How can we get people to eat healthier foods?
Global health leaders are rolling out new plans to promote good nutrition and combat obesity.
A friend posed the question: Should refined sugar products should be regulated like cigarettes?
I shared the question on Facebook. My friend Gary, a lawyer based in Sweden, wrote:
“Consumers should have the right and ability to readily understand sugar content—this serves the individual and the society at large. In Sweden, the percent of sugar is required on all manufactured food products, and this simplifies product comparisons and making informed purchases.”
How can public health leaders encourage healthy eating habits? Should we improve food labels, or impose taxes on soda and unhealthy foods?
In this piece I’ll review the latest government efforts to regulate food companies and promote healthy diets. These policies, while controversial, could help reduce the incidence of obesity and chronic disease.
What makes food healthful?
As a kid, I was taught healthy eating meant following the food pyramid—an archaic visual guide that suggested we could eat as much bread, pasta and carbs as wanted. Fats and oils, considered to be unhealthy, were placed in a tiny triangle at the top.
Later, I learned that this food pyramid was part of a decades-long lobbying effort by the sugar industry to demonize fats.
Science journalist Amos Zeeberg writes:
“In the latter half of the 20th century, nutritionists told us to eat less fat, saturated fat and cholesterol. The missing fat was, mostly, replaced by carbohydrates, and rates of obesity and heart disease continued to climb ever higher. Many nutritionists now say that replacing fat with carbohydrates was an error with terrible consequences for human health.”
Guidance on diet and nutrition is constantly changing. The field of nutritional epidemiology has struggled to find consensus on critical dietary issues.
Why? It’s hard to draw reliable conclusions from nutrition studies. A dietary intervention doesn’t happen in a vacuum—there are confounding variables at play, like lifestyle and exercise. You can't randomize people to eat just sugar, or just Vitamin C, or just fiber. Nutrients are eaten together, may have synergistic effects, and may interact with microbiomes within the human body in ways we are just beginning to understand.
Even today, nutritionists don’t have a consensus on questions like: Do eggs increase the risk of heart disease? Does red wine prevent cancer? Are artificial sweeteners bad for us?
One thing nutritionists do agree on: Added sugar is bad. Excessive sugar intake increases risk of diabetes, liver and kidney damage, heart disease, cancer and death.
We have a food culture in America that drives bad choices. Food companies engineer their processed foods to be hyper-palatable, irresistible. They’re cheap, convenient and ubiquitous. No wonder they’ve dominated the American diet for decades—and caused a huge increase in disease.
Here is today’s version of the food pyramid. Notice that refined grains have been moved from the bottom to the top:
Should there be a soda tax?
When I was in law school, I took a course on Food and Drug Law. I gained an appreciation for the role government plays in regulating food products.
Helping consumers make healthier food choices—with lower intake of sugars, saturated fats, salt, and energy, and higher intake of dietary fiber and fruits and vegetables—is a big challenge in public health.
What can governments do?
Health experts see sugary beverages as the lowest-hanging fruit in terms of ways to lower sugar intake. A study found that sugary drinks cause 184,000 deaths worldwide annually.
New York City in 2013 proposed a portion cap rule, banning the sale of sweetened drinks larger than 16 fluid ounces. A court struck down the ban as exceeding the city’s authority.
At least four states—Connecticut, Hawaii, New York, and Washington—have considered imposing statewide taxes on sugar-sweetened beverages.
These measures are controversial. Critics say a soda tax would place an unfair burden on families that don't have access to healthier options, which are often not available in less wealthy neighborhoods. And studies have cast doubt on how effective soda taxes are as a deterrent to help lower rates of obesity.
What else might work?
Nutri-Score food labels
Better food labeling can help consumers understand nutrition information and identify foods that contribute to healthy eating patterns.
The EU has recommended that European countries adopt a Nutri-Score rating that grades packaged foods, from the healthiest “Green A” down to the “Red E.”
