drink yourself fat.” Los Angeles County created a “Sugar Pack” campaign aimed to increase awareness of the number of sugar packets in sugary drinks, as well as the adverse health effects of obesity.

Examples of this type of tactic could include:

  • Launching public awareness and counter-advertising campaigns for sugary products

  • Requiring warning labels on packaging or advertising for sugary drinks

  • Providing nutrition education in schools, worksites, and community settings

SUGARY DRINKS
What are sugary drinks?

Sugary drinks include soda, fruit-flavored drinks, flavored water, sports and energy drinks, and sweetened coffee and tea.

Why worry about sugary drinks?

Sugary drinks are the number one source of added sugars in our diet, representing almost half of all added sugars we consume. Added sugars are a major culprit in the obesity and diabetes epidemics. Availability of these drinks has increased dramatically. In the last 60 years the availability of regular carbonated soft drinks has tripled.

Learn more about how many sugary drinks are being consumed in the US and how consumption patterns differ by age, race/ethnicity, and income.

Sugary drinks are uniquely harmful. They have little to no nutritional value but are the number one source of added sugars in the American diet. Just one 20-oz. Coca-Cola has approximately 120 percent of the daily maximum recommended sugar under federal guidelines for a healthy diet. Yet we continue to drink too much, driven by the billions Big Soda lavishes on marketing, especially to young and poor people. And that spending pays off: Every day half of U.S. adults and two thirds of youth consume sugary drinks—adding up to approximately 50 gallons per person each year.

When sugar is delivered in a liquid form it bypasses the body’s defense against consuming too many calories: sugary drinks don’t make you feel full. These beverages offer little to no nutritional benefits, and the extra calories and sugar in these drinks outweigh any added vitamins. Sugary drinks have been found to displace healthier foods in the diet.

Soda is marketed as an habitual refreshment, rather than an occasional treat, particularly to children, youth, and communities of color. In 2013 alone, beverage companies spent $866 million to advertise sugary drinks—four times more than on 100% juice and water. One beverage company nearly tripled its advertising to children from 2010 to 2013. Black youth in 2013 saw more than twice as many television ads for sugary drinks and energy drinks as white youth.

Parents believe some sugary drinks are healthy

  • 1 in 5 believed sports drinks are “good, healthy drinks for children”
  • One-third believed children need sports drinks for hydration.
  • More than one quarter believed fruit-flavored drinks are somewhat/very healthy

Parents are likely to provide children and youth with sugary drinks

  • 77% report providing their children with fruit-flavored drinks
  • 62% report providing their children with soda
  • 51% report providing their children with sports drinks

Consumption of sugary drinks varies by age, sex, race/ethnicity, income, and education. For example, adolescents, teenagers, and young adults consume more calories per day from these drinks than very young children or middle-aged or older adults. Throughout the lifespan, males consume more than females. While 64% of white teenagers drink at least one sugary drink every day, 74% of Black teens do so. Black and Hispanic teens consume more sports drinks and energy drinks compared to white teens. Children from low education households have almost 40% increased chances of consuming these drinks than children from higher education households. Young adults from low income households have almost 50% increased chances of consuming these drinks than higher income counterparts.

Early eating patterns set the course for lifelong preferences and habits, so it’s alarming that every day nearly a third of children ages 12–23 months consume sugary drinks. Our children and youth are consuming too many sugary drinks.

Consumption of soda varies across the country, with higher consumption in the South. Now is the time to act to reduce exposure to sugary drinks. There is growing public recognition that they are not healthy, and there is growing support for policy makers to act.

Warning Labels

Everyone has a right to know how sugary drinks affect health. Warning labels are a low-cost, effective, and simple way to get the word out. Beverage companies spend close to a billion dollars every year to convince us, and especially our children, to drink these beverages. But they don’t warn us of the risks.

Requiring beverage companies to put a simple statement on cans, bottles, and dispensers of sugary drinks and on menus and ads that promote them, will alert consumers to the risks of consuming sugary drinks, and may discourage parents from buying them for their kids. Cities and states across the country are considering policies to require these warning labels at both state and local levels.

WARNING LABELS

Why warning labels?

