Institute of Medicine. 2012. Front-of-Package Nutrition Rating Systems and Symbols: Promoting Healthier Choices. Washington, DC: The National Academies Press

Relevance and background

Over the past half century, food preparation methods and consumption patterns have moved steadily away from reliance on relatively simple, basic foods to dependence on more prepared, processed, and “convenience” foods. At the same time, nutrition concerns in the United States have transitioned from primarily nutrient deficiencies to a combination of positive energy balance, nutrient imbalances, and overconsumption of food components associated with chronic, degenerative diseases. Consequently, since the early 1970s and in response to the 1969 White House Conference on Food, Nutrition and Health, the FDA has responded to consumer demand by requiring certain nutrition-related information be provided on food packaging. What is required and how it must be presented has evolved tremendously since that time, but the main goal of federal regulations in this regard has remained the provision of consumer-friendly nutrition information to improve health.

In one of its most recent attempts to accomplish this goal, Congress directed the CDC to undertake a study in collaboration with the Institute of Medicine (IOM) to examine and provide recommendations regarding front-of-package nutrition rating systems and symbols. This initiative was implemented in 2 phases. In Phase I, an expert committee reviewed front-of-package systems being used in the United States and abroad and considered their purpose, overall merits, and scientific underpinnings. Among other findings, they concluded that the most critical nutritional components to include in front-of-package nutrition rating systems are calories, saturated fat and trans fats, and sodium; they found insufficient evidence that other nutrients and food components (including total fat, cholesterol, added sugars, vitamins, and minerals other than sodium) should be included. After the publication of the Phase I report (IOM, 2010), Phase II was collaboratively commenced by the CDC, FDA, and the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion. The findings and recommendations of the Phase II initiative are the subject of the publication reviewed here.

Summary of findings

In light of several important publications released after that of the Phase I report (e.g., 2010 Dietary Guidelines for Americans), the committee concluded that “added sugars” should be added to the roster of nutritional components to be included in any front-of-package nutrition rating systems. They also identified 4 characteristics universal to most successful front-of-label systems: that they be simple, interpretive (as opposed to simply factual); ordinal (as opposed to cardinal); and easily identifiable and remembered by the general public. As a comparison, they suggested the development of a labeling system similar to the U.S. Environmental Protection Agency’s and Department of Energy’s Energy Star program, which effectively identifies, compares, and contrasts household appliances in terms of whether they deliver high-quality performance while saving energy and reducing operating costs.

At the conclusion of its deliberations, the committee developed a set of characteristics deemed necessary for a successful front-of-package nutrition rating system (described in the following). They also concluded that the system should in some fashion indicate the extent to which the product does or does not exceed acceptable levels of saturated/trans fats, sodium, and added sugars—the 3 food components deemed of special concern to the health of the U.S. population.

Recommendations for systems and symbols

Acknowledging that no system or symbol is flawless, the committee concluded that a single, standardized system that is easily understood by most age groups and appears on all food products is both desirable and feasible. As such, they recommended that the FDA and USDA develop, test, and implement a system with the following overarching characteristics.

  • The system should feature a simple, standardized symbol that effectively translates selected information from the Nutrition Facts panel to the consumer; information on the front-of-package labeling system, and Nutrition Facts panel should be mutually reinforcing.

  • The system should display (1) calories in common household measure serving sizes and (2) a measure of nutritional “points” based on the amounts of saturated/trans fats, added sugars, and sodium that they contain, with 0 and 3 points being the least and most healthful, respectively. For example, a food with levels of saturated/trans fats, added sugars, and sodium all below specified cutoff values would get 3 points, whereas a food with acceptable sodium and added sugar contents but excessive saturated/trans fats would earn 2 points. Products containing saturated/trans fats, added sugars, or sodium at levels in amounts exceeding specified criteria limits would not be eligible for any points.

  • The chosen symbol and information should appear in a consistent location on all grocery products, for example, on the upper left corner.

  • All information provided should be consistent with current nutrition labeling regulations.

  • The system should be re-evaluated frequently.

Examples of possible symbols are provided, although the committee did not endorse any system or graphic over another. In addition to delineating the general attributes of what they predict will constitute a successful front-of-package labeling system, the committee recommended that the implementation of any such system include a multistakeholder, multifaceted awareness and promotion campaign featuring ongoing monitoring, research, and evaluation.


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