What warning labels could look like on your favorite foods

Your food may soon come with warnings.

The Food and Drug Administration plans to propose labeling this fall for the front of food and drink packages to help Americans make healthier choices to address exploding obesity rates, years after other countries took similar action.

The labels are supposed to flag products containing high levels of sodium, saturated fat or added sugars - common features of ultra-processed foods that make up more than half of the calories Americans consume each day.

But the labeling options under consideration by the FDA are not clear enough to protect Americans’ health, some nutrition experts and lawmakers say, including Sen. Bernie Sanders (I-Vt.), chairman of the Senate health committee who has proposed a stricter system.

“Other countries understand that childhood obesity is a major health crisis,” Sanders said. “We’ve got to do the same.”

Nearly 20 percent of U.S. children are obese, nearly four times the rate in the 1970s before the proliferation of ultra-processed food, according to the Centers for Disease Control and Prevention. Several studies have identified these industrially produced, hyper-palatable foods as risk factors for chronic diseases shortening life spans in the United States.

Food companies are pushing against the addition of labels to the fronts of packaged foods and dispute the FDA’s argument that doing so can affect Americans’ food choices and obesity rates. Industry representatives warn that such requirements would drive up food prices. They question whether the FDA has the authority to enact such sweeping changes and say companies have grounds to potentially sue the federal government over limiting commercial free speech.

Here are two potential labeling options the FDA says it is considering:

The one on the left would signal high levels of added sugars, saturated fat or sodium, which the agency defines as having 20 percent or more of the recommended daily amount per serving.

The other features colors signaling how much saturated fat, sodium and added sugars per serving the food contains. If an item contains 5 percent or less of the daily value of any of those nutrients, a green “low” label is placed next to it. If the food is at or over 20 percent for that nutrient, it gets a red “high” label. Everything in between gets a yellow “medium” label.

Experts say both U.S. versions are weak and confusing compared with labels used in Chile, which has undertaken one of the most ambitious efforts in the world to fight obesity. The South American country slaps black octagons akin to stop signs on foods high in calories, saturated fat, sodium or sugar. (The Chilean nutrient thresholds are based on 100 grams of food - not per serving, as in the United States.)

Researchers at the University of North Carolina Global Food Research Program analyzed common American snacks such as Goldfish crackers, Cheetos and Cheerios for The Washington Post to show what their packaging could look like under the U.S. proposals compared to how the same product would be labeled in Chile.

For example, Cheerios, advertised in the United States as a cereal that “can help lower cholesterol as part of a heart healthy diet,” would receive a yellow label to indicate “medium” sodium levels under one of the proposed FDA options. (It would not qualify for a label under the other FDA option.) Consuming foods with too much sodium can raise the risk of heart disease, stroke and high blood pressure. The product, according to UNC researchers, would receive stop-sign-shaped warnings for high sodium and calories if sold in Chile. The FDA proposals do not include warnings for high-calorie foods.

Under Sanders’s proposed legislation, Cheerios would also receive a label identifying it as “ultra-processed.”

Nature Valley granola bars, whose packaging promotes their whole grain content, would get a red label to indicate “high” levels of added sugars and two yellow labels for “medium” levels of saturated fat and sodium, under one of the FDA proposals. In Chile, the granola bars get two warning labels for high levels of sugar and calories.

General Mills, which makes Cheerios and the Nature Valley granola bars, said in a statement the company is tracking the FDA proposals. “We remain focused on meeting consumers’ nutrition and taste needs,” General Mills spokeswoman Mollie Wulff said.

Research shows that easy-to-understand warning labels - such as the ones used in Chile as well as Mexico, Peru, Israel and Uruguay - are most effective in helping consumers quickly identify unhealthy products.

Focus groups of mothers in Chile showed the labels improved their ability to make better nutritional choices for their families. Their children also recognized the black stop sign shapes and told them not to buy food with warning labels because teachers would not accept them as school snacks. Researchers found that the message to eat healthier especially resonated among young children from lower- and middle-class families.

Chile’s front-of-package warning labels were associated with significant decreases in the overall calories, sugar, sodium and saturated fat contained in foods purchased by consumers, according to research by the UNC team.

Researchers, in examining the nutritional profiles of products in Chile before and after the labels took effect, found a 7 percent drop in the number of products that would be required to carry warning labels, signaling that many companies reformulated their foods.

But such blatant warnings are unlikely to ever grace food packages sold in the United States, nutrition experts and food companies say.

“My strong concern is that if we get a front-of-package labeling that is at best ineffective, that’s going to preclude any kind of stronger option for decades, if not for forever,” said Lindsey Smith Taillie, associate professor of nutrition at the University of North Carolina at Chapel Hill who directed the comparisons. “It’s underscoring the extent to which the food industry has interfered with public health.”

The FDA did not include stop-sign-shaped warnings in the focus groups it conducted to determine which labels consumers thought most clearly identified products containing unhealthy components.

“We focused our research using insights from focus group testing, review of the scientific literature, review of schemes from other countries and to align with our legal authority,” said Robin McKinnon, an FDA senior adviser for nutrition policy in the agency’s Center for Food Safety and Applied Nutrition.

Goldfish, the popular American childhood snack, would not be considered a high-sodium product in the United States, even though it would bear warnings for “high sodium” and “high calories” if sold in Chile. Instead, the FDA would flag Goldfish for containing “medium” levels of sodium and saturated fat.

Megan Koehler, a spokeswoman for Campbell Soup Company, which makes Goldfish, said the brand’s packaging complies with all existing FDA regulations and requirements. “We are not going to respond to hypothetical scenarios,” she said.