  • Evidence suggests potential positive impact
  • Consumers have the right to know
  • Low cost
  • Broad reach
  • Adoption campaigns generate earned media
  • Polling shows high levels of support

Everyone has a right to know how sugary drinks affect health. Beverage companies spend over a billion dollars every year to convince us, and especially our children, to drink their products. But they don’t warn us of the risks. A low-cost and simple way to do that is to require the companies to apply a warning label to cans, bottles, and dispensers of sugary drinks, and to the ads, both in stores and outdoors, that promote them. The label would have a simple message like the one pictured above.

Advocates believe a sugary drink warning label will help people reduce consumption of sugary drinks, based on evidence showing that tobacco warning labels have small but positive effects. Warnings on tobacco may increase the knowledge of health risks, prevent relapse, deter youth and adults from initiating smoking, deter smokers when they are about to light up, increase the attempts to quit, and reduce the appeal of the pack.

Like warning labels on cigarette packages, sugary drink warning labels can alert people to the risks of consuming the beverages, and may even discourage people from buying them. Preliminary studies, conducted through on-line surveys, suggest that warning labels might change people’s perceptions of the drinks and their interest in purchasing them. After seeing the warnings, both adolescent and adult study participants were more aware of the health risks associated with drinking them. Adolescents were also less likely to buy them, and the adults were less likely to buy them for their children.

When surveyed, the public was overwhelmingly in favor of warning labels on sugary drinks. In a 2016 Field poll, 78% of Californians said yes to warning labels. Support varied by race and political affiliation, but a majority of people in all categories supported warning labels.

Source: Public Health Advocates, 2016

Campaigns to adopt warning label legislation, as well as the presence of labels on cans, bottles, dispensers, promotional ads, or at a point of purchase, help keep the awareness of the harmful effects of consuming sugary drinks in the public’s eye and on decision-makers’ radar. This awareness can be the catalyst to create and support other policies to reduce the availability, affordability, and even the appeal, of sugary drinks. The more policies we have in place to encourage consumers to shift to healthful beverages, and away from sugary ones, the better!

Communities taking action

State and local governments across the country have considered policies to require sugary drink warning labels. While local and state warning label policies share the same goal of educating the public about the dangers of consuming sugary drinks, they employ different approaches.. States would place labels on the containers and dispensers themselves, whereas localities would place the labels on ads for sugary drinks, in order to avoid possible conflicts with state or federal law or problems with implementation.

In 2015 San Francisco became the first U.S. jurisdiction to pass a warning label bill. It requires labels on outdoor advertising. The American Beverage Association immediately sued to block implementation, claiming that, among other things, their products were being unfairly singled out as more dangerous than other high-calorie foods. However, a federal District Judge dismissed industry arguments and concluded that the City’s mandated warning is factual and accurate, and that sugary drinks are a significant source of calories that contribute to health problems. Warning that sugary drinks contribute to tooth decay, obesity and diabetes is also reasonably related to the City’s interest in public health and safety.

Industry appealed this decision to the 9th US Circuit Court of Appeals. In September 2017, a three-judge panel from San Francisco’s 9th U.S. Circuit Court of Appeals ruled that

  • the warnings were “unduly burdensome” and “chill[ed] protected commercial speech” under the First Amendment because they were required to take up 20% of the space on any advertisement.
  • the language in the label was not “factual and uncontroversial”, and
  • the warnings were misleading in violation of the First Amendment because the warning is required exclusively on advertisements for sugar-sweetened beverages, and not on advertisements for other products with equal or greater amounts of added sugars and calories.

The court ordered a preliminary injunction to block implementation of the label ordinance. In January 2018, the 9th US Circuit Court granted the San Francisco city attorney’s petition for a rehearing with a new 11 judge panel. Until this case is settled, warning labels will not be implemented in the city.

In June 2016, the Baltimore City Council held a hearing on a proposed warning label ordinance for which Healthy Food America provided testimony. The ordinance did not get out of committee. Warning label bills have been introduced in the states of California, Hawaii, New York, Vermont, and Washington. As of December 2017, none of these bills have passed yet.

For more information on warning labels:

Studies: