FOOD AND DRUG ADMINISTRATION AND
DEPARTMENT OF HEALTH AND HUMAN SERVICES,
"EXPLORING
THE LINK BETWEEN WEIGHT MANAGEMENT
AND FOOD LABELS AND PACKAGING"
Thursday,
November 20, 2003
Lister
Hill Audutorium
National
Institutes of Health
Bethesda,
Maryland
[TRANSCRIPT
PREPARED FROM A TAPE RECORDING.]
C O N T E N T
S
WELCOME 3
OPENING REMARKS 12
FRAME WORKSHOP AND CHARGE TO PARTICIPANTS 26
"CURRENT FDA FOOD LABELING POLICIES" 30
"CONSUMER INTERFACE WITH THE FOOD LABEL" 50
"FOOD INDUSTRY PERSPECTIVE ON CALORIE MODIFIED
PRODUCTS AND FOOD LABELING" 63
"HOW DOES NUTRITIONAL LABELING AFFECT CALORIC
INTAKES?" 80
"HOW PACKAGING UNKNOWINGLY INFLUENCES CONSUMPTION
AND CALORIE INTAKE" 97
"HOW DOES THE CURRENT LABEL AND PACKAGING HELP OR
HINDER THOSE ENGAGED IN WEIGHT-LOSS PROGRAMS?--FROM WEIGHT WATCHERS" 119
"HOW DOES THE CURRENT LABEL AND PACKAGING HELP OR
HINDER THOSE ENGAGED IN WEIGHT-LOSS PROGRAMS?--FROM
A GENERAL DIETICIANS PERSPECTIVE" 138
"WHAT LABELING OR PACKAGING CHANGES WITH RESPECT
TO WEIGHT MANAGEMENT MIGHT STIMULATE PRODUCT REFORMULATION DECISIONS?" 159
WHAT CAN BE LEARNED FROM EXPERIENCES WITH LOGOS OR
CERTIFICATION?--THE CASE OF THE SWEDISH KEY HOLE" 183
"MARKETING THE LABEL TO CONSUMERS" 199
FOOD PACKAGING AND LABELING 209
FOOD PACKAGING AND LABELING: Q&A 244
RESTAURANTS 282
RESTAURANTS:
FIRST Q&A SESSION 326
RESTAURANTS PANEL, CONTINUED 341
P R O C E E D I N
G S
WELCOME
MR. LEVITT: The microphone
is working up here. Are we on? Rich Williams, can you hear me back there?
MR. WILLIAMS: Yes, I
can.
MR. LEVITT: Okay. Terrific.
Good morning, everyone. My name
is Joe Levitts. I am Director of the
Center for Food Safety and Applied Nutrition at the Food and Drug
Administration, Department of Health and Human Services. And it is my pleasure to welcome you to
today's workshop entitled "Exploring the Link Between Weight Management
and Food Labels and Packaging."
Today's meeting is being co-sponsored by the Food and Drug
Administration, led by the Obesity Working Group, which Dr. Lester Crawford
chairs, and I'm the vice chair, as well as the Office of the Secretary, Office
of the Assistant Secretary for Planning and Evaluation in the Department of
Health and Human Services. And in a
moment, I'll have the pleasure of introducing Ms. Ann-Marie Lynch, who is a
Principal Deputy Assistant Secretary for Planning and Evaluation.
This reflects the very top priority that the obesity issue is
receiving by the entire Department, led by Secretary Tommy Thompson, as well as
within our agency, led by our Commissioner Dr. Mark McClelland.
This past summer, FDA established an obesity working group, and
we are moving ahead rapidly. We've
already held a public meeting in October, also on the NIH campus. And, of course, our workshop today. We have a public docket, and we are
receiving comments; and we'll urge additional comments following this meeting
to be submitted there for our collective use.
And, as people I think by now know, we're moving on a fast
track, and our final report is due to the Commissioner on February 12th of
2004.
Today's agenda has three parts.
Part One is short opening session.
As I said, following me, we'll also have a welcome by Ms. Ann-Marie
Lynch, followed by our keynote presentation by FDA Deputy Commissioner Lester
Crawford and our charge to the group by Tomas Philipson, Senior Advisor in the
Commissioner's Office and a Visiting Scientist.
The bulk of the morning will be devoted to prepared
presentations. We have a blue-ribbon
list of people from FDA, from industry, from academia, from the weight loss
community, even from foreign countries.
And in the afternoon, we are going to get a little more informal and
convert the session into two roundtable discussions, one dealing with the food
label and packaging, and the second dealing with restaurants.
We want to be very clear that FDA is looking at both of these
areas. What can we do dealing with food
labels and packaging, and what can be done vis a vis restaurants, recognizing
that we need to look at the obesity issue as a whole, looking at both diet
issues, as well as exercise issues.
And, yes, somebody asked me, I do have on my pedometer today. And was able to walk over from the Metro.
So, we're trying to do our part.
As always, a lot of work goes into putting together a meeting
like this. I want to thank three people
in particular. First, is Rick Canady
from FDA, who's sitting right over here.
Second, is Lana Bush, from ASPI, who is right behind him. And the third is Amber Jessup from my
center, who is right back there in the middle.
So, thank the three of you. We
know how much work it is to put on a meeting like this.
Finally, I have just a few housekeeping announcements from the
house here, so it's listed up here.
Number one, no food or beverage is allowed in the auditorium. Number two, there is a message desk phone
number. It is as follows: 301-496-4062. Three, pay phones are located behind the Visitors' Center. Four, when we do get later into the area of
interactive discussion, there is a microphone.
You need to press the "MIC" button, and I think you'll see it
flash up red, so you know your microphone is on. I think by now all presenters have checked in at the preparation
room. And finally, for those who do not
have an NIH or a FDA ID, even though I have one, everybody in the building is
required to wear their pass for--visitor's pass for security purposes.
With those introductions, it is my pleasure to introduce to you
Ann-Marie Lynch, Principal Deputy Assistant Secretary for Planning and
Evaluation, DHHS. I need to embarrass
her for just one moment with her background.
Ann-Marie advises the Secretary, Tommy Thompson, on health
policy initiatives and is responsible for major activities in the areas of
policy coordination, legislation development, policy research and evaluation
economic analysis. She joined the
Administration in June 2001 as a Deputy Assistant Secretary, Office of Health
Policy. Prior to joining the
Administration she had significant public and private sector experience,
including serving as staff director of the Health Subcommittee of the U.S.
House of Representatives Ways and Means.
Ms. Lynch holds a master's degree in economics from Duke University,
and a bachelor's in economics from Fairfield University. Please, a warm welcome for Ann-Marie Lynch.
[Applause.]
MS. LYNCH: Great. Good morning. I'm delighted to be here, and welcome you to this wonderful
conference. I just wanted to start with
a few comments.
First, in looking at the latest available information, we find
that seven out of ten individuals die each year of a chronic disease. More than 300,000 Americans will die this
year from obesity-related heart disease, diabetes, and illnesses directly
affected by overweight or obesity.
In the year 2000, the total annual cost of obesity in the United
States was estimated to be $117 billion--that includes direct medical care
costs.
Currently, about 15 percent of children and teenagers are
already overweight, and excess weight significantly increases our children's
risk factors for a range of health problems, including diabetes, heart disease,
asthma, and emotional mental health problems.
The good news is that obesity and co-morbidities are preventable
through healthy eating, nutritious food in proper amounts, and physical
activity. And the bad news is that many
Americans are not taking the steps to prevent obesity and its co-morbidities.
The Administration has put forth a prevention agenda focused on
a healthier U.S., which promotes four fundamentals of good health. These are:
physical activity, healthy eating, regular preventive checkups, and
avoiding risky behaviors.
Secretary Thompson supports the Administration's prevention
agenda through the Steps to a Healthier U.S.
Steps emphasizes innovative community activities, in cooperation among
policy makers, local health agencies, and the public to invest in disease
prevention. And in September of this
year, the Secretary announced 12 Step grants, totaling more than $13.7 million,
strictly to promote community initiatives to promote better health and prevent
disease.
Our Administration is committed to community-based,
evidence-based, scientifically-sound public health policies and initiatives
that ensure that our nation's health and well being exist for today and most
important for the future. And we are
pleased to have a role here today in helping the Secretary achieve his goal of
ensuring that Americans are strong, healthy, and independent.
We're working with the FDA to explore the connections between
food labeling and weight management; and, to assist them, we've developed a
focused research agenda addressing fundamental questions about the association,
if any, between nutrition information on food labels and weight management in
the U.S. population.
We're pleased to sponsor the workshop, at which we hope will
examine the available evidence to identify the options for providing
information to consumers' weight management decisions.
And right now, I'm pleased to introduce to you Dr. Lester
Crawford. Dr. Crawford brings a
tremendous amount of experience to his position as Deputy Commissioner of the
FDA. He has served as the head of the
FDA Center for Veterinary Medicine, Administrator of the Department's
Agriculture, Food Safety, and Inspection Service, and the Executive Director of
the Association of American Veterinary Medical Colleges.
During 10 years at FDA and USDA, he played major roles in the
mandatory nutrition labeling, the Guaranteed Agreement on Tariffs and Trade,
and the controls of chemicals and microorganisms in the food supply.
Most recently, he served as director of Virginia Tech Center for
Food and Nutrition Policy. He's also
served as Executive Vice President of the National Food Processors Association;
Chairman, Department of Physiology and Pharmacology at the University of
Georgia. He has a doctorate in
Veterinary Medicine from Auburn University, and also earned a Ph.D. in
Pharmacology from the University of Georgia.
His honorary doctorate is from Budapest University. So, with that warm up--I'd like to
[inaudible] Dr. Crawford. Thank you.
OPENING REMARKS
DR. CRAWFORD: Thank you
very much, Ann-Marie.
[Applause.]
And thank you also for your inspired leadership with respect to
this conference and for your sponsorship of it. We appreciate that very much, and it's always great to be working
together in the Department of Health and Human Services. I've been in Health and Human Services three
other times, and two of those three times the FDA did not have diplomatic
relations with the Department. So,
we're happy for what you have done to bring all that together. It's very much appreciated.
And thanks to Joe Levitt for his leadership. We--Joe and I have found ourselves appointed
by Commissioner McClelland to two impossible task forces. This is one of them. The previous one was the health claim ones. But, through Joe's leadership, we actually
produced something useful out of that one.
It was a surprise to me. But I
think it's going to work, and I think this is going to work, too. And we've got a major problem, as all of you
know, on our hands here. And that does
not happen to do with my use of the slides.
We probably are going to move our little cursor around here. That's okay.
MR. LEVITT: Of course,
figuring out how to move it is challenge.
DR. CRAWFORD: I think
I'd use my middle finger.
MR. LEVITT: It's the one
that says Koestler on there.
DR. CRAWFORD: All right,
Rick, the next thing is the second slide.
We'll just do it this way.
Perfect. Yes. You do the left to the right. The thing in the middle.
We had a meeting this past weekend in Boston that many of you
are familiar with is the Harvard food meeting that takes place every year under
the leadership of former Secretary Glickman of Agriculture and Professor Ray
Goldberg of Harvard. And in that
meeting, this is the 10th year of it, and a careful glance at the record, which
is memorialized in a book I suppose each year, reveals that throughout the
preceding nine years, there's never been a mention nor a paper on obesity. This past weekend, 10 of the 16
presentations were on obesity and several interesting things came out of that.
There was a person invited who was from the National Health
Service in England, and her summary comment was that she believed that in the
very near future that obesity, as it occurs today in England, which is about
what it is here, would wreck their National Health Service; that there was no
way they accommodate the increase in health claims and payments and in the
infrastructure of that system. She
thought it was going to be compromised by the obesity epidemic in that country.
And then the Deputy Minister of Agriculture of Canada made an
even more ominous conclusion, based on his study of the situation in
Canada. We always think of ourselves as
the only one having this major public health problem. He believed that in their country and perhaps in others that for
the first time in the last 100 years that the longevity increases that are
announced at the end of every year by the World Health Organization were going
to decrease in their country and perhaps in much of the developing world.
In our country, we're having 300,000 obesity-related deaths per
year. We believe that can only
escalate, and we have to be prepared.
Now, the other thing that must be said is that out of the flavor of that
meeting and out of our general meeting on this subject, which we held earlier,
it is clear that it is very easy, very tempting and facile, and, I think,
useless to continue to blame the food industry as a victim in this kind of
thing for some reason. We all eat the
food. We all have freedom of choice. This country is certainly free in that
respect. And if the portion size is too
large, it doesn't take a very high intellect to understand that if you're
gaining weight at the rate of 12 pounds a month or something like that, that
this might be a little too much for you.
So I think we need to stop--we need to hold harmless the food industry
as they join together, as they certainly are today, they did in the first
meeting, and they did in some follow-up meetings to this as we move forward
towards a mutual solution. If we blame
the psychiatrists of the United States or the food industry of the United
States or the medical profession or the dietetic profession, than we will get
nowhere, because we'll balkanize those interests, and there won't be any
unifying message that we'll go forward with.
So let's get off that, and in order to begin that, we're going to go
forward.
Now, the obesity epidemic, as is mentioned here--we have now
completed our circuitry through the slides.
[Laughter.]
And with many thanks to you for being here today, Mr. Levitt.
[Laughter.]
Here we go. I got it. Don't worry, Rick. You can--over 30 percent of the U.S. population--Ann-Marie
mentioned some of this, and the body mass index of 30 or higher is what we're
going with here. Thirteen percent of
children, which is a doubling of what it was when NLEA was passed some 10 years
ago, and the deaths I've already mentioned.
And we'll talk further during this session and elsewhere about
co-morbidities.
The Obesity Working Group has a charge for the Commissioner,
which is from the Commissioner, which is publicly available. Also, his excellent speech at the general
meeting, which was held about a month ago, is still getting a lot of
currency. It was mentioned this morning
in the Washington Post, in the A-section, and will be again around the world,
and that is something that we believe is an enlargement of our charge and also
an indication of the seriousness that he and Secretary Thompson take this to
be.
The--we have a six-month time frame. We met yesterday with the Department officials about whether or
not we're going to achieve this, and what we're going to do with it when it's
accomplished. But we're on that time
frame, and we're obligated to finish by then.
And we haven't talked yet, Mr. Levitt, it was reamplified
yesterday. We have only that amount of
time.
We have an act--developed an action plan, and this is from the
charge, to develop a clear, coherent, and effective public health message. And the rest of that sentence was that
unifies all the various sectors in solving this problem.
We need a public education program. Many people believe that the "E" in NLEA has never
really been fully utilized, and I would be one that would agree with that. I remember when we were working on
NLEA--the--my part of it was in the Department of Agriculture. We did not need the law in FSIS for meat and
poultry. What we needed was simply a
declaration by the Administrator through the delegation of authority from the
Secretary. And we imposed this. I remember when we were talking about it, we
planned a major public health information program just from FSIS, which was
funded at the $4 million category. And
I don't think that was ever completely funded, and it needs to be; and then
perhaps even that figure was modest, because as we looked through this
particular exercise that we're going through now and how many people actually
read the food label, we find the figures to be disturbingly low. And we also find it to be associated with
people who have a real medical need to read the food label, like diabetics and
people with metabolic diseases of other sorts.
And I think that we have to take some of the blame for that in the
Government and probably also in the food industry and in the supermarkets.
But the--we don't need blame.
We need a positive message going forward. Enhancing the food label, if you're going to enhance it, it can't
be like the Sears Roebuck catalogue. It
must be targeted. It must be
readable. It has to accommodate people
that have to wear bifocals. It has to
be something that gets the job done, and just changing it willy nilly is not
what we're about. But I would be
surprised if in the Obesity Working Group report on February 12th of 2004, we
don't have something in there about recommendations on the food label.
The dialogue with the industry is going on. We're following this up with two other focus
group sessions before the end of the time that we have to finish the report.
Then we're also facilitating the development of more and better
therapeutics. The Center for Drug
Evaluation and Research is very much a part of our obesity working group, and
they're weighing in with the latest information, and also the realistic
projections of how good these medical devices and drugs are going to contribute
to the solving of this problem.
And I think we can't rule out the fact that there is some sort
of magic potion there. The research on
leptins and various other compounds is very encouraging, but there's nothing in
the bottle yet, nor in the syringe.
Then identifying research on healthier foods and consumer
behavior is certainly going to be a major part of it. Then we have to enlist the help of the stakeholders. When it's all said and done, the authority
of FDA to solve this problem is not the same as we have to solve an illegal
drug problem or an illegal food supplement problem, or something like
that. This is going to be involved I
think for a long, long time, and the tools that we have at our advantage are
some regulatory power, but mainly moral suasion and scientific suasion.
The public meeting, which was held on October 23rd, just about a
month ago, explored six key questions.
And the respondents, for those of you who weren't there, were asked to
comment on these things.
The effectiveness of the education campaigns. Has that ever been vetted? Has it ever been evaluated and audited. And the answer seems to be no. But the question is, how do you do that?
What are the most urgent
research needs of the National Institutes of Health.
Evan Hubbard is here today, and he has been very much a part of
the planning of this and the development of it. And there are certainly research needs that will be listed in the
final report. We need to know about
those from you, and we need to include them in the report in terms of the
recommendations to the Commissioner, and ultimately to the Secretary.
Data. What data exists
on obesity prevention and treatment through behavioral and medical
interventions. That also should be a
major part.
Changes needed in food labeling to stimulate development and
consumption of lower calorie foods.
When we talked about calories at the time of NLEA, when the Commissioner
of FDA and the Administrator of FSIS did a country-wide tour of hearings at
major medical centers and elsewhere, which took about six grueling weeks, we heard
a lot about the calorie content. But we
heard mostly about fats. And we heard
almost nothing about carbohydrates. And
the passion about fats in the year 1993 was extraordinary. It was, I think, we deluded ourselves into
believing that if we could just get prominent labeling about fats and the
division between saturated and unsaturated fats that people would read the
label and wind up being svelte and happy forever. That did not turn out to be the case, and we probably erred, if
we erred, we erred on behalf of the prevailing sentiment in the medical and
nutrition community. And I would say
also, looking back on those hearings and rereading some of the transcripts, we
heard inspired commentary from just rank and file individuals. And that's what we need to hear again. They weren't necessarily nutritionists. They weren't physicians, but they were
impassioned about the problem of not being able to look on the label and find
out what was in the food, from a nutritional point of view.
And then what opportunities are there to develop healthier foods
and what can FDA do to reduce overweight and obesity. Within our authority and within what expect FDA to do, what can
we do?
Now, the stakeholder engagement, we've already--I mentioned
these first two meetings, of course.
We're having a consumer roundtable to follow this up. All of these meetings are open to the
public. They're not--we're not
sequestering any group. And then we're
having the medical community roundtable, and then the Secretary's Prevention
Summit is in early 2004. And Ann-Marie
and others in the Department will be heavily involved in that. And I suspect that our report, if it's well
received, will be major part of that.
The qualified health claims initiative also is part of
this. That came out of the first task
force that Joe and I headed up.
Putting more information on the food label, stimulating
competition based on health effects, a part of that. Increased consumer consciousness of food's impact on health.
We think we're getting there.
Commissioner McClelland has, again, made a number of speeches in various
sectors, particularly within the medical community, and he's proclaimed,
convincingly, that, of all the things that FDA is inspired to do and required
to do, that prevention through nutrition is probably the most effective public
health tool at our disposal.
You can mention vaccines as something that's very important, but
no less important is nutrition and nutrition information.
We have to meet three conditions. We have to have some degree of scientific evidence for health
claims. It has to be pre-approved by
FDA, and the labeling cannot be misleading.
Now, at this point, I'm going to pause, with gratitude to the
Chairman and to everyone involved in this, particularly the audience; and
introduce Tom Philipson, who is an economist working at FDA, on a sabbatical,
who has brought commonsense, good judgement, and fine taste to the Food and
Drug Administration. He's from the
University of Chicago, and, Tom, it's all yours.
FRAME WORKSHOP AND CHARGE TO PARTICIPANTS
DR. PHILIPSON: I'm going
to be very brief, sort of setting the charge of the conference and also taking
care of some logistical details because I'm going to be the main time police
once we get going here, to discipline people to stay within their time.
As Lester mentioned, the Obesity Working Group has organized
this conference. This is part of--this
is a part of the effort of the Working Group, which, again, was launched in
August, and we'll have a final report in mid-February.
And in sort of setting the stage for today's conference, it
was--we sort of came to this with a belief that the emphasis should be very
much on the science as opposed to sort of opinionating around the topic. So, we're really interested in what people
have to bring in terms of facts to bear on this topic of labeling obesity.
We're coming to the topic of labeling obesity in a sort of--on
the Obesity Working Group in a sort of perspective where we're currently
labeling products. And, for good or for
bad, that's very difficult for some consumers to be able to handle, to learn
about their diets, which are daily diets or weekly diets, in an efficient
manner. So the type of labeling that we
currently have is sort of not as consumer friendly, if you want, as you would
like it be in order for people to understand the impact, in particular, for
example, the caloric impact of their diet, and the [inaudible] on obesity.
So, the conference was organized to try to understand, better
understand, how current labeling is actually used by people in managing their
weight and also whether new forms of labeling can help them do so better.
And, as you noted on the program, we've included restaurants in
this conference. And the whole basis
for that was that we wanted to think about, in a constructive manner, how to go
from product-based labeling, which we're currently doing, into higher level
labeling of meals, which could potentially more easily be used by consumers to
learn about their diets.
So, as Lester emphasized, this is not a blame of a restaurant in
any way or another. It's all about
trying to facilitate for consumers to learn about their overall diets instead
of using current product labeling to go up on a more aggregate level by
potentially thinking about ways in which information could be provided, whether
through the private sector or public sector, about their meals or potentially
about their overall diet.
So, in that--with that background, we have sort of two agendas
within that--we're considering the package foods, both in the morning and the
afternoon, and then additionally, we're considering restaurants, which is, of
course, sort of the new area that we're trying to learn about here.
There's going to be a report of this conference that will most
likely be part of the final report of the Obesity Working Group. But also we're accepting comments for the
conference until December 12th, and there should be a web site in the packet
indicating where public comments are available.
We're particularly interested in those for the morning session,
because there will be--due to time constraints--there will not be any public
comments or public participation or audience participation in the morning. There will be some limited audience
participation in the afternoon regarding the panels.
There will also be a transcript of the minutes--or minutes of
the conference also on a web site provided in the packet.
With those logistics in place, I'd like to start the program,
and, like I said, I will be sort of prodding people. There's a pretty--very tight schedule if you open the program,
you'll see that we have a lot of speaker to go through, both in the morning and
in the afternoon.
But I'd like to start off with introducing Christine
Taylor. She's Director of the Office of
Nutritional Product Labeling and Dietary Supplements in the Food Center for
Safety and Applied Nutrition at FDA.
She will talking about current FDA food labeling policies.
"CURRENT FDA FOOD LABELING POLICIES"
MS. TAYLOR: Good morning
and thank you very much. It's indeed a
pleasure to be here, and I confess I'm going to need some technical help to get
my program up.
I'm pleased to be here despite the fact I have the rather
daunting task of in 15 minutes trying to set the whole context for the label
and what it does in terms of calories.
So, bear with me as I try to set that context, because I think it's an
important.
UNIDENTIFIED SPEAKER:
Use the wheel. Go down.
MS. TAYLOR: Excuse me,
I'm doing a remedial read. If we can
start at the beginning. Great. Thanks
an awful lot.
Anyway, please do bear with me as we try to make a kind of
contextual background for the discussion we'll have today. I think it's always good to start off with a
few simple definitions, and that is the fact that when you say "the
label," you're really talking about a lot of things. There is, of course, the nutrition label,
which is the infamous facts panel that I suppose most of us are very much aware
of, at least those of use that work at the agency. It's a required component of the packaged food label in the
U.S. It had its start really for very
different reasons than perhaps we're talking about today in 1971. But it really got its basis in 1990 with the
Nutrition Labeling and Education Act, which allowed the agency to create this
mandatory component of the food label.
With that, we also got voluntary provisions for claims on
labels, which I think also plays a role in some of the issues we're tackling
today.
But when you do say the label, just to keep in mind there are
other things that are part of the label.
You have product identification.
You have ingredients statements.
You have manufacturer contact information. You have other statements on the food label; things such as may
contain peanuts, and other things such as that.
So, the label itself is a fairly diverse unit.
What I'm going to try to do today--these are my touchstones--is
to give you a little bit o the conceptual underpinnings for how the label got
started in 1990, talk specifically about the current provisions for calories,
and then, at least from my perspective, talk a little about what we've been
hearing and what the future might hold in store.
Again, background definitions just so we are all aware we're
talking about the same thing.
When you talk about food labeling, you have the packaged foods
component, which is under the purview of FDA.
And it is generally required, with some exceptions.
You also have labeling on raw meats and poultry. That is withing the U.S. Department of Agriculture. Labeling for fruits, vegetable, and fresh
fish is a kind of voluntary program.
It's voluntary unless it's not done.
So, it's a hybrid in many ways.
And that's implemented through the use of poster signs, placards, where
fresh fruits, vegetables, and fish are sold.
And then there is the issue of restaurants. NLEA, the Nutrition Labeling and Education
Act, did not direct the agency to do anything about restaurants. And currently, there are no provisions in
place for restaurant labeling.
Probably the starting point for any kind of contextual
background would be the nutrition facts panel.
The theme, I think, we'll sound today, and you'll hear it from a variety
of FDAers, is that a lot of work went into developing that nutrition facts
panel, as well as the claims that were a component of NLEA. But there was a full recognition at the time
that we were just beginning; that it was a flexible environment in which we
were working. We were doing the best we
could with what we had at the time, and that things would change. We would get a better understanding of how
consumers interact with such things as food labels; and that, in the future,
there would be a set of issues that would need to be addressed in terms of how
best to improve the label. And I think
that's part of what's happening today.
Certainly, at the time research was done, the question is: was there enough research? No, there's never enough research done for
any of these things. But a considerable
amount of research was conducted at that time so the best possible label, as we
understood it, could be put out. There
was full recognition that to be useful, this is a label that had to be used on
all packaged foods, and I can't emphasize enough how the universal mandatory
requirement does influence what you can and cannot do with the label. And there was full recognition at the time
that it was to serve as a tool for a variety of endpoints. It had to derive from the health initiatives
we had at that time. But also there was
considerable interest in its being stable over time so that consumers could
have a uniform way of getting the message.
For those of you that need to be reminded what we're talking
about when we talk about the facts panel, this is the shortened version of
it. Larger packages are allowed to--or
required to have additional information.
But this is basically the nutrition facts panel in its simplest form.
The conceptual underpinnings for the facts panel I think are
important as we begin to think about the changes that might be in place if
calories are a particularly important component or some other kind of
information.
At the time, there was a great deal of interest in making sure
that this tool, the nutrition facts panel, matched what were current
recommendations for health initiatives.
And so, examination of dietary guidelines, health recommendations from
the Government, those things became the core component of the facts panel. And I do want to emphasize that many other
declarations were allowed voluntarily; that there was not at all an effort to
restrict it, but rather, given limited space, what was the absolute core amount
of information consumers used, and then, at the manufacturers' discretion, if
they wanted to list the 20 or 15 or however many nutrients that they felt were
important for their product. The label
had that flexibility.
The other component to keep in mind is that by going with what
were the general recommendations put out by authoritative bodies that allowed
the label to be stable over time, but we recognized that those recommendations
would change and that someday we'd gather in a room just like this to begin to
talk about modifying the label.
Another important part of the conceptual underpinnings for the
nutrition facts panel is a consistent format.
I remember those heady days very well where the design people were
probably as powerful as anyone else in the room in terms of how that label
would look. There was considerable
interest that it be the same kind of label for each and every food with the
things in the same place so that consumers could use it as easily and as
readily as possible.
There was a considerable amount of research done on the design,
and one of the other components at that time was a complete realization that we
were dealing with a lot of constraints in terms of space. And those were things that get lost
sometimes in the shuffle as you think about the label. But it is being asked to
do an awful lot in a very small space, and that's something to keep in mind.
Now, as we did think about the core component of the nutrition
facts panel, we did think a considerable amount about the consumer
interface. What we found from focus
group research was that the most useable information was, in fact, the numbers,
coupled--and that's an important thing to note--coupled with some kind of
context.
NLEA had told us to present the nutrition information within the
context of the total daily diet. And
that meant for us that we had to not just only give the numbers, because there
was evidence in front of us that if you put the number 100 milligrams in front
of a consumer, they're likely to read 100 milligrams as more than one
gram. So they needed it in some kind of
context. But quite clearly, what we got
from the focus groups was consumer interest in having those numbers
anyway. So you needed the numbers, and
you needed the context.
They felt that if we used pie charts, pictures, graphic signals
alone, they were somehow being manipulated.
They kept saying give me the numbers.
They wanted to feel empowered that they could make choices.
The context, though, we found was extremely important for how
these numbers were then interpreted by consumers, and, as it says here, we
coupled the numbers with the percent daily value.
That being the context.
Now, when we did the research in 1992, we did check to make sure
that the percent daily value, given that any tool you'll use will have
limitations and perhaps not work for all groups all the time, at least that the
percent daily value was better than the other options we had available--bar
graphs, pie charts, adjectival descriptors--high, low, medium in fat; high,
low, medium in sodium. Quite clearly,
the research at that time indicated that consumers felt much more comfortable
with the numbers and felt that the pie charts, the pie graphs or whatever were
in some way fooling them. We'd also
found from earlier research that things such as stars and smiling faces and
thumbs up and thumbs down, those kinds of things came out through the research
we had as being vague, condescending, and childish.
So we were finding that the consumers needed some kind of
numeric context; at the same time, we could see from how they were using the
label and interpreting the label, that they needed a context.
We also were faced with the issue of some of our context being
in the domain of a percent of calories; that many of the recommendations we had
were being driven by your caloric intake.
We had gone then through the National Academy of Sciences' referenced
daily allowances, dietary intakes, in order to try and come up with a number
for calories. And when we did a
weighted average of the Academy's caloric recommendations, we got a number in
the neighborhood 2,300 calories. We did
propose that number, but were convinced by comments that we should round it
down. And so, as you can see from
today's label, we're using as basis for the label, when calories are an issue,
the 2,000 calorie diet. You do see it
listed at the very bottom--whoops, the very bottom here, and then what it does
say is the percent daily values are based on a 2,000 calorie diet. This is for a slightly label where they can
also put the context of the 2,500 calorie label.
Finally, returning to conceptual underpinnings and the consumer
interface, as we've worked with consumers in the food label, as much as you'd
like to think that they would use the food label to build their diet, track it
during the day, that's very unusual.
You have to be a highly motivated person in order to use the food
package for that purpose. And they get
frustrated because frankly packaged foods are not the only thing they eat. You do have restaurants and other sources of
food that are not necessarily labeled.
So, the notion that the label has to address someone keeping a diary,
while it's a desirable endpoint, for some anyway, it's not really pragmatically
how the label gets used.
What we've seen is that they use the label to compare two like
foods. They use it to make a choice,
which really when you look back at NLEA that was part of what the purpose of
the label was for is to help consumers make choices. If they're going to eat cookies, they obviously compare, from
what we've seen, two packages of cookies.
They might compare ice cream to frozen yogurt, but they're not going to
compare ice cream to frozen broccoli.
It's just not a transition they make.
And consequently, you need to keep that in mind as you think about it. If you're thinking about red lights, green
lights, what does a consumer do if both bags of cookies have a red light on
them? What they're really wanting to do
is be able to compare them numerically.
At least that is what they've told us now, and I think there's always
room for more consumer research.
Lastly, in terms of conceptual underpinnings, the nutrition
facts panel is a tool. It assists consumers in implementing dietary choices,
and it was never intended to do the whole job.
That's different than being able to do a better job. But there is an expectation that people come
to the food label both motivated and perhaps informed. And we have to look at ways of how that
interface affects flexibility in terms of modifying the food label.
Also, clearly, it's a tool for many purposes. Consumers vary a lot. Their interests vary a lot. Their needs vary a lot, and the use of the
label undoubtedly varies.
One last footnote before we actually talk about the label itself
if that the Nutrition Facts Panel is based on serving size. We recognized early on that when the food
label was being constructed, the nutrition information had to be presented per
some amount. And, for a long time,
there was a considerable exploration of per recommended serving sizes; that it
would be incumbent on the agency to develop recommended serving sizes. We explored that option and ran into
incredible snags from someone saying, what do you mean you've got a recommended
serving size for cheesecake, all the way down to what would that mean for a
single label value.
So based on notice and comment rulemaking, as well as our own
efforts, we found that per recommended serving size was not a very viable
option at that point in time.
The other option that was also considered was per unit
measure. Many of you who may be
familiar with the European approach to labeling, it's in the domain of 100
grams. Our tests indicated that
consumers, in fact, had trouble with the per 100 grams because per 100 grams of
soup is not necessarily is per 100 grams of cookies. And so there was a comparison issue.
What we ended up with was on amounts customarily consumed, and
we had to go to existing food consumption databases and, through an incredible
resource-intensive effort, try to get average serving sizes for the data we had
from the 1980s.
By necessity, this is a very complicated, but critical, component
to the food label, and it had to go across the food supply. So, the notion here that serving size is an
easy thing to fix is something I want to just put on the table. But there are some questions about serving
sizes that I think do need to be addressed.
We have definitely had limited resources, and I would venture a
guess that there are a number of products out there that are inappropriately
labeled for our own rules, and we do need to up our resources to try and take
care of that. We do recognize there's
been a change in manufacturers' packaging practices. They're definitely using large single-serving containers than
they were in the 1990s, when we set this up.
And, while manufacturers can voluntarily declare the contents of the
entire package for their nutrition label, many don't. So, there's a question of what we need to do about that requires
such declarations, and then, of course, go back and consider in the last 10 or
12 years are Americans really eating a lot more and do we need to reconsider
what we've got for serving sizes.
Let me then just quickly so that I run out of time and eat into
Sue Borra's time, I'll go through then what we do have in place for calories on
the food label.
Starting right off, you can have calories per serving, and that
has already been mentioned by Dr. Crawford.
It's there, but, at the time, there was a considerable emphasis on fat
rather than on calories. And we even
included calories from fat. Also, at
that point in time, we didn't put any context for the calories. There is no daily value for calories. So the question is, is there a need for more
emphasis and do we need a percent DV.
Also it includes calories from fat. Just so you can visually see it, you have up in the very top of
the label calories, and then calories from fat. And here it is within the context of the whole label. You see it up there under amounts per
serving.
There is also the option or nutrition claims. Admittedly, they're done voluntarily, but
they do exist. There are nutrient content
claims, which characterize we've provided for calorie-free, low-calorie, which
is less than 40K cal per serving, and, of course, the infamous if it's low in
calorie naturally, then it needs to make reference to that. Celery a low-calorie food.
We have comparison claims.
Reduced calorie, an example being 25 percent fewer calories than our
regular yogurt. So, you have not only
the facts panel; you have these claims.
There's also, too, the option for other information for
nutrients that would contain, the maximum nutrients that would contain
calories. There are declarations for fats, carbohydrates, and proteins, but you
also have claims for fat, fat-free, low and fat reduced, lite, and claims
related to sugar.
Finally, before I end, the notion of health messages can't go
unmentioned. There is, of course,
always within the NLEA, the option for health claims, which is about a
relationship between a substance and a disease. None are now specifically authorized that I see as being
specifically related to the obesity problem, and I guess the question I have is
how attractive are these really. A
claim such as low-calorie diets may reduce your risk of obesity may not be
what's most grabbing for consumers.
We may need to look more at dietary guidance messages, things
along the lines of food patterns. Diets
rich in fruits and vegetables may help you avoid overweight, and those are
options I think the agency very much wants to put on the table as a way of
exploring the obesity communication issue.
Finally, my last two slides.
I do want to point out we have some lessons that we learned in
developing the food label, and that is very clearly anyone who worked on the
label will tell you that there was a plethora of commonsense suggestions that
made a lot of sense as we sat and listened to them for how the label would be
developed or implemented. I can't
emphasize enough the importance of research here. We had such surprising
outcomes when very logical things blew up on us, and I think that's because the
label doesn't operate in a vacuum.
Consumers did need to feel empowered in using the label. They were not entirely comfortable with a
no-brainer approach, and I think we have to be careful of that as we consider
our options for the future. But
skepticism crept in the strangest of ways.
A health claim on lasagna was not sellable to people. They would accept a health claim on yogurt,
but not on lasagna. Lasagna is not a
healthy food from their perspective, at least the research we had in front of
us.
The message about transfat that was tentatively put out by the
agency what it did in terms of detracting from the larger effort on saturated
fat. So, there's a certain need to be
wary as you move through this. There
are strengths to the label; that it's consistent and generally effective, and
its format is very iconoclastic, if you well, or iconic. And it has sustained itself over time. Its weakness is, and this is the message I
do want to leave you with, is that the calorie signal on the food label is not
as strong as it should be and certainly as it could be, and that we do need to
think about matching calorie declarations with this newer packaging. There are suggestions offered to FDA. They're not, in any way, meant to preclude a
larger discussion here, but just so you know that we have been receiving
messages from groups such as this.
Larger type size, bolding, more space, why eliminate the percent
calories from fat--is that really any longer appropriate. Provide a context for calories. Look at an accompanying graphic. If people like numbers and are having
trouble with the context, take a look at that.
Address the single-serving containers, which can be very misleading to consumers
and encourage health messages.
The challenge, as I see it, is to sharpen the calorie signal
without losing the desirable components of the food label.
So, thanks a lot, and I look forward to hearing the discussions
today.
[Applause.]
MR. PHILIPSON: It's
going to move right along. We have Sue
Borra. She's Senior Vice President and
Director of Nutrition, International Food Information Council.
"CONSUMER INTERFACE WITH THE FOOD LABEL"
MS. BORRA: Thank you
very much, and thank you for the opportunity to talk about my favor subject,
the consumer and how they interface with not only nutrition, but certainly the
food label. And thanks to Chris,
because she set an excellent stage to then take it from the standpoint of let's
look at the consumer and how they are viewing this. What's going on in their world, and what are some of the consumer
realities that we have to keep in mind.
And I did congratulate the meeting planners for putting the
consumer right up front in these discussions, because if we forget our ultimate
audience being the consumer, we will not succeed in this endeavor.
To understand that organization that I work with, the
International Food Information Council, our mission is a communications
mission. We want to communicate
science-based information on nutrition and food safety. And the work that we do is supported by the
broad-based food and beverage and ag industries.
However, to do a good job in communications on nutrition science
and food safety, we have to do consumer research. And IFIC does a tremendous amount of consumer research, as well
as looking at consumer research that's out there and available that we can
learn from as well.
So, for today, what I would like to share with you very quickly
is talking from the consumer perspective, what do consumers currently believe
about nutrition and healthful eating.
Where are they at in that continuum of information and knowledge? What do they say about using the food
label? What are they telling us that
they're doing? And, I think the final
and most important question that we have today: can consumer understanding and use of calorie and serving
information on food labels, can that be improved and what do we have to do to
get there?
So what are consumers' beliefs about healthy diets? I think this looks like the typical consumer
in the grocery store, trying to figure out what to do for that afternoon meal
or evening meal, and the questions that they come up as they're facing the food
shelves: things like I can't eat any
dessert snack foods or my favorite foods.
If it taste good, it must be bad for me.
Healthy eating takes way too much time and then 30 percent of
what? So that gives you an idea of how
they are faced with decisions in the marketplace.
From the FMI consumer trends, this is the 2003 data, a general
question was asked of consumers: how
concerned are you about the nutritional content of the foods that you eat? And in this year, we saw, what is that, 92
percent of folks saying that they were either very or somewhat concerned. But it's important to look at this trend
over a period of time of how people have been relating to issues related to
nutrition. This is the trending of the
folks saying they were very concerned since 1990. You see it reached a peak of concern, if you will, in 1992, at 64
percent, and we've been hovering around the mid-50s. But it means that we have a receptive audience to nutrition
information.
Probably more importantly about this question is what is it
specifically about nutrition that concerns you most, is the question that's
asked. And this is an unaided
answer. They can answer anything they
want. And, for the most part, dietary
fat, the concept of fat, is still top most in the mind of consumers when you
ask that question.
You seen some changes over the years; however, fat is far ahead
of anything else in that lump of the list towards the bottom. As you can see, calories is the purple
circle, and that's still not as top of mine as dietary fat.
So, if we're talking about issues about obesity and how people
can manage weight, we're going to need to see that calorie information and
interest move up.
Now, consumers--the good news is that they say that nutrition
and diet are important to them personally.
Eighty-five percent--that's a high level of folks--saying that they
think this is very important, and this is from ADA trend survey that was
released last year.
However, when you talk to them about are you making significant
changes to achieve a healthful diet.
Less than a third say that they're really able or making that change to
do something. So, we find that there's
a high level of interest, but the ability to put it into action is the key that
we have to understand and understand how can we bridge that gap for
consumers. How can we help them do a
better job?
And those of you who do focus group research and work with
consumers, this is the common thing that you hear. They believe it's highly confusing when you talk about nutrition,
and they always talk about--and "they." I always put "they" in quotes. Who's that?
"They" keep changing their minds. This is exactly what they tell us all the time, and this is what
they're faced with on just even on bookshelves in terms of how to eat a
healthful. Everybody has a different
answer they feel.
Now, what are consumers views on weight and health, because I
think this is important as we're talking about this idea of weight management
and how they're going to deal with this is in a labeling context. And this year, my [inaudible] Foundation did
conduct some consumer research with adults on how they were approaching this
whole issue of weight and health. And
some of the things that we found in this qualitative research is first of all
that consumers do have a broad view of health, and it includes things like
weight management and weight control and wellness. But it's a very broad definition for them on health. They see that--they have a commitment to
healthier living to improve their overall life adjustment, and they think that
this needs to be something that they have to do to make it last. So, while we still have an interest in quick
fix, when they really start to think about it, they know it's about
lifestyle. They know it's about
commitment. And one of the quotes
there, it's really a commitment to overall lifestyle is what we heard them
talking about.
Interestingly out of this research, we talked about information
needs, and consumers are feeling overwhelmed and bombarded with
information. They actually told us, I
think we know what we're supposed to do.
We--I have information that I know I'm supposed to eat better. I know I'm supposed to get more physical
activity. But I'm not doing it, so
please help me get to that point. And
it's things like motivation, helping them give the tools, the how-to's, versus
just general information; and they said that they would hopefully then be able
to do it in both terms of nutrition and physical activity.
Some qualitative research that we conducted this year, getting
into--we were actually doing some research on how they were perceiving transfat
labeling information, but in getting them ready to talk about it, we asked how
often did they look at the list of ingredients and nutrition information when
deciding which foods to purchase or eat.
And certainly, 54 percent said they always or almost always do it in at
least in this context; though about half of them do, half don't is probably
what the answer is.
We asked them what kind of information were they aware of on the
food package label. And this was
interesting to me were--can--the caloric information actually rated higher than
the dietary fat information. On other
surveys that I've done in the past, when you talk about food labels, they
usually talk about fat first. And this
was one of the first times that I heard them talking about calories first, so
that's showing that there is some changes that are occurring in the mind set.
And then we asked which of the following contents listed on the
nutrition label do you consider when purchasing a food, and this was another
interesting fact that calories did come up on top. Calories and fat were the top two, but they were definitely up in
there, and calories did rank.
Another fact from FMI trends of last year--consumer knowledge
and use of food labels. What do
consumers say they're doing. Well,
almost 80 percent said they are looking for and purchasing low-fat products so
that fat concept is still out there.
And 54 percent said they've started purchasing a product due to
information on a food label, just another way to look at how they're using this
information out there.
But while we're talking about nutrition and health, I think this
is one of the most important slides that I can put out all day; that the reason
folks choose foods, taste is the ruling component of it. We can have the greatest nutrition
information and motivation in the world, but if the food doesn't taste good,
it's not going to make it through the consumer's purchase habits.
Now, the concept of consumers understanding and use of calorie
and serving size, and there is lots of information out there for them. There's lots of resources, but this is where
I think we have a huge void in consumer research and consumer understanding,
and that we are going to have to do this research in order to be able to be
helpful in this process.
Last year, the Dietary Guidelines Alliance did some research on
consumers and portion size and serving size.
Just a couple of quick findings from that.
Consumers use those terms interchangeably. Portion size, serving size, they were aware
of these terms, but they were not concerned that they were that much
different. However, some would talk
about it and say, a serving size is what somebody's recommending me to eat, or
a portion size is what they actually do eat.
Very interesting in this research:
a lot of folks had really strong recommenda--feelings about who the heck
is telling me how much food I should eat.
It was almost indignant about who are they to tell me how much food I
should have in my diet, which we found that was very interesting and something
that we're going to have to deal with as we come up with information for
consumers. And one of the consumer
comments here: I think it's equal. If you take a portion of chicken, that's a
serving. One serving equals one
portion. However, another consumer
said: when they say serving size,
typically that's smaller than an average adult would eat. But a portion for me, if it's something I
like, might be the whole plate as opposed to the portion for somebody else.
They looked at, and I think you'll find this in many research
about consumers, is that they talk about serving size information on nutrition
facts panels as being impractical, and they don't really say--they say they
don't really use this information unless they're following a dietary regime. They talk about it in terms of if I was on a
special diet, or if I was really trying to reduce my weight, I might use
that. But most people, even if they're
overweight, don't think that they even necessarily have to be in that category.
They didn't feel that it was representative of what people
eat. Here's a great quote: the serving size on the box is always too
small. It's more for a child. You got itty-bitty servings. And then when you--they say, if I think
you're trying to watch your weight, then the serving size guidelines will be
very helpful. If you're not counting
calories or on that type of plan, then they're not much use.
So, in this need for consumer research, what are some of the
questions that we need to look at? How
do consumers, how do they actually really utilize calorie information on a food
label? Do they understand this concept
of energy balance or what can--does energy balance understanding really help
them in any way? Can calorie
information on a food label, can it impact behavior? Will it make some--help them improve their caloric intake? Are there ways to more effectively
communicate calories in the context of single-serving, multi-serving packages
that makes more sense for consumers?
And then what messages about calorie and serving size would be truly
motivational, not just informational, helping them to bridge the gap between
what they know and what they're doing.
And, in fact, I'm very pleased that GMA is going to make--Grocery
Manufacturers of America will be making a grant to the IFIC Foundation to
conduct this research that we're hopeful to begin in the beginning of the year,
so we'll be able to share that with our colleagues.
So, in summary, I think these are the key points I'd like to
take away with today that consumers are telling us that nutrition information
is important, but they are certainly telling us that it's difficult to achieve
healthful eating; and certainly the statistics on where we were on overweight
and obesity bear that out; that they tell us that they are using the food label
in making their food decisions, so it still has some relevance in use in
today's consumer world. But I do
believe that we do need consumer research to understand how consumers are using
calorie and serving information and how can we make that more relevant and
useful for the consumer in the future.
Thank you very much for the opportunity to talk today.
[Applause.]
"FOOD INDUSTRY PERSPECTIVE ON CALORIE MODIFIED
PRODUCTS AND FOOD LABELING"
MR. PHILIPSON: Thank you
very much. Next speaker will come from
industry, which is we're very happy to have here, and there's a lot of
discussion on what consumers want in terms of both foods and information. And, as opposed to my job, where my income
is not dependent on delivering what consumers want, industry actually has that
contingency. So we're very interested
in learning from them.
We're going to hear from Robert Earl, who's going to talk. He's the Senior Director of Nutrition Policy
at the National Food Processors Association, and he's going to talk about the
food industry's perspective on calorie modified products and food labeling.
MR. EARL: What do we
have to do to--anyway, while they're getting the technology up and running, I
want to thank the Food and Drug Administration and the Department of Health and
Human Services, Dr. Crawford, and Ann-Marie, and the FDA Obesity Task Force for
convening this important workshop to discuss these topics today.
I'm with the National Food Processors Association, and we are
the principal scientific and trade association representing the broad base of
the food industry, focusing on food science, food safety, food security,
nutrition, and health. And we have four
locations: here in Washington,
D.C. Our laboratories and support
facilities in Dublin, California, and in Seattle, Washington, and also in the
past year we have opened an Asia office in Bangkok, Thailand to represent more
global food interests in science and technology.
What we're involved with doing?
We're the voice of the $500 billion food processing industry on science
and public policy issues, on the issues ranging from food safety to nutrition,
technical and regulatory affairs, and consumer issues.
Our members produce the widest variety of food products, from
foods packaged and processed ranging from containers of glass cans, et cetera,
from beverages through dried, and boxed and canned other products. And also our members include suppliers of
technology to the food industry.
We represent the food industry on issues such as obesity, food
labeling, food science and technology issues, and provide research technical
services, education, communications, and crisis management support.
So the food processor's role in food labeling and also its use
in weight management. We produce a full
range of high-quality nutritious food products for American consumers. These products meet consumers' desire for
health nutrition, convenience, taste, and value. And just underscoring that taste and value are up there at the
top of the list, as Sue has mentioned, but also we're very much involved in
responding to consumer needs related to health and nutrition.
We're firm believers nutrition facts and other label elements
provide information that is there to be able to make caloric choices and
choices among food products. And this
is via on and off package nutrition education messages, not only through
information that our members use on food products, but also in other
advertising and marketing.
Back right around the passage of the Nutrition Labeling in
Education Act, NFPA was a leader in education about nutrition information on
foods. We led initial efforts about
using nutrition facts for food choices in our label facts for healthy eating
program. This was a joint cooperative
effort reviewed by the Food and Drug Administration, and by the U.S. Department
of Agriculture.
And just to underscore, again, that all food products, virtually
all of them, carry nutrition facts information. And this was a key effort in putting the "E" in the
NLEA, as several of our government speakers have already this morning, and to
provide a synergy between government and industry in overall labeling and
education efforts.
But again, Chris has used the food label, and just to highlight,
based on the topics that we're looking at today, the red circle. Serving size information up at the top of
the nutrition facts panel. Calories
from fat per serving. With it, where I
have the green arrow and circle. And
dietary pattern information--that's okay, I think--given the time, don't need
to turn around. Dietary pattern
information, down at the bottom when the full nutrition facts label is used.
But one of the other areas that Christine discussed earlier this
morning was that we have foods, and they are used in dietary modification. The food industry has responded to consumer
concerns and abundant options to meet diet and health needs, and these are done
principally through the use and formulation of all food products, but also
through the use of tools in nutrient content claims that appear on food
products. And we have nutrient content
claims that help consumers make choices, such as healthy, lean, light, and lite
related to fat and calories. And we
have reduced and low related to calories, fat, saturated fat, and sodium.
It's very difficult to assess the numbers of products that are
sold in the marketplace, but it is very clear:
all you have to do is to walk into a supermarket, open a consumer
magazine, listen to radio, or watch television, and you know that there is an
abundant and strong and vibrant sector of the marketplace in these types of
calorie, fat, and other modified products for diet and health.
And it's very important to underscore that the use and
understanding of nutrient content claims on food packages is a very important
aspect and key part beyond the nutrition panel in helping consumers make
choices.
Now, Sue has talked about use of food products and consumer
beliefs related to the importance of nutrition and health, and I want to just
highlight a couple of different sources of information to look at how consumers
use and feel there is an importance related to calorie information.
And this information comes from the Calorie Control Council lite
product survey. Consumers prefer
descriptors on these food products: low
calorie at 32 percent; sugar free, 29 percent; reduced sugar, 23.9; and diet at
13.8.
But what also is interesting how different sectors of the
population perceive and utilize these terms.
Individuals on diets and older adults preferred sugar free as the term for
signaling calorically modified foods, and adolescents preferred low calorie.
Again, other findings:
they also ask questions about fat descriptors and fat free was highest
in recognition and preference and then low fat, reduced fat, and lite hovered around
20 percent each. But overall, in both
categories, for fat and for caloric information, approximately 78 percent of
consumers felt that nutrient content was very important in making food choices.
And looking also at nutrition and self help. Prevention Magazine and the Food Marketing
Institute in 2001 did their shopping for health survey. One in seven consumers feel that eating and
choosing foods is important to staying healthy. Seventy-percent of consumers believe their diets could be better.
Barriers exist over confusion about nutrition, cost, and
convenience outside of the supermarket.
And some of these barriers perceived by consumers. There was a perception that healthier foods
are not readily available outside the grocery store. Healthier foods may cost more.
Inconvenience of preparation and their desire for pre-prepared foods and
innovative packaging.
There was also this confusion that appears in the media and the
scientific literature about the ongoing debate and evolution of nutrition and
health information; that we have one study saying one thing one week, and the
other saying something may be bad for you the next week. And there's consumer confusion about
changing health and nutrition messages.
But in looking at how the industry has responded, I think it's
important to return back and look at some of the experience in food product
development and bringing foods to the marketplace. And one of the areas where there was collaboration and response
by the food industry to government recommendations is to look back at the
Healthy People 2000 objectives.
Objective 2.15 in those objectives requested that the food
industry increase to at least 5,000 brand items the availability of processed
food products reduced in fat and saturated fat. The baseline was 2,500 food products in 1986, as they were
developing the health objectives for 2000 and the decade beyond.
But interestingly, by 1991, there were 5,618 products, a growth
of over 125 percent. That category
continued to grow across the decade, and this one of the few objectives that
was met in the Healthy People 2000 series.
And I think this underscores that industry can respond, both to
consumers' desire for healthful foods and information about diet and health,
and also to government requests to build healthful diets and to help educate
consumers.
But when we look at Healthy People 2010, we no longer have an
objective for modified food products.
There are weight and obesity goals.
We have a breadth of food consumption goals, both to increase
consumption of foods and to decrease other categories, very consistent with the
dietary guidelines for Americans' messages.
There's also not really a calorie message in the Healthy People
2010 objectives. But there are also
other areas related to physical activity and other lifestyle factors.
But, again, just to briefly go through some of the issues of
what we're confronted with in dealing with preparing food products for the
public to help modify and make diet and health selections and also to address
weight issues.
We have a growing problem of overweight and obesity in
America. It's also a growing concern in
the international arena, but it's very complex.
Food is often seen as the target. Processed foods, restaurants, and fast food. But I think we all can agree, and, as we
heard from Dr. Crawford this morning some of the government's role, but there
must be a concerted effort to look at this on all fronts, from a biological,
medical, environmental, behavioral, and educational arenas in nutrition and health, and looking at
obesity and weight management. We
cannot overlook that it is both nutrition and physical activity that are
important. Also, information is needed
about how to eat and how to build healthful diets and incorporate them into healthful
lifestyles versus the good food bad messages and what to eat issues.
We need to avoid and underscore that we need to avoid the good
food-bad food concept. But education
has been stated by our previous speakers, and we concur that it is important and
needed by all parties--government, industry, health professionals, and consumer
advocates. Because, again, what is
essential for healthy weight? It's that
balance between nutrition and physical activity.
But it goes beyond that.
There are other factors in the nutrition and obesity paradox: environment and biology, genetics,
environment and behavior, prosperity versus poverty, knowledge and
unknowningness, awareness and unawareness.
Other factors in this paradox:
time versus no time. We're all
very active we say, but is that really that we are busy. There's care versus apathy. Social activities versus--excuse me,
physical activities versus sedentary activities and behavior. Information and no information. And societal aspirations versus stagnant
process.
Again, to underscore at NFPA and our members, we believe that we
need to move forward and look at how to eat, not what to eat.
But again, the food industry response: over the past several decades in meeting consumers' desire for
diet and health. In the '70s and '80s,
there was a focus on sodium, fat, and cholesterol, and we responded with
modified products.
In the '80s and '90s, fat saturated fat and cholesterol
continued, of course.
In the 1990's and early into this new millennium focus on
transfat. But also as we embark in the
new millennium, we're in sort of a dietary limbo at this point, between fat and
carbohydrate. Which is best? Which is maximized? Which is minimized in diet? Science is evolving, and the debate will
continue.
And for 2000 and beyond, there needs to be a continued focus on
health and wellness, look at overall diet and calories and also the energy
balance issues.
So now, what are some of the food label issues? Christine Taylor, this morning, did talk a
bit about this, but I want to underscore that, from our perspective, we agree
that perhaps the architecture of the nutrition facts panel needs some
revisiting. Need to look at what the
appropriate focus is on fat and heart disease risk reduction. Does there need to be a change or
amplification of calorie information?
Again, any food label modifications require intensive consumer
research. We need to go back and
revisit and look at the issues from the past, when the label was developed, and
build upon those in any future research.
Also, nutrition and lifestyle education in the broad sense,
whether it be through dietary guidelines or through the government's Healthier
U.S. initiative, need to use information tools like the nutrition facts panel.
You know, we know that consumers, although it's beginning to
change possibly, consumers focus on the middle portion, on the macronutrient
parts of the food label. And there's
not as much focus on the information on servings and calories at the top of the
label. These are some of the
architectural issues that may need to be addressed to think about the use of
the label as a weight management and toward healthy weight tool.
There's no daily value for calories. You have calories from fat, but not a huge contextual message,
except for looking at the top and the bottom of the label, to put those two
together in looking at overall diet.
Also, like to say that in the next few weeks, I believe, we
should expect the report of the National Academy of Sciences' Institute of
Medicine's Food Nutrition Board Study on use of the DRI, information on
nutrition labeling and food labeling information, and perhaps their principles
and recommendations may be very useful in this debate as well, as we move
forward.
But the National Food Processors Association and the food
industry should look at believing that there's a synergy of information here,
using nutrition facts as a tool to build healthful diets, make food selections,
and then combine that with the messages in the food guide pyramid and the
dietary guidelines so that consumers can build healthful diets and live
healthful lifestyles.
But there's another issue here as well. When we think about the issues related to
serving size, there is the disparity between the nutrition labeling information
about serving size and serving size as articulated in the food guide
pyramid. It is our opinion and belief
that there should be a move toward trying to harmonize those two items in the
direction of commonly consumed and household unit amounts that are used in food
labeling to most--provide most benefit to the American consumer.
Now, to conclude. We do
believe that already the presentation of nutrition information on food packages
is ample, is abundant on almost all food products and available at point of
purchase for many fresh products, and that expands both into the areas of FDA
jurisdiction, as well as USDA for meat and poultry.
Education about diet and health is paramount, and this goes
beyond the food label.
We need to maximize the synergy between dietary guidance and
food guide pyramid messages by using label information.
We need to focus on development of positive messages. Perhaps with the work of the other FDA task
force on qualified health claims and consumer messages to focus on positive
messages to deliver to the consumer about how to eat, not necessarily so much
what to eat.
And we need to provide a climate for actionable behavior change.
Again, the food label provides information, but it does not
provide education. Focusing on labeling
of single nutrients or food components alone is not going to solve the obesity
issue. Learn from past experience with
the nutrition label and carry that forward with future research so that we can
learn and revisit those important things that Chris described this morning when
the format research was done in developing the current food label.
Thoroughly test and evaluate any changes with consumers to
ensure that they can use the information as a tool for making decisions about
food choices and then to incorporate them into their diets.
And finally, the "E" in the NLEA cannot be overlooked,
even though it is a decade beyond that time, government, industry, health
professionals, consumer groups all need to educate and be part of that and
really move ahead in educating about diet and healthful lifestyles. Thank you very much.
[Applause.]
"HOW DOES NUTRITIONAL LABELING AFFECT
CALORIC INTAKES?"
MR. PHILIPSON: Next
we'll hear from the academic community.
We're going to hear Rodolfo Nayga, who is a professor of Department of
Agriculture Economics at Texas A&M University. He will speak on how does nutritional labeling affect caloric
intakes.
DR. NAYGA: Thank
you. I'm pleased to be here. What I want to talk about today is part of
our research that we did a couple of years ago on determining whether use of
nutritional label has an effect on the quality of the diet and on caloric
intakes from fats and saturated fats.
So what I'm going to talk about just very briefly since previous
speakers have discussed this already is about the NLEA, the motivation of our
study, the dietary impact study objectives, our empirical framework, just very
briefly, the estimation procedure, and our general findings, and very briefly
as well, future areas of research.
So there are three aims of the NLEA, as we all know. One is to promote consumer nutritional
education. So that's the "E"
in the NLEA. But another one is to
enable consumers to make more healthful food choices, and this is really the
focus of my talk today.
And the third one is to provide incentive to the food industry
to create innovative and healthier new products for consumers.
So what we did was focused on this different types of
nutritional information on food labels.
So we examined the nutrition facts panel, use of the list of ingredients
information, the use of serving size information and the number of servings,
nutrient content claims, like low-fat, low-calorie, and health claims, which
characterize the relationship between a nutrient and a disease.
So whenever I talk about this topic to my students, I always
show this picture, because they all love this product, and I love this product
as well. And so I asked them how many
servings there are in this product.
Right. And all of them say one
or two. Right? And I can attest to that as well, because I
can probably consume this product in one sitting. And also wanted them to guess how the much percentage of
saturated fat per serving, and they all are amazed when I show them the back to
this picture that shows that there are four servings in this particular
package; and that there are 55 percent--there's 55 percent of calories from
saturated fat. So the implication of
that is if you consume the whole ice cream package in one day, then you had
your share of saturated fat for how many days?
Two days; right?
So it shows the importance really of reading nutritional labels.
So the motivation is pretty straightforward. We all know that, despite all this talk
about us becoming more nutritionally conscious, that we're not really eating
healthfully, just one out of every ten eating healthfully. Four of the top ten causes of death, as has
been mentioned this morning, are associated with poor diets. Diet-related health conditions cost society
a lot of money; right? Not only in
medical costs, but lost productivity, because if you get sick you can't work,
obviously.
And we're not proud of this, that we lead the world in terms of
this global epidemic; right? I have
given a similar talk around the world, and they all are amazed at overweight we
are here in the U.S.; right?
These are just some interesting figures, or numbers, if you
will. It says here the average number
of daily calories successful weight losers probably eat, 1,800. Number of calories in a plain cinnamon
crunch bagel, 510. I was amazed by that
as well.
But what's interesting is I think the last two over there, it
says the diameter, in inches, of a typical restaurant plate 20 years ago,
10. And diameter in inches of a typical
restaurant plate today, 12; right?
Serving size obviously. This is
just to show you that, indeed, the top causes of death are diet-related, so if
you can only improve our diet a little, we could save a lot of lives and money,
as well.
It costs the food industry a lot of money to do these
nutritional labels in the past. So the
issue is really pretty simple that we wanted to examine. We wanted to know does it really affect
consumer choice; right?
So what we wanted to know, was we wanted to know the effect of
general nutritional label use on consumers' intake of selected nutrients. And, for this presentation, we're focusing
on calories from total fat and calories from saturated fat.
But I agree with Robert that we also need to, I think, examine
the overall diet; right? Not just
particular nutrients.
So we also wanted to know the effect of nutritional label use
and health claims on the overall diet quality.
In terms of empirical framework, we used Stigler's Economics of
Information Search, and a lot of studies have been conducted in this area,
which indicated that some variables need to be--are important, indeed, to be
examined, as well.
In addition, for your--those of you who are economists,
obviously the famous health demand production model of Grossman is what we used
here. So, basically, we're using
nutritional label as a choice variable in the utility maximization routine.
The data is from USDA.
It's the Continuing Survey of Food Intakes, the CSFII. And we had a sample size of 5,400
nationwide--national sample.
What we did here was examine the relationship of diet between
label users and non-label users. And
since the characteristics, we found out, of these two groups are different, we
had to correct somehow for that econometrically. And really, so this slide is just showing that we did some sample
selection models between label users and non-label users, and useful
information--maximum likelihood estimation.
This is just to show you as well how we calculated these net
impacts of label use, between label users and not label users.
So you're probably asking, how are we going to examine or
measure the overall quality of a person's diet? Well, that's a dilemma, but luckily USDA has this measure called
the HEI, the Healthy Eating Index, which measures how well people's diet
conform with recommended healthful eating patterns. And this index represents a sum total of 10 different
components. So it's an index from 0 to
100; right? Each component will have a
range of 0 to 10.
Components one to five measure the extent to which a person's
diet conforms with the food guide pyramid recommendations; okay? The sixth component measures fat consumption
as a percentage of energy intake. The
seventh, saturated fat as a percentage of energy intake. This is just the food guide pyramid. The eighth component measures total
cholesterol intake. The ninth measures
sodium intake, and interestingly, as well, they included a 10th component,
which reflects the variety of a person's diet; okay?
So this is the HEI. It's
an index from zero to a hundred. And
from this sample that we had anyway, we found out that the average HEI in the
U.S. population, as represented by this sample, is guess what? You'd probably say 80; right? No, it's 60s, in the low 60s.
Now, USDA has said that to be considered a health eater, that
the minimum HEI must be 80; okay? So
we're way below the recommended level or threshhold level.
So these are results from our econometric models; okay? And this is the percentage of calories from
total fat. These are for the non-label
users. We found that age has a
non-linear effect. It increases
positively, and then it declines at a certain age level. We found, at least for the non-label users,
that females have a higher percentage of calories of total fat than males by
1.6 percent. This is on a daily,
average daily basis.
The whites greater than the others, which are the non-Caucasians
and the non-African Americans, by 4.8 percent.
Interestingly, employed individuals greater than unemployed by 1.5
percent. Suburban greater than city
residents by 1.6 percent on a daily basis.
Western residents greater than southern residents by two percent. Regular exercisers greater than
non-exercisers by 2.2 percent.
However, there is some--
[End of Tape labeled Side 2]
African Americans higher than whites by one percent. And whites higher than the others, which
would include Pacific Islanders, American Indians, Asian Americans.
Non-metro residents greater than suburban residents by 1.6
percent. Midwest greater than southern
by one percent. Those who are not on
special diet greater than those who are on special diet, as recommended by a
medical doctor, by 4.7 percent. So
that's pretty high.
Smokers greater than non-smokers by 1.3 percent, so there's a
correlation there between this health behavior.
Non-exercisers, as well, greater than regular exercisers, by 1.4
percent.
Now, these are for the label users in total fat.
We also--non-vegetarians, I think this is pretty obvious, have
higher percentage calories from total fat than vegetarians by three percent.
We also examined saturated fat, and these are for the non-label
users. Age, non-linear. Whites greater than others. Schooling in years had a positive effect of
.10 percent per year, ceteris paribus.
Midwest greater than southern residents, .8 percent. Those not on special diet higher than those
who are on special diet by 1.5 percent.
Regular exercisers higher than non-exercisers by .6 percent.
And then these are for the label users. The whites greater than others by 1.6
percent. Non-metro residents greater
than suburban residents by .6 percent.
Schooling in years now, interesting you have--it has a negative effect. But perhaps we should have included a
non-linear component to this, and I think we're going to do that, because I'm
curious, as well, about this effect.
But it's a good result obviously.
Food stamp recipients we found, for label users, have higher
percentage of calories from saturated fat than the non-food stamp recipients,
by .7 percent.
Knowledge about diet disease negative effect, which is
okay. Not on special diet greater than
special diet, by 2.1 percent. Smokers
higher percentage of calories from saturated fat compared to non-smokers by .6
percent. Non-regular exercisers higher than
regular exercisers. And non-vegetarians
higher than vegetarians. So, at least
for the label user models, I think they're all pretty consistent with our prior
hypothesis.
So we calculated the net effect based, once again, on our
econometric models, and this is what we found.
Now, this is based on the HEI, right, that we--or based on the
percentage of calories from total fat or saturated fats, and the difference
between label users and non-label users, net difference, is minus 6.9 percent
for the percentage of calories from total fat.
And then for the percentage of calories from saturated fat, the net
difference is minus 2.1 percent on a daily basis. Okay, so the signs are obviously the right ones.
We also calculated the percentage of individuals meeting the
dietary guidelines. This is for
calories from total fat. Not surprising
that the dietary guideline for total fat is 30 percent or less. It's not surprising that very few of us meet
that dietary guideline. But at least
among those who meet the dietary guidelines, a higher percentage are label
users compared to non-label users.
But if you go to 31 to 45 percent, that changes a little
bit. And it even changes more
dramatically once it's over, greater than, 45 percent.
For saturated fat, the dietary guideline is less than 10
percent; right? And once again, very
few of us meet the dietary guideline, but at least it's higher, much, much
higher, among the label users than among non-label users. And once again, it drastically changes as
you go far along, especially when you go greater than 15 percent.
So I think these are really interesting results.
Now, we also did, as a bonus, we also did the cholesterol,
fiber, and sodium, and we found these net differences. Negative 67.6 for cholesterol, which is
good. Fiber, we're supposed to eat
fiber, so label users, we found, have higher fiber intake on average than
non-label users. And then sodium,
negative 29.58 milligrams per day.
Now, these are the results for our models related to the overall
diet quality, okay, using the HEI that I just explained a few minutes ago. So we examined this for the five different
types of nutritional information that I talked to you about earlier. So list of ingredients, the net effect
difference is 3.5. Serving size,
4.17. Nutritional panel, nutritional
facts panel, 4.51. Nutrient content
claims 5.4, and then the health claims, 6.14.
I know, Robert, you had a slide there earlier that says that perhaps we
should get with those diet health claims or disease health claims. But based on this research anyway, we found
that in terms of its effect, okay, or correlation, if you will, that health
claims can help.
Now, I'm going to pause here for a minute, because I want to put
these numbers into perspective. Now,
remember that HEI is from zero to a hundred.
The average HEI in the U.S. population from this survey, from this
sample, was in the low 60s. USDA
mentioned that the threshold level is 80, so if you're just an average eater,
and even if you read health claims or use health claims, that will only put you
closer to 70, not 80. So it's not
a--these numbers are not as high as some of us would probably hope to be, but
at least they're helping.
Now, we have to be reminded as well that, you know, it takes
time for these to take the effect, so perhaps if with more education, these
numbers can be improved.
We also did some simulations based on some of our demographic
factors that we included in our models, and this is what we found out. So this our difference between label users
and non-label users for different ethnic groups. So the African Americans have lower HEIs, in average, compared to
others for both label-users and non-label users. We did find much significance differences in the region, although
the South it was a little bit lower.
Education level, we found indeed that there is that positive trend;
okay? That the higher the education
level, the higher is the diet quality; okay?
However, also included employment status in our model, and this
is what we found out. So you're
probably thinking now, why is that happening; right? I'm fully employed. Does
that mean my diet is poorer than those who are unemployed? Well, I'm fully employed as well;
right? And I think this partly reflects
what we call in economics as the opportunity costs of time. That means the value of your time. Sometimes if you're fully employed, you
don't have time--much--that time to really take your diet into consideration. Another thing I want to mention is we
included the full-time mothers in the unemployed category, and we should have
probably separated that as a separate category.
Smoking. Smokers have
lower HEIs for both label-users and non-label users than non-smokers. We also found that those who exercise
regularly have higher HEIs than those who don't exercise regularly.
Not a surprise for special diet; okay? And then for food stamp, now this doesn't reflect the fact--it
doesn't mean that the food stamp program is a failure. All it means that despite the food stamp
program, that the quality of the diet of the food stamp participants are still
lower than the non-food stamp participants on average.
And I think some future research--this is a great picture;
right? I met a Bo earlier from
McDonald's, and I apologize, Bo. But the
reason I'm showing this is because of obviously the topic in the next session
is about restaurants. I think there's
obviously a great need for more research in that area, nutritional labeling in
the food away from home market. This is
just a picture I took in one of our local papers in College Station,
Texas. And this is the owner of a
restaurant trying to capitalize on this issue; right?
A lot of the restaurants now are also taking this into account,
like Wendy's. We all know about the
McDonald's and the Appleby's trying to take advantage of this issue. This one, as well.
And I think there's also a need for a lot more research on the
new qualified health claims that are--that just have been approved. Thank you.
[Applause.]
"HOW PACKAGING UNKNOWINGLY INFLUENCES CONSUMPTION
AND CALORIE INTAKE"
DR. PHILIPSON:
Okay. We actually are right on
time, a little bit early actually. But
we'll take a break. We're continuing
this session at 10:35 a.m. here. So,
please, be back in time so that we can--
[Recess.]
Illinois in the wonderful City of Chicago.
DR. WANSINK:
Champaign.
Champaign-Urbana. Thank you,
Tomas.
I like what Susan Borra said earlier today, because she said
there's a big dis-link between what people think and actually what they
do. Everyone wants to eat
healthier. Not everybody does eat
healthier. And that's going the folks
who we talk about today.
Now, there's a couple key take-away on this big slide, and that
is the notion of consumption.
Everything I'm going to talk about today is related to why people
consume the amount they do, but more importantly why they unknowingly consume
how much they do.
Now, this is our research that was done at the food and brand
lab, which is my lab down at the University of Illinois, and what it is it's an
interdisciplinary group of researchers.
The notion here is that if you're going to study food consumption, we
can't have all nutritionists do it, because they've got a good angle, but not
the whole picture. We can't have our
marketing people do it, because they've got part of the picture, but not the
whole angle, also. So, essentially,
what we do is we bring in psychologists, people from the hotel school, and
anthropologists, and we all study why people consume what they do, using either
controlled-field situations or actually field situations such as some test
kitchens, some restaurants, snack rooms, and things like this we use.
The basic idea is to try to answer these questions not
necessarily by asking people what they think they're going to do, but actually
seeing what they do do, okay, by looking at lab experiments, field studies,
consumer panels, and things like this.
The vast majority of what we do is related to consumption, a
little bit is related to food choice.
And in getting started, there's three general things I want to talk
about. Three general sort of principles
we've sort of just found kind of mistakenly through the last few years.
The first is that consumers pretty much follow the law of least
effort. We don't like to do more than
we have to do, so that's why we get convenient packaging and that's why we get
really wide distribution, and, you know, great fast food restaurant at every
major corner, and it's also why we get the chance to essentially buy whatever
he wants instead of having to buy and prepare what we want to eat.
We also have the option of value, okay. So we get super-sizes at lower per unit
prices, and we get discounted pre-bundled meals; okay? That's not always to say we want value, but
we want the option of having value.
We also want a wide variety of choices, which is why we get
brand extensions and new flavors, and we get the option of having one dollar BK
salads that are less expensive than the fries.
But interestingly enough, end up being eaten at a rate of about one to
thirty compared to the french fries.
Okay, the two key questions that are sort of implied in this
talk is first of all, why does packaging influence consumption? Hey, and why should we care?
Why does it influence consumption? Well, consumption volume is a tremendously low involvement
decision. Okay, we may make some
decision as to whether we want to eat salad or soup. Okay, but once we get that soup, we're not saying, really, how
much do I want? Do I want eight ounces
or really eight and half ounces? You
know, we just eat it. It's very low
involvement.
And the second thing is we think a lot about what we eat, but
not how much. It's very automatic, and
we're very impressionable by the environment.
Why should we care?
Well, there's a couple of interesting studies that have been--one's been
done and one that's forthcoming next year that says that just 50 fewer calories
a day for most of us would decrease or result in weight loss over a year's time
in 85 percent of all adults. And what's
going on there is that most of us, 85 percent of us, yeah, do we eat too much
everyday? Yeah, but it's a little bit;
it's 25 to 50 calories. Essentially,
that doesn't mean anything on a day-to-day basis, but over the course of 365
days, and we've got three pounds right there; okay.
So, essentially, things we can do that can even reverse this a
little bit, that can even just cut down what the typical person consumes by 30,
40, 50 calories can result in decreasing the--if you call them obesity epidemic,
decreasing that.
And second of all, I think why we should care is that this
provides a win-win opportunity for profitable new offerings--new products for
people and essentially weight-loss friendly packaging if companies chose to do
this.
There's a very important caveat. Like most of today's talks have been about packaging, the
packaging is only one driver of food consumption volume.
Now, if I can be so bold to make a prediction, I think that
probably in the next six weeks, even if all of us are incredibly vigilant, and
even though we think a lot about nutrition, and we're very concerned about this
sort of stuff, in the next six weeks, the average one of us is going to gain
one and half to three to pounds. Okay. And how much of that is going to have to do
with packaging? None of it. Okay.
Here's what it's going to have to do with. It's going to have to do with the eating
environment we're going to find ourselves in for Thanksgiving, the holidays,
and for New Years Eve. Essentially,
we're going to be--we're going to be at the phase where there's less
effort. We're going to be eating with
others. There's a lot more
distractions, and there's great atmospherics that encourage us to eat a lot
more than we otherwise would. And
that's one of the big drivers of why we eat.
The other one ends up being the food environment. And you can see that can be the size of
packages and portions, but it's also the salience of food, how it's structured
and the variety of it, the stockpiling and the shape of things. And so if we want to essentially point at
the problem of obesity, it isn't just big packages. Big packages is one little
thing amidst a whole lot of other stuff that's sort of going on; okay?
But the two big mediators that I'm going to talk a little bit
about today is the fact that, because of these things, we don't watch how much
we eat. Effectively, we don't monitor
our consumption very effectively. And
the second thing that happens is large packages, large sizes, and even the
shape of packages can actually influence what we believe is a normal or
appropriate amount to eat, and we'll be looking at data related to that.
So, for those of you who had your muffin, and you're saying, I'm
just looking for the right time to take a little nap here.
[Laughter.]
Especially with the dim lights, it's a problem.
I'll give the whole presentation in just one slide, and then
after that, I'll give a little more details.
The first part of what I'm going to talk about is how does
packaging influence consumption. Well,
I'll show you that package size influences it, and even influences it with
foods we don't like; okay? Then I'm
going to show you that package size influence it through visual illusions. Okay, and both of these are ways that
unknowingly make us eat more than we want.
Then I'm going to look at three possible solutions, and these
are preliminary data and three solutions, and first of all, I'm going to
conclude that we can't rely only on label information. And I'll show that it's because we ignore
it. Then I'll show that we can't rely
only on small portions, making things smaller, because we overcompensate by
eating more of those things. Then, I'm
going to show some preliminary evidence that shows that structural changes to
packages make people much more aware of their eating, and they may help reduce
intake.
Okay, first of all package size increases consumption. Back throughout the '90s, I did a lot of
studies related to how if you give people, let's say, a medium, a large, an
extra large package how it influences people.
Typically, the studies would go something like this. We might give somebody a half-pound bag of
M&Ms, or a full pound bag of M&Ms, or a two-pound bag of M&Ms, and
we give them a videotape. We'd say,
hey, we're interested in knowing what you think about this videotape. Take it home. Take your M&Ms. And
as soon as you finishing watching the videotape tonight, give us a call.
Well, they do that. As
soon as they would call, we'd say, great.
We're going to be right over to pick up your video and your unfinished
bag of M&Ms. We'd do this. We'd get the M&Ms. And what we typically found, and this is
over 47 to 48 categories, when you go from one size to another size, when you
double the size, effectively that the consumption of these products goes up
from a range of about 18 to 48 percent.
Okay. Now, eventually these
things get so huge that they stop having an effect; okay? Because there's only so many M&Ms you
can eat or so much spaghetti you can eat.
This is a tremendously, tremendously robust effect, and it's found
across all sorts of categories. I think
the only exception was bleach.
[Laughter.]
It didn't work there. So
the question is: does this always
happen? Well, I'm going to tell you,
yeah. What we did, we did a field study
up in Chicago, and what we did was we took--we went to a movie called
Payback. I don't know if anybody saw
that movie. I really doubt it,
actually. Other than the people here.
And so when people came in, we gave them, we told them it was Illinois
History Week; could have been. And we
gave free popcorn, either a huge bucket or a smaller bucket--a large or an
extra large size. But the thing was
half the people got fresh popcorn, and half the people got popcorn that was
14-days old; okay.
[Laughter.]
And this is--I mean it wasn't rancid, because it didn't have
butter on it, but, you know eat it, and you're going to go--aren't these like
those packing styrofoam peanuts. I
mean, God it's just terrible; okay.
What ended up happening was they--and after the movie what we
did is we grabbed their popcorn, and we waited and asked them a few questions;
okay.
And what we found is that if people were given popcorn, and you
gave them a huge bucket, they ate about 45 to 50 percent more from the huge bucket
than they did the moderately huge bucket.
[Laughter.]
Okay. But even if they
had this terrible, terrible popcorn, what happened is they still ate 40 to 45
percent more. It still had an
impact. And if you said, hey, what did
you think of that popcorn, they'd go, oh, God, that stuff was terrible.
[Laughter.]
You'd go, well, why did you eat so much of it, and invariably
people don't think that they increased their consumption. And all these studies, if you say, how much
do you think you eat, people will tremendously underestimate how much they eat,
and they don't realize they're being influenced by these sort of things.
So this basic relationship between packaging and consumption is
really automatic, because it's not just in food. It's not just in foods we don't like, but it's--we've also done
this with dog food. People pour more
dog food if you give them a big bag of dog food than if it's a smaller
bag. We've even found it with plant
food. You know that little watery
stuff.
And so this is probably is not something that's going to be
saved by a label.
Now, the second thing I'm going to talk about briefly is how
does package shape influence how we bias our consumption. And I don't know if you can think back,
back, back to, you know, Psych 101, but they talked about Piaget, and Piaget
would give these kids these bizarre shapes; and what he found if you gave kids
something that's tall and skinny, they thought it contained, the package or
contained more than if you gave something short and wide to the same
volume. And the basic idea, you
remember this T-test, and somebody goes, hey, hey. Is it taller or is it wider?
You know, we'll go, oh, it's taller by about 20 percent more. Well, you know, in reality it's the same
size. And the same basic notion of how
we look at packages is also why when we're in St. Louis, we go, wow, look at
the height of that arch, and we don't go, wow, it is so wide.
[Laughter.]
Okay. Even though,
they're essentially the same size. The
fact is you can say, well, yeah, that's just a visual illusion. Those are just parlor tricks. Well, no they're not, because they have a
tremendous impact on how much people consume.
Let's take a look at some people who should be vigilant and
should know better. These were teenagers
at a nutrition and fitness camp up on New Hampshire. I don't know if you know about these nutrition and fitness camps,
but, you know, wealthy parents tend to send their kids there to lose a few
pounds over the summer, and they, you know, come back losing about a
thousand--you know, five pounds, which is about a thousand dollars a
pound. But over the course of that
time, they're told, they're taught about nutrition size. They're taught about portion size. They're taught about estimating calories and
all these sort of things. And what
happens is you should think that these people would be immune to a lot of the
visual tricks that go around--go on around us.
But what we did is we, at cafeteria time or at breakfast time
and at lunch time in the cafeteria, when kids came through, we gave them either
a tall skinny glass or a short fat glass.
Now, based on what Piaget said, if people think a tall skinny glass
holds more than a short fat glass, we should find people more in short fat
glasses than tall skinny glasses, even though they contain the same
volume. Well, after they exited the
line, we asked them, how much they thought they poured, and we looked at it.
What we found in general was that if you gave these kids these
short, wide glasses, they were about 22 ounce glasses, they ended up consuming
about 88 percent more than if you gave them a tall skinny glass. But they had no idea that this was
happening. So if they poured soda pop,
they poured about 88 percent more. If
they poured milk, they poured more. If
they poured juice, they poured more.
This was also true with adults.
And to try to see how ubiquitous this is, just to see if really somebody
who's very and who's very attuned to this can do this, we did it with a third
population. And we wanted to do it with
a very specific target volume, which is 1.5 ounces. Does anybody know what 1.5 ounces is? Oh, yeah. Okay. It's a shot glass; right.
So what we did we went to Philadelphia bartenders and said,
look, what we want you to do is pour, we gave them some bottles of gin, rum,
whiskey, and I think vodka, and said, hey, pour how much gin in a gin and
tonic. Pour how much rum you'd put in a
rum and coke. How much whiskey in a
whiskey on the rocks and stuff. And the
poured these things, and what we find out is even those these guys had, these
people had more than five years of experience, bartenders, even experienced
bartenders poured about 28 percent more alcohol into these short tumblers than
they did the highball glasses. And we
said, even experts aren't unaffected by this bias; okay?
So, it's hard enough for us to believe that if we eat more from
big packages, even if you don't like the food, and if experts even end up being
influenced by biases, that we can influence consumers very easily. So, a key finding: package size and shape influence consumption. They implicitly suggest an amount to eat,
and they do so almost automatically, regardless of our experience, regardless
of whether we even like the product, regardless of whether it's even edible;
okay?
[Laughter.]
Now, there's three possible solutions that have been
suggested. There's a whole lot more,
but I will just look at three today.
One is to provide label information.
One is to provide smaller portions, and one is to make structural
changes to the packaging.
This first option looks at will label information decrease
overeating. And the conventional view
is that if people have nutritional information, it will influence their
behavior. An alternate view is that
many people largely ignore package information, and essentially if you tell
people it's healthy, it might even backfire.
People go, wow, if Snackwell's are that low in calorie, I'll have ten of
them; okay?
So we tested this in an environment versus McDonald's, and the idea
here is that Subway is often heralded as being, you know, the information god
or goddess, because they have these nutrition facts on napkins, on glasses, on
placemats. You walk in, there's posters
all over. And McDonald's is supposed
to, and they have it in some places in some locations. And the idea is if people read nutritional
information, does it really help?
We intercepted 500 people after lunch-- 250 from Subways, and
250 from McDonald's in 10 cities--and asked them, hey, give us some nutritional
facts you've learned, and we asked them how much they ate.
And what we found is that the average person could recall less
than one nutritional fact from either Subway or McDonald's. And, in fact, what happened is though, as
you might guess people ate a little more if they ate at McDonald's than Subway,
they were much more accurate in estimating how much they ate than the person at
Subway. The person at Subway said--he
said, how much do you think you ate.
And they go, about 390 calories worth.
In reality, they ate about 610, and part of the problem was that they
kind of added cheese and mayonnaise and chips and cokes and stuff like this,
thinking that essentially they were bullet proof because they were at a healthy
place to eat. Okay, and basic--you
can't really rely on information because a lot of people really, really ignore
this sort of stuff.
Option number two, will smaller portions decrease
consumption? Well, the conventional
view is that if you give people smaller portions, they'll eat less; okay? And it may not be so. We took 180 adults to see a movie, and we
offered them either big bowels of normal size Chips Ahoy cookies, and said,
it's going to take you an hour and a half, take as many Chips Ahoy as you
want. Or we offered them a big bowel of
really those small bitty ones; okay, the mini Chips Ahoy, which are about a
third of calories. And what we ended up
finding is that people ate a lot more calories of the small cookies than the
regular size cookies. Okay, and they
underestimated how much they were actually eating. So what it looks like is we can't really rely on small portions
either, because we overcompensate by eating more of these sort of things.
Okay, so far, we know that we can't rely on label information,
because we ignore it. We can't rely on
small portions, because we may overcompensate for it. Can we structurally change packages to make people more aware of
what they're eating and less mindless.
And we just finished this a short time ago, and all of these
things are sponsored by either the USDA or the Attorney General has an
initiative for childhood obesity. So
they sponsored all these studies. And
what we did here is to try to make people more aware of their eating. We did a potato chip divider study. We gave people potato chips in one of these
little tubes, and we modified it so that we put in a red potato chip every
seven chips, every fourteen chips, or we put in no red chips. And they came in, and they said, hey, you're
going to watch a show, sit down, eat away.
And what we ended up finding is that structural dividers in
these cans, even though they said absolutely nothing on them, even though they
didn't say one serving or whatever, when people ran into dividers, they
decreased their consumption. So, you
can see kind of walking up the track there, the seven chip divider people ended
up eating about, I think it's about eight cookies. They ate about twice that in fourteen. When they hit the no divider condition, they ended up eating
about 21. And you can see the gap
between the blue and the brown--between the calories they ate and the number
they thought they ate, because no divider they were much more inaccurate as to
how much they're eating.
Okay. So structural
packaging barriers appear to decrease consumption. Okay, they can decrease consumption, and they might even be
profitable. For instance, it might be
possible to develop a healthy portion line of package and sort of price it
appropriately.
The key is to make people aware of how much they're eating without
decreasing their enjoyment in the food.
As we know earlier, enjoying food and having it taste good is the number
one thing people look for.
So the summary of packaging research is that we can't rely only
on label information, because people appear to ignore it. Are there more effective ways it can be
presented? Well, we're working on a few
different ideas that we hope might be more effective.
We can't rely only on small portions, because people seem to
overcompensate when they eat small portions.
Well, are there other alternatives to just having small portions?
And the last thing is that structural changes in packaging hold
promise. There are lot of other forums,
and there may be situations where it does and doesn't work, and that would be
the thing to look at next. Thank you.
[Applause.]
"HOW DOES THE CURRENT LABEL AND PACKAGING HELP OR
HINDER THOSE
ENGAGED IN WEIGHT-LOSS
PROGRAMS?--FROM WEIGHT WATCHERS"
DR. PHILIPSON: Thank
you. When we, both in the Obesity
Working Group more generally, have thought about how labeling, whether done in
on packages or restaurants would help manage people's weight, we were sort of
drawn to the question of how actually programs in the private sector interact
with the label in terms of guiding, using the label to help people manage
weight, and that was sort of the motivation for the two next speakers.
We're going to hear from Karen Miller-Kovach. She's the Chief Scientist of Weight
Watchers, International, and she will speak about how does the current label
and packaging help or hinder those engaged in weight loss programs, a
perspective from Weight Watchers.
MS. MILLER-KOVACH: All
right. I'm probably going to need some
help here. Thank you.
Great. Thank you.
Well, I'd like to thank you for having me here today, and I am
going to speak just briefly in terms of what Weight Watchers has done using the
current nutrition facts panel, but really kind of go more into the future,
because this is certainly a very future oriented workshop.
And while I'd like to--I'd like to start out by saying as a
person who is responsible for weight-loss programs and services at 30
countries, in 30 countries around the world, while our nutrition facts, our
nutrition labeling, has opportunities for improvement, and it's great that
we're moving forward, I can also come and say that we are the envy of the world
in terms of the kinds of information that is available that really is not
available in other places.
I'd also like to make the point that the Weight Watchers Program
and the services that we offer, we have one of our core beliefs is that they
need to be based in science. And, as
such, Weight Watchers is not tied to a single dietary approach. In fact, we have a history of evolving our
weight-loss program and services, our diets and programs, as science has
evolved.
And I give you a couple of examples of that. And coming into the more, the closer future,
in 1997 Weight Watchers introduce the points weight-loss system here in the
U.S., and this thing off to the right for those of you who may not be familiar
with it is what we call a points finder.
And it relies on the nutrition facts panel, using per serving the
calories, the total fat, and the dietary fiber per serving to--then use your
little slide calculator to come up with the points value for that. The points value is a single whole number,
and the Weight Watchers Program is built on the--on you get so many points for
the day. Stay within your points
target, and you'll lose weight. And so
it's a much more easy, portable way to use information than counting calories,
counting grams of fat, counting grams of fiber. It rolls them all down into one single number, and this is an
example of how we have used the nutrition facts panel, and the information
that's available to the American consumer to make weight loss simple, easy, and
livable for people.
And since 2000, while we are still on the points weight-loss
system, we have based, and being convinced by the evidence that's been coming
out associated with more of a dash-type approach to eating, increased our
emphasis in terms of educational efforts on fruits, vegetables, whole grains,
and non-fat dairy. We did that before,
but we have increased our emphasis on that.
Now, being a for-profit business in a specific segment, we are
always doing market research, because we need to understand the issues, the
attitudes, the beliefs, and really what's going among our core market. And our core market, as I should believe
should be the core market of the people who are here looking at this workshop
and how do overweight Americans use food packages and labeling, because we do
have an obesity epidemic, our core market is overweight Americans who are
interested and motivated to lose weight within the next few weeks or to start
that weight-loss attempt within the next few weeks.
We do our market research in a number of ways, including
quantitative surveys, focus groups, one-on-one. And so, would I would like to do is spend the bulk of my time
doing is to a little bit of a step beyond where Sue Borra took this morning and
to take you into the minds of the typical overweight American in July, August,
and September of this year, who knows they're overweight, and who is planning
on taking action and starting a weight-loss program within the next month. That's who we're talking about.
One of our motivations for doing this is that, as a for profit
business who is always doing market research, we look for kernels. We look for kernels of trends, and then want
to explore them in terms of how we can use this. What do we want to do about it.
We want to be on the forefront.
And one of the things that we were seeing is that we were seeing
kernels, because kernels can build into beautiful plants or kernels can build
into weeds. And we were seeing these
kernels developing associated with the use of carbohydrates, and the emphasis
of carbohydrates, particularly cutting out carbohydrates among our
segment. And we wanted to really get
behind that.
A couple of these kernels that led us to believe this research,
and it was a concentrated research effort that we did, was that we know
currently that about 25 to 30 million Americans are on a no- and low-carb diet;
that 21 percent of women who are aged 18 to 64 say that they will go on one of
these within the next two to three months.
And certainly, we shop like everyone else in grocery stores and saw the
abundance or the rising abundance of these no- and low-carb foods that were
starting to hit the market. And we were
interested in intrigued. And we also
recently heard that $13 billion from the food industry, a small bit in the $500
billion food industry, but $13 billion is currently estimated to be in no- and
low-carb food sales in 2003.
So, again, to better understand both the consumer and the science
perspectives taking a look at this, we did a comprehensive concentrated market
and scientific research initiative in this.
And I'd like to share the results with you.
I know the time is limited, so what I'm going to do is focus on
the consumer side, to get you into the consumer's head. While some of the science is presented, I am
assuming that you're familiar with that, and we'll stay away from that.
The market research consisted of 75 one-on-one, one-hour
interviews that were geographically dispersed around the United States. As I said, a variety of dieters were
targeted. All of them were
overweight. All of them had between 30 and
75 pounds to lose, and all of them expressed a high degree of readiness to
change to start a weight-loss program within the next month.
The one-on-one interviews were done by a trained clinical
psychologist who does not work for Weight Watchers, and was then summarized in
terms of a report. And then we further
supplemented these findings with 14 focus groups in September and October. So that would add about 140 to 150 people to
the base that we're talking about.
As far as findings go, I'd like to make clear, although it's not
on a slide, that what I'm going to be talking about in going into the
consumer's mind is summarizing all of this work. And I will only be saying to you things that were expressed by
the majority of people who were interviewed and were expressed with a strong
degree of conviction. So, I'm not going
to say, well, one person out of the 75 said this, and so we hold it as a
truth. We don't. Again, the views that I'm about to give you,
or the synopsis, represents the majority of consumers stating beliefs with
conviction.
One of the key things that I would like to--a key point that I
would like to make, because it was a real learning for me as we were doing
this, is we hear, and I've heard it this morning already, say that consumers
are confused. They're confused. We asked consumers, are you confused, and
they said, no, I'm not confused. I know
exactly what's going on right now. And
in the area of weight management, I believe this to be true. I have been told this to be true, and I
believe it. And I am not confused. And I think that that's a key point, because
if you express to someone that you're trying to clear up confusion, and they
don't think that they're confused, it makes a big difference.
Essentially, what we found were three gaps between the current
state of the science and the state of consumer beliefs as it relates to the use
of no- and low-carb diets. They have to
do with how they work, do they work, and what does it do to your health? And there was an underlying thought process,
again, that was believed to be true among the people that we believed--that we
spoke with.
Basically, the American overweight person who wants to lose
weight today believes that following a no- or low-carb diet leads to weight
loss, despite eating unlimited amounts of food. And logically, therefore, it can only be the carbs that are in
the food that turn into body fat, because how else can you eat unlimited
amounts of food and lose weight? And,
as we just heard, people are notoriously terrible at being able to estimate how
many calories they're eating. And so
there is a belief that because you can eat unlimited amounts of foods and foods
that we have beat into people are a high calorie foods that they believe that
they're actually consuming more calories and losing weight. So, it has to be the carbs. There can be no other logical explanation.
In addition, the conviction of this belief is strengthened
because there is a strong belief among these people that a no- and low-carb
diet is the current recommended treatment for diabetes. Diabetics are on controlled carb diets. Controlled carbs must be no-carb; therefore,
these diets are what's used to treat diabetes.
Diabetics have to watch their diet and be concerned about their
health. So, if it's good for a
diabetic, it's good for me, because I know I'm at risk for diabetes because I'm
overweight.
And then they're bombarded with a lot of information from the
media when they go grocery shopping again to reinforce this belief that they
have.
So, let's take a quick look at those three gaps that exist
between what people believe to be, they believe to be today, and perhaps what
the science is suggesting.
As far as the way it works, there is a popular belief, held by
many millions and millions of Americans today, that all carbs turn to sugar in
your diet. Only carbs are converted
into body fat. The others--I don't know
what happens to them, but nothing--they don't go to fat; and that on a no- and
low-carb diet, you can eat more calories than before. In fact, calories don't matter.
Calories don't count; and that without the carbs, your body, because
only carbs can turn to fat, if you don't eat the carbs, your body has to get
energy from somewhere, so it breaks down the fat.
And to add to that, to be synergistic with your body having to
cut down the fat, if you eat fat, it helps bring more fat out of your fat
cells, and lose more weight. As it was
so eloquently put by one of the focus group, or one of the interviewees, I
don't know how it works, but I know the fat eats the fat in your body, and it's
a beautiful thing.
[Laughter.]
But do these diets work? Do they work in the short term?
Do they work in the long term? I
think that one area of potential synergy in terms of the science and the belief
is that in the short term, these no- and low-carb diets work faster than other
diets. There is a greater weight loss
in the initial stage than they've seen in terms of their previous experience.
And that recent studies have shown, again, this is the popular
belief, is that recent studies have shown, because I do read the newspaper,
that these no-carb and low-carb diets work better than other diets in the short
term, in the long term, for the rest of my life. If I lose weight this way, it will stay off. It's been proven. I read it in the newspaper.
Implications on health.
I already spoke to this; that the current popular belief among the
overweight American today is that these kinds of regimens are the preferred
recommended treatment for diabetes; that these, this methodology has been given
a clean bill of health, by leading obesity experts; and that the no- and
low-carb diets represent the latest nutritional thinking by leading experts.
And I think that in some ways, perhaps we can adjourn and convene and that,
because we heard from several, not a majority, being clear on that, not a
majority, but probably about one or two dozen of the consumers that we spoke to
that the pyramid is coming out in 2005.
Meat is on the bottom. Bread is
on the top.
It's been decided. It's
just going to take the government while to get the picture done.
A couple of other things that came out of this research that,
again, I--they didn't fit into my nice little format, so I can't--so I just put
them on a different slide. But sitting
in the back of the room became a bit of concern is that the other overriding
belief among the adults that we spoke, and it was all adults that we spoke to,
is that this type of dietary approach, while proven to be safe and efficacious,
the way you treat diabetes, you know, you really shouldn't feed it to your
kids. Kids needs fruits and vegetables.
And kids need low-fat milk. And we were concerned about this enough to
being asking the question later on in the survey process, is do you believe
that if you eat one way, and you feed your children other, and you tell your
children not to do what you're doing, do you have a concern associated with
that? An the uniform answer was
no. My children do what I tell them to
do and don't look at what I do.
Also, we heard in terms of speaking with people a couple of just
fun stories. One is that there was a concern
associated with the continuation of the new habits with the return to bad
habits. One woman spoke eloquently of
her husband, who had lost some weight on a low-carb diet, and said for 30 years
his breakfast had been toast and juice.
And then he switched to bacon and eggs.
Now, he had bacon and eggs, toast and juice. And was enjoying himself.
And the third thing that I just thought was interesting was
spousal syndrome. That's the effect of
weight on the other members of the household when one was following one of
these regimens, because the other foods are there, and they eat everything, and
there's actually weight gain.
So, the conclusion based on this research that I thought this
group wouldn't get much to hear this kind of thing otherwise, especially with
it being so timely, this has only been--we're talking about two to three months
down--is that there are currently consumers that have strong misbeliefs about
carbs, and carbs is definitely the next wave in terms of weight management. People do look at the carbs on the label.
The gaps in the understanding are making them make decisions,
look at labels for things that perhaps were not intended, and if there was a
better knowledge, they might be making different decisions, and that these
gaps, it is a wave, and it's just a little, it's just a little ripple right
now, but it is growing into a wave.
The biggest concern that I have as a health care professional,
and I would again like to reiterate that Weight Watchers isn't tied to any
specific dietary approach. So if
low-carbs, reducing carbs, cutting out all carbs, is demonstrated to be safe,
efficacious, and the way it should be in the future, we can go there. We can go there pretty quickly.
But as a health care professional, I have a concern, and I've
heard it expressed this morning, and I'm so grateful to hear that others are
seeing it and are expressing concern before, and that is that we not repeat
what we did with fat.
Ten years ago, I sat in focus groups, and I heard people talk
about calories don't count. It's all
about fat grams. Calories don't make
you fat. Fat makes you fat. It's the ice cream I eat that makes me fat.
Today, I could have listened to those same tapes and just
substituted fat for carbs. Calories
don't count. It's the grams of
carbohydrate that I eat. Calories don't
make you fat. Carbs make you fat, and
it was that high carb ice cream that did me in.
I'm concerned because I think that many of us experienced it in
terms of the low-fat wave; that we thought that we were doing good. We overemphasized. We simplified messages too much, and we were left with a public
who said that they felt that they had gone through the fat prod; that they had
done what they were told, and the were heavier than ever. I see us on the cusp of doing that again.
Weight Watchers so now in terms of the labeling, Weight Watchers
is really strongly convinced that any regulations regarding the food packaging
claims and labeling needs to be science-based.
I think we would all agree on that.
I think perhaps where we have fallen short, and I raise this as
just a discussion point, has to do with context. We heard about context this morning, and I'd like to just add a
thought, if you would, to the area of context.
I believe that essentially there are three contexts, and this is where
there's a lot of cross coverage, and a lot of the confusion comes in, because
we eat food for many reasons. But from
a scientific perspective, we can eat food to prevent a nutritional
deficiency. We can eat food to optimize
health and prevent a disease. And we
can--and we do eat food to achieve or maintain a healthy body weight, and those
contexts get interchanged; and the messages associated with them get
interchanged. And the context in which
things are presented is not clear.
Olive oil is healthy. Do
you know how many people poured olive oil all over everything and thought they
were going to lose weight? Olive oil,
lard, same number of calories. The
context wasn't there, and so I think that that is something, if we are
concerned about the obesity epidemic in the U.S., and we want to use the labels
and the packaging and the health claims to convey that, it's very--it needs to
very clear when a statement is being made the context. What is the outcome when you're saying
something's healthy or it's good?
And just as a point of information, I appreciated this forum to
be able to provide you with the small little blip that Weight Watchers is
trying to express these views out to the public. We have what we're calling about The Truth About Carbs
Initiative. I have provided a copy of
the brochure for everyone who is here.
And what we are doing is we're trying to get information out in terms of
carbohydrates that although carbohydrates are created equal, don't throw the
baby out with the bath water; and that we have different forums for this. We are providing it to all of our members,
which is several million people in the U.S., making it available to the public,
physicians, and professional organizations.
Thank you.
[Applause.]
"HOW DOES THE CURRENT LABEL AND PACKAGING HELP OR
HINDER THOSE ENGAGED IN WEIGHT-LOSS PROGRAMS?--FROM
A GENERAL DIETICIANS PERSPECTIVE."
DR. PHILIPSON: The fact
that we're roughly--and I heard numbers being mentioned in the neighborhood of
$40 billion or $50 billion being spent on dieting-related behavior. And I also heard numbers that very few of
these diets seem to work in the long run.
That fact has sort of motivate part of the Obesity Working Group to look
at ways in which FDA could potentially facilitate any kind of learning or
certification about diets. Presumably
on a voluntary basis; certainly on a voluntary basis in the sense that
currently FDA provides--evaluates information about the safety and
effectiveness of a lot of products, devices, and biologics and drugs. And the potentially the same model could be
applied to diets. That is to say, what
are the consequences in terms of safety and efficacy of a given diet. And so, we very much welcome public comments
to this workshop on the topic of whether such an effort would be useful in
terms of having some kind of certification process or evaluation process of the
science underlying effectiveness claims about particular diets.
That relates to the second speaker on the same topic, which is
Susan Cummings. She's the Coordinator
of Clinical Services at HMG Weight Center, American Dietetic Association. She's going to be talking how to--about how
the current labeling and packaging help or hinder those engaged in weight-loss
programs, from a general dietician's perspective.
MS. CUMMINGS: Good
morning. Well, I want to thank FDA for
inviting me here, and I'd also like to thank my colleagues at the Washington
Office of the American Dietetic Association for putting together the testimony
that is your packet.
I am here today not only as a representative of ADA, I need to
say the disclaimer that any subjective information that I provide is my own and
coming from a dietician out in the trenches perspective. But the American Dietetic Association is
the--this nation's largest organization of food and nutrition health
professionals. And dieticians are
trained to take the science, the very complex science of nutrition and bring
that to the individual, make it applicable, make it interpretable, and then to
not only take that education, to not only educate with that information, but to
help affect behavior change.
And so we do that by providing medical nutrition therapy. Now, I've been a dietician for years. But the last 16 of those years specializing
in weight management. And I have to say
that my career has sort of gone the rocky road of the dieter in this
country. You know the '70s and '80s, we
thought of as the dieting decades. I
think of as the dieting decades.
So if an individual came to me to lose weight, I would go and
design a diet for them, and give it to them.
And if they came back, and they didn't lose any weight, well, there's
something wrong with this diet. And I
would run back and redesign the diet and find another diet and give them
that. And if they came back and lost
weight, great. And so that was the
great diet.
And then, as time went on, I think the culmination of the
dieting decade was in the late '80s, if you remember Oprah Winfrey. Does anybody remember Oprah coming in and
carrying--dragging a wagon full of fat, 67 pounds of fat that she had lost on
this diet. And, at that time, it was a
protein sparing modified fast. And
these diets were provided in medical centers, with multidisciplinary teams of
dieticians, doctors, physical therapists, and the diet was terrific. It worked.
But what happened a year later?
Oprah and everybody else who went on this diet regained the weight.
And to me, that was the culmination of the dieting decades. Okay, diet doesn't work. We've got to stop trying to find the perfect
diet.
And we moved into the '90s, which not only brought on a
non-dieting movement and a size-acceptance movement, but we started toward, and
I for one agreed with, looking at a healthy, eating healthfully, and not so
much focusing on dieting. And so,
low-fats became an important message because Americans were suffering from
heart disease, primarily, and we needed to look at fat.
And the problem was is that, when I, as a dietician, recommended
a low-fat diet, I'm thinking in terms of more fruits, vegetables, whole
grains. Well, unfortunately, that
message got very misconstrued. And the
food industry, in their zeal to give Americans what we want, consumers what we
want, and to address this need of low-fat, you know, started making claims on
food labels. Low fat. Low fat.
So people who never ate chips were eating chips because they
were baked, and they didn't have any fat.
People who maybe didn't eat a lot of cookies started eating Snackwell
cookies because they were low-fat.
And so, what happened is, is we started eating less fat and
about 150 more calories a day.
So, we have to be very careful, again, as we've heard a number
of speakers say today about the message that we give. And I'd like to--what am I doing? I don't want to end my show.
I don't want to end it. Richard?
I want to know--I want to change the slide. There we go.
So the American Dietetic Association has always supported
mandatory labeling and has participated in the talks that had led to the
Nutrition Labeling and Education Act.
And I have to say that, as a dietician, currently I work as the
Coordinator of Clinical Services at the Massachusetts General Hospital Weight
Center, where we have a research component, and we also provide adult and
pediatric clinical programs.
Our programs provide a lifestyle intervention programs of diet
and nutrition, physical activity. We
have programs for binge eating disorder, and also we provide extensive programs
for individuals undergoing weight-loss surgery.
And every one of these programs has a protocol that includes
label reading and teaching labels.
And when I was asked today--why do I keep doing that? Let me do that. When I was asked today to talk, the topic that I was asked to
talk about was current food--do current labels and packaging help or hinder
those engaged in weight loss, a dietician's perspective. And I thought, well, can we answer
that. Do they help? Maybe.
Do they hinder? Maybe.
But first I think we have to put in the context of which we're
talking about, and that is obesity.
What causes obesity? And in the
very general sense, obesity is caused by some combination of genetics,
development, and environment. And the
environmental influences are those that influence our activity, our physical
activity, our movement, our exercise, our food choices, how much we eat, what
we eat, the content of what we eat.
Developmental causes, the way I like to think of developmental
are those things that are hardwired in at a very early age. For instance, you could be--I'll use a
non-food example. You could be raised
in Austria, let's say, and you learn how to speak Austrian. You're not born with an Austrian
accent. You learn how to speak
Austrian.
Then you move to the United States, and you're very smart, and
you're very rich, and you may even be very successful. You may even become the Governor of
California. However, you still speak
with an Austrian accent. That is
something that's been hardwired in since a very young age, and very difficult
to change.
Well, from a food and behavioral perspective, there are a number
of behaviors that get wired in at a very early age that I find 40- and
50-year-olds, people that I work, still struggle with trying to change. That may be mom, I don't feel good. Honey, let's get some ice cream. So that we learn to feel better and to
comfort ourselves with food. And then
as we get older, and mom's not around, food is comforting us.
That may also be--there was some work done by Barbara Rules
[phonetic] and her colleagues at Penn State.
And they looked at the influence of portion sizes on children. Now, we all know if you take a toddler, and
put a toddler in a high chair and give this toddler food, when this toddler's
finished eating, what happens? There's still more food on the plate, but what
does the toddler do? Throws it
over. Puts the plate of spaghetti on
their head. They're not going to eat
it. Their internal regulators are not
going to eat the food. But then,
there's some evidence that suggests four-, five-, six-year-olds will actually
override that and will eat what's put in front of them.
