Nutritional Pearls: Mind the Packaging

Christopher is a 40-year-old man concerned about his heart health. He had recently had a minor heart attack and has been increasingly mindful about his eating habits. He says he eats foods labeled as “heart healthy” but wondered how real the claims were.

How would you advise your patient?
 

(Answer and discussion on next page)

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Answer: Front-of-package food labels are often misleading.

Here in the United States the Food and Drug Administration (FDA) has regulations for the types of claims that can appear on packaged foods. These are known in the industry as "front of package" (FOP) claims and come in two general types: nutrient content claims ("high in fiber!") and disease-risk reduction claims ("a diet high in fiber may help improve cholesterol scores"). While other terms are also regulated, such as "cholesterol-free" or "nonfat," that doesn't mean that manufacturers are required to display those claims even if they're applicable.

Nor does it mean that the manufacturers are limited to only putting claims on their packages that are government-regulated: there are plenty of claims and ratings systems that originate with the food manufacturers themselves (for example, Kellogg's 'Get the Facts' program) or other organizations (such as the Whole Grain Council).

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Some people believe that one of the reasons that processed foods are so ubiquitous nowadays is because of those nutrition and health claims on food packaging: it would appear that people believe that a food bearing one of these nutrition or health claims on the box is better for them than a similar food not bearing that claim.

The Research

A team of researchers in Canada decided to find out whether the presence of health claims on food packaging was related to the level of processing: were more-processed foods more likely to be labeled with such health claims?

The authors selected one representative store from each of the top three food retailers in Canada and recorded all of the descriptive text on the front of packaged foods: everything from the brand and product name to the size of the package and all nutrient or product-specific health claims. They excluded fresh produce, meat, fish, poultry, and dried herbs and spices because they don't typically carry nutrition labelling, and they also excluded foods that are designed for specific populations or uses, such as baby foods. After removing duplicates there were over 20,000 products in their database.

The authors looked at each product and assigned it a code for the presence of any sort of nutrition or health claim, further breaking down those references as positive (containing something people should be encouraged to consume: "high in fiber!") or negative (not containing something people should should minimize or avoid: "Low in fat!" or "No trans-fats!")

They further coded each product by its level of food processing, using three different food processing classification systems - all similar but not identical. Generally, foods that were considered highly processed are those that "require minimal or no preparation," where "a majority of ingredients are preservatives including stabilizers, emulsifiers, flavours and colours," or "industrially formulated mixtures processed to the extent they are no longer recognizable as their original source."

The Results

The authors note that 41% of all the products they recorded carried some sort of nutrition reference, and the largest percentage of all products were those that were considered the most processed. Almost 50% of those highly processed foods had some sort of nutrition reference on the front of the packaging, with almost a third making negative references and as many as 24.5% making positive references. Indeed, the most-processed foods were most likely to carry negative nutrition references - and most of those referred to fat.

What's the "Take-Home"?

Just because the product has a health claim on the label does not mean that the product is good for you. Coca-Cola® might be low in fat, for example, but that doesn't make it good for you. Look beyond the packaging and read the Nutrition Facts.

Reference:

Christoforou A, Dachner N, Mendelson R, Tarasuk V. Front-of-package nutrition references are positively associated with food processing [published online June 15, 2017]. Pub Health Nutr.
https://doi.org/10.1017/S1368980017001057.