Similarly, Cheetos, an orange finger-licking favorite, would not receive any FDA labels warning of high levels of sodium, even though in Chile it gets warnings for both high sodium and calories. But, like Goldfish, the label would show “medium” levels of sodium and saturated fat.

PepsiCo, which makes Cheetos, did not respond to requests for comment.

Top industry representatives including the Consumer Brands Association and FMI, The Food Industry Association - whose members include General Mills, PepsiCo and Campbell’s - told The Post that the labeling options under consideration by the FDA are too subjective, leaving such labels open to legal challenges. The American Beverage Association and other plaintiffs had filed a lawsuit in 2015 against an effort by the city and county of San Francisco to attach warnings to advertisements for sugary drinks. On appeal, the 9th Circuit ruled that the ordinance violated the First Amendment, which protects commercial speech.

“We feel strongly that what consumers are getting should be fact based and that the systems that are just reliant upon symbols or scales can be ambiguous and could be missing a big part of the nutrition story,” said Sarah Gallo, a senior vice president of the Consumer Brands Association, about potential FDA food labels.

The association said the labels simply do not work, pointing to data showing obesity rates in Chile have increased since the country put in place the labels in 2016. But the UNC researchers noted that data included the coronavirus pandemic, when obesity rates skyrocketed during lockdowns.

The industry prefers the voluntary labeling system it created in 2011, which effectively delayed the federal effort to mandate warning labels by more than a dozen years. Under that system, food companies can choose to showcase information readily available on the back of a package - such as calorie count and fiber - on the front.

That follows a worldwide pattern of the industry pushing for “the least informative form of front-of-pack labeling,” said Mike Rayner, a population health professor at the University of Oxford. Rayner helped lead the charge in Britain for a voluntary food labeling system featuring red, yellow and green colors to indicate how healthy the product is. The food industry will always oppose mandatory labels, he said. “They don’t like colors and they don’t like warning signs” that are easiest for consumers to understand.

Sanders said Congress needs to stand up to industry pressure in the United States, much like it did decades ago against tobacco companies when it mandated warning labels on cigarette boxes.

Sanders’s proposed legislation would add rectangular labels warning consumers about ultra-processed foods, non-sugar sweeteners and sugar-sweetened beverages as well as octagonal labels for foods that are high in “added sugar, saturated fat or sodium, or any other nutrient of concern.”

During a recent phone interview, Sanders read the nutrition facts on the back of a bottle of red fruit-punch-flavored Gatorade - 34 grams of total sugars, he said, amounts to more than eight teaspoons.

“How many people even know what a gram is compared to a teaspoon?” Sanders exclaimed. “Does this label give you the information as the parent or the kid to make good judgments as to whether or not I should purchase this product? It doesn’t.”

Under his proposal, that Gatorade bottle would receive labels designating the sports drink as an ultra-processed food and a sugar-sweetened beverage.

PepsiCo, which owns Gatorade, did not respond to requests for comment.

In the United States, the First Amendment provides a measure of protection for “commercial speech” such as advertising, with some exceptions for false or deceptive claims. Martin Hahn, general counsel for SNAC International, the lobbying group for the snack industry, said forcing companies to promote the government’s view on the nutritional value of products unduly burdens business.

Hahn said “just looking at a single nutrient and saying ‘Danger! Danger! Danger!’” is “controversial” and “disparaging” because it’s not a holistic look at a person’s diet.

Hahn has previously lobbied on behalf of the Consumer Brands Association, which was formerly known as the Grocery Manufacturers Association. He is a part of a group of Hogan Lovells lawyers - one of whom had worked as an in-house counsel for Hershey Company, Kraft Foods and PepsiCo - who questioned the FDA’s authority to mandate food labels in an April legal analysis for the Washington Legal Foundation, a free enterprise think tank that received a $20,000 donation from the Consumer Brands Association in 2017.

In the most recent government funding bill, Congress demanded the FDA submit an explanation of its legal authority to require labels on the front of food packages. Federal officials responded by pointing to previous laws - primarily the 1990 Nutrition Labeling and Education Act - which the agency says gives it the power to ensure nutritional information is displayed in a way the public can “readily observe and comprehend.”

The recent Supreme Court decision curtailing the power of federal agencies when a law is ambiguous or Congress does not specify its intentions could bolster industry challenges to government regulations, legal experts say.

Industry groups are also warning consumers that new labeling requirements could drive up prices at the grocery store, an undesirable message for the Biden-Harris administration before the election. (Researchers found that prices did not change in Chile following the mandate that unhealthy foods be prominently labeled.) Health advocates worry the Biden White House will postpone the proposed rule, which has already been delayed almost a year, though administration officials say the measure is a key part of a White House plan to promote nutrition.

The FDA has yet to send a draft of the proposed rule to the White House budget office for review, a required step before public release. White House spokeswoman Kelly Scully noted that front-of-pack labels are “one of the many key deliverables” of the administration’s strategy on hunger, nutrition and health.

Even if Biden officials release a proposal as planned in October, it’s unlikely former president Donald Trump would continue the effort if he wins the presidency. Under the Trump administration, the United States had pushed back against labels on the front of food packages amid its negotiations over the North American Free Trade Agreement.

Neena Prasad, a primary care physician and Food Policy Program lead at Bloomberg Philanthropies, said it is “extremely concerning” that the United States has not done more to address the nation’s exploding rates of diet-related diseases.

“The evidence is so clear. And there are examples from around the world that show what the tools in our toolbox are and what is effective,” Prasad said. “One can only conclude that the interests of the manufacturers of these products is a higher priority than public health.”