In one study that she did, and I'm going to sip of this, if you
don't mind--and one study that was done was and they gave four-, five-,
six-year-olds lunch, a standard lunch over a period of time. And then they increased the size of that
lunch by 15 percent, and the children ate the increased size without
commenting, without feeling like they were eating more.
They did the same thing with dinner, and increased that size by
30 percent.
So, in fact, in the early--portions do matter. And if we have--if we think about food
labels, they're not only--or how we're going to impact food packaging or if we
need to impact food packaging. I think
of it in terms of it does have a place.
It has a small place in the environment, and teaching people how to
change their eating and giving them the knowledge to do so. And it may also play a role in the
developmental stage, because if mom's reading the label, or mom's serving
smaller portion sizes, then the child's getting smaller portion sizes.
Now, all of this, of course, is influenced by genetics. We cannot become overweight or have obesity
without the predisposition to--without the genetic predisposition. And what makes this such a difficult disease
to deal with is that we don't have one cause. There is not one gene, like blue
eyes and brown eyes, that cause obesity.
It's a polygenetic disorder. And
what may have happened to those children who could eat more food when it's
presented to them is they may have a genetic defect where they don't have the
same fullness level or their satiety level, you know, is higher. So that it may take more food for them--you
know, they may be able to eat more food without feeling uncomfortably full.
Now, if we look at genetics, and we think about then and now,
you know, we can't say that what's causing Americans to be heavier now. Is it our genes? Because obviously our genetics haven't changed. So what's changed over the course of time?
And basically, if you look at this slide, and you look at then;
let's say then is--boy, I'm really challenged here. All right. Let's say then
is 1965, and in 1965, let's say that my sister and I share 50 percent of the
same genes, and my genes in 1965, you know, we're genetically predisposed to
obesity on a continuum. So some people
may have a 20 percent predisposition.
Others, 30 percent. Others, 50
percent. And let's say I have a 20
percent predisposition to have obesity.
Now, obesity is defined as a body mass index of 30 or higher. Mild obesity starts at 30. And let's say that my--I stand right here in
the yellow, and I have a 20 to 30 percent predisposition to obesity. And my sister, let's say, right here in the
red, and she has a body mass index of 30, and this is back in 1970, when, in
fact, I'm outside the phone rings and I got to run through the house and answer
the one phone in the house that's hanging on the wall. Or I'm sitting and watching TV, and I have
to get up and down and change those three channels. Or fix--get up and fix the ears on the antennae. Where I have to move a lot more, and where
the food--and where food is not as easily accessible.
Now, let's fast forward to 2003. I don't have to move as much.
I can actually sit in my chair, change the channels, answer my phone,
and work on a computer. And I can do
that for hours and be very comfortable.
And I have a sofa with a secret, which was some furniture was
advertising up in Boston not long ago, I can flip up the little pack and take
out my snack foods that are there.
So, in this environment, my 20 percent predisposition to obesity
is pulled right over. My poor sister is
now has obesity at, you know, severe obesity.
So you can think of the environment as an SUV, just pulling the genetics
right along.
So, how, you know, so how do we deal with this? How do we work with this? Well, the American Dietetic Association did
a trends and you, nutrition and you trends 2000 survey, of 700 consumers, male
and female, head of households, age 25 and older.
And what we learned from this was that number one: individuals were asked what are their
biggest concerns that they read about in the news; that they're aware of. And 65 percent of them were very concerned
about obesity, and 53 said that their greatest concerns was obesity.
Now, if--one of the things that dieticians are trained in is how
do you affect behavior change, and there's certain tools--education alone,
knowledge alone does not change behavior.
We know some of the smartest people in the world who are smoking. I mean, it just doesn't change behavior.
However, you do need an awareness, and you do need knowledge to
start making that change. And there are
tools of cognitive restructuring and motivational interviewing that help bring
people along.
And so, we know now that the first level of awareness is there
and that that is important for change; okay?
We also know that consumers are increasingly aware of the
connection between diet and health, that we seek information on nutrition and
healthful eating, and that we select foods to achieve balanced nutrition and
healthy diet. The problem is that
sometimes that information is very confusing.
We heard a lot of messages today, a lot of information today, about how,
you know, the dieters are very confused, and I have to say that I spend 65
percent of my non-reimbursable time undoing the myths and the information that
the consumer, that my clients, my patients come in with.
Now, an example is that 77 percent of consumers are aware of
low-fat foods, and in this survey, 56 percent of those 77 increased their
consumption of foods based on this awareness.
So, awareness is important as a first step.
Now the current food labels address heart disease; that's why we
have total fat and saturated fat. They
address hypertension through looking at sodium. Diabetes through carbohydrate, fiber, and sugars. Renal disease and proteins.
Will they help or hinder the individual engaged in a weight
management for obesity? You know, we
don't know that yet. I can tell you
that as a dietician, and we heard Dr. Crawford this morning talk about most
people who use labels now use it because they have a specific reason to use it. They're already sick. They already have a reason, somebody with
diabetes has a reason to look at carbohydrates or has a reason to look at
fiber.
But what about obesity; okay?
Number one, I think if we look at the current label, I have to say from
somebody in the trenches, working with individuals, seeing about 300 patients a
month, that I can tell you that if you're looking for some room on the label, I
think we heard a little bit about landscape on the label, I would recommend
that you use the percent daily value space, because most people, number one, do
not eat numbers and certainly don't eat percentages; and it's very difficult
for an individual to look at a label and interpret that.
In addition, I agree with the comments we heard from Christine
Taylor this morning that the label is not, was not designed nor should it be,
the end all and be all; that most people probably use it to compare one item to
another item. So using it as a--you
know, looking at a percent of a total intake is very confusing.
In addition to that, the reference diet of 2,000 calories is
probably most people looking at weight loss do not, are not on a 2,000-calorie
diet. For myself, at my height and my
weight, I need about 1,700 calories to maintain my weight. Most of the people that I would say Weight
Watchers probably works with are on 27 to 30 points, which is--whoops, how many
calories is that? And so 1,400, 1,500
calories for women. Men maybe 1,800 to
2,200 calories. So the reference diet
itself not only is a little bit hard to find on the label, it may not pertain
to those that are looking or engaged in weight-management programs.
In addition to that, the perception is that the serving
size--that serving sizes are larger than those on the food guide pyramid. Now, I love the food guide pyramid when it
came out. I was back--you know, I was
raised in the days of the four food groups.
Anybody here remember the four food groups?
And from a nutrition perspective, the four food groups didn't
really give you a lot of information.
So when the food guide pyramid came out, I thought this is
terrific. At least it's a visual. We can see that the base of a healthy meal
plan is grains, fruits, and vegetables, and the problem is that the serving
sizes have changed over time. And,
therefore, a serving size on the food guide pyramid obviously is not the same
serving size that people consume or nor that is used in the marketplace.
And, in fact, in Trends 2000 Survey, the only group that people
could identify the correct serving size was bread. All others, they underestimated the food guide pyramid serving
size or they overestimated what they were eating.
Okay, another limitation is packaged foods are not usually eaten
in exact portions listed. So, it makes
it very difficult for a consumer to translate the information on the package to
their daily intake. And adding to the
confusion is that if a product has half the--is half--less than half the weight
of the standard-sized product, they can be--it can be considered a single-size
serving. So, in this case, if you look
at a 12-ounce can of Coke and an eight-ounce can of Coke, the calories listed,
the information listed is per serving or per container. But if you look at a 20-ounce bottle of
Coke, the serving size is two and a half.
How many people here have recently seen an eight-ounce bottle of
soda, Coke? I was walking through the
supermarket not too long ago, and I saw it, and I--it looked like play food
that I should have brought home for my daughter's kitchen. Talk about portion distortion. So, you know, most kids when they buy soda
nowadays or people when they buy soda think a single serving is the 20-ounce
bottle. Okay. You know, candy bars have gone up in size about five times since
the '60s and '70s, and in the last decade about twice its size. How many people sit in the movies and eat
this half of this 510-calorie Snickers bar?
Most likely, not much.
And adding also to the confusion of serving sizes is what we
actually get when we're out there.
A--you know, the food guide pyramid recommends six to eleven servings of
grains, and this here bagel is four ounces.
How many servings of grains is that?
How many servings of your six servings a day that are recommended is
this four ounce? Yeah, it's four.
And the bagel place by my house is six ounces. So I have that bagel in the morning, I'm
done with the grains for the day.
Okay. So I think it's
important, and the other thing I want to get back to a little--you know, I just
wanted to say is that this whole message of low carbohydrate, you know, high
fat, low protein, high protein, it's not only confusing to the consumer. We don't really have the answers yet. Maybe, in fact, with the new sciences coming
out around obesity, maybe, in fact, some people do better on a higher protein
diet. And maybe, in fact, some other
people do better on a higher carbohydrate diet. And we need to kind of put things in the context of, you know, a
balanced diet, but also the more information that comes out about what causes
obesity, what causes us to get larger, I think we'll be able to talk a little
bit more about individualizing treatment.
But no one diet is going to do it.
Consumers are seeking useful information, and they're paying
attention, so we have their awareness and their interest. But I think we have to be careful about how
much information we're going to put on a label. This says, the new food labels are a bit more candid, but don't
let that scare you.
And basically, I think if we give too much information as far as
health claims, we're going to be back here every 10 years thinking about how
are we going to change the label to meet the new needs. Ten years ago, it was low-fat. Today, it's high protein. Who knows what it will be next. And please, be careful, because, again, you
know, we're out there in the trenches.
I'm seeing people day in and day out that are so confused and have no
idea what they're supposed to be doing, never mind translating numbers into a
healthful diet. Oh, I did something,
but that should probably end it.
So, I think I'll end there.
Thank you for your time, and I hope this gave you some perspective of
those of us in the trenches dealing with this issue.
[Applause.]
"WHAT LABELING OR PACKAGING CHANGES WITH RESPECT
TO
WEIGHT
MANAGEMENT MIGHT STIMULATE PRODUCT
REFORMULATION DECISIONS?"
DR. PHILIPSON: Labeling
not only affects the choices that people make among current products, also the
availability of certain products. We're
going to hear next from Bob Smith. He's
President of R.E. Smith Consulting on what labeling or packaging changes with
respect to weight management might stimulate product reformulation decisions.
DR. SMITH: Thank you,
Tomas. You'll notice we're running just
a little behind, and so the solution we've come up with is that I can speak for
the next hour, and we'll not have lunch in keeping with the--
[Laughter.]
What do you think about that, Tomas? Thank you very much.
You can see the title of the overall--that's it--got it--program
today, and I was asked specifically to talk about what labeling or packing
changes with respect to weight management might stimulate product reformulation
decisions.
Well, first of all, I'd like to say, and, as most of the
speakers have, I'd like to make a declaration that I do not speak for the food
industry. I don't believe there's
anybody in the food industry that speaks for the food industry. But I have three decades of work in the
area, and I have some observations I'd like to share with you today.
I'd like to start out with defining what are the factors, some
of the factors that industry uses today when deciding to develop a new product
or reformulate an existing one, particularly to make it a healthy food.
Well, here are some of the factors, and it's certainly not all
of them. But first of all, you have to
define what the health issue is. What
is it that you are concerned about?
What is the consumer concerned about?
What are we trying to accomplish?
Will the product make a meaningful contribution towards resolving this
issue? And that's an important
point. If you're coming out with a
healthy product, the product must help to resolve it.
Can the health claim be stated is a very big item for the
individual company that's making these products. Is there a consumer awareness about the health issue? Will the consumer the product a value
added? Is the remedy safe? Can an existing product deliver the claim or
do we have to use a whole new product type?
And finally, of course, will the product generate a profit?
These are some of the issues that are talked about in the board
rooms before that product is even considered.
Well, in the past, present, and in the future, the healthy
products need points of differentiation.
And that will be the theme underlying everything I say today. A company has to have points of
differentiation before they can bring a product out on the market and make it
successful. As I said, there are areas
where we can make points of differentiation, and we certainly advantage of that
in the industry. The ingredients
statement, for example, is being used widely to bring about points of
differentiation. For example, changes
to more nutritious good ingredients; that is, whole grain flours instead of
white flours. Removal of perceived non-nutrient
bad ingredients. Colors, stabilizers,
preservatives. People use that. Use of organic ingredients is used
extensively in some areas, and use of good additives--probiotics, added
vitamins, minerals, and anti-oxidants--are taken into consideration in
ingredient statement approval or upgrade, if you like.
The Nutrition Facts Panel allows for some points of
differentiation to be mentioned. Zero
percentage of perceived bad nutrients, such as fat, sugar nutrients,
cholesterol, sodium, transfats, and high levels of good nutrients, then
vitamins, minerals, fiber, protein.
We also have other areas on the package that we can use to make
these points of differentiation. One is
the front panel. This is very expensive
real estate, but it can be used. And
that's where you would flag such things at baked, not fried, sugarless, fat-free,
cholesterol free, low in perceived bad ingredient nutrients, whatever they
might be, high in perceived in good ingredients or nutrients, and that's where
you'd highlight relationships between product and health factors, such as the
oats in cholesterol lowering or low-fat in cancer connections.
And then on the back panel, you can actually tell a story, in
many cases, about the nutritional value of the product--fiber and cancer, oats
and cholesterol, calcium and bone health, cranberries and urinary tract health.
In order to underscore the fact that these points of
differentiation are terribly important, I want to introduce you to a near
relative of mine that I like to talk about, and it has been talked about today,
as a matter of fact, Snackwells.
In early to late 1980s, we at the Nabisco Foods Group talked
about what we could do to bring about a healthy product to the market, knowing
full well that in that period of time, the population became aware of the fact
that intake, that fat intake was implicated in many chronic diseases. Nabisco management, at that time, again,
committed to making lower and no-fat products in their snack lines.
There were two challenges obviously. The major challenge for my group in the technology area was how
to make a good tasting, because that's terribly important, functional, and a
low-fat product. Marketing was also
challenged in this particular endeavor.
How does one position a new snack concept so consumers can understand
the benefits, and, therefore, purchase them.
Well, from the point of view of technology, we pursued two
areas. The first was the classical
R&D fat removal and replacement process, where we replaced the fats with
contemporary fat replacers at that time.
And that result in low- or no-fat versions of virtually all the snack
items at Nabisco, including the Snackwells.
At the same time, our fundamental research organization
developed a lower-calorie fat, resulting in the commercialization of Salitrim,
a five-calorie per gram [inaudible] stearified fat, later to be called Benefat,
which is still under commercial use today.
And just so that--sorry--we look at the marketing
objectives. Sometimes people like
myself in research don't think much of marketing, but I certainly give them
kudos. In addition to sustaining the
project over a long time, which is very difficult for marketing people to do,
they have a very short attention span.
[Laughter.]
The marketing folks at Nabisco have contributed three
significant advances without which, I think, Snackwells may have failed. First, they secured the name Snackwells,
which was just a wonderful name for a product such as we're making. Secondly, they undertook for the first time
to package the product in green packages.
That had never been done before, and you can see the impact of
that. You can hardly go through a store
now without all the packages being green.
And finally, when the market demand exceeded our estimates, and that was
a mistake we made, by about 500 percent, the marketing group developed the
cookie man advertisements, which clearly stated to the consumer that we were in
a mess. We weren't producing enough of
these things. Showed how consumers were
intercepting our trucks and fighting over packages of this material in the
storefront. It made an enormous
communication vehicle for us. And so,
that was a major, major contribution.
And just so that we all know what I'm talking about, I brought along a
couple of things here--these were on overheads. It will take too long to put them on overheads, but you've all
recognized this. This is a picture of
the Snackwell front package, just so you'll know what I'm talking about. And I have to admit that my wife is very unhappy. I carry this package around