By categorizing foods and beverages into five colors that reflect their overall nutritional quality (i.e. “healthier” or “less healthy”), the Nutri-Score may help people choose food products of higher nutritional quality.
Some experts believe Nutri-Score is a flawed approach. My friend Megan works in nutrition at Johns Hopkins Bloomberg School of Public Health. She said:
“We recommend front-of-package warning labels over systems like Nutri-Score for many reasons—one is that consumers don’t readily understand scoring systems that combine a whole bunch of information behind the scenes.”
Megan highlighted some other limitations of Nutri-Score:
“It gives points for fiber and other positive aspects of foods, which the food industry exploits so buttery, salty popcorn (for example) receives an artificially higher letter because it’s “whole grain.”
And the other biggest issue—the rainbow! It’s so pretty. Consumers love it. But it is not as effective as black and white warning labels. Why? Because colorful labels don’t stand out on colorful packages, which the food industry knows!”
The FDA’s new food labels
In April 2022, the FDA updated the Nutrition Facts label on packaged foods and drinks. It’s the first major update to the label in over 20 years:
“Calories from Fat” has been removed, because research shows the type of fat consumed is more important than the amount.
“Added Sugars” in grams and as a percent Daily Value is now required on the label.
Vitamin D and potassium are now required on the label, because Americans do not always get the recommended amounts.
The FDA is looking at rolling out a new “healthy” symbol for food manufacturers to validate their nutrient content. It’s part of the FDA’s broader efforts to help reduce the burden of diet-related chronic diseases and advance health equity.
What we can learn from Chile
Chile has been a pioneer in adopting better food labeling.
In 2016, Chile was the first country to implement a mandatory, national front-of-package nutrient warning label policy. Chile’s law mandated that food companies restrict marketing to children, and banned school sales for products high in calories, sodium, sugar, or saturated fat.
A centerpiece of the rules is a series of black stop signs that must appear on the front of packaged foods and beverages high in salt, sugar, fat or calories.
“The warning labels from Chile are considered most effective by most global health nutritionists,” said Megan, from Johns Hopkins School of Public Health.
A study last year found that Chile’s labels are working. Chileans consumed fewer calories and less sugar, sodium, and saturated fat from unhealthy food and beverage purchases after implementation of the new law. The labels are so clear to consumers that evidence shows even kids warn their parents not to buy such products.
Peru, Uruguay, and Israel have adopted Chilean-style front-of-package labels. A dozen other countries are considering them as well.
Getting people to adjust their eating habits is hard. The food we eat reflects our culture, our values. Nobody wants to be lectured about what they should be eating.
Yet public health leaders must do something to respond to the skyrocketing rates of disease caused by added sugar and ultra-processed foods.
We regulate things like tobacco and environmental pollution because they cause what economists call “negative externalities.” They go beyond the individual user and have far-reaching impacts on public health.
The same is true for added sugar. The processed food industry is responsible for our nation’s epidemic obesity / diabetes / heart disease, and all of us shoulder the immense healthcare costs associated with it. Government should intervene when you have a public health crisis of this magnitude. That means regulating Big Sugar.
I’d love to hear your thoughts. What role should government play in educating the public on nutrition and guiding people toward healthier eating habits?
Until next time,
By Daniel Zahler
Hi there! Thanks for reading. If you stumble on my newsletter, you will notice that I write about health and wellness trends, and strategies & tactics on how to optimize cognitive, physical and emotional health. For 10 years I’ve helped the world’s leading healthcare and life sciences companies develop innovative new solutions to improve health globally. I have worked as a biotech investor at RA Capital, a McKinsey consultant, and a tech entrepreneur. I was trained as a research scientist at Harvard College and Yale Medical School, and serve as a GLG council member advising global business leaders on healthcare innovation.
Check out my articles in Thrive Global here.
Enjoy this?
There are a few things to do:
Follow me on Twitter.
Hit reply with your feedback and ideas :)
Share this post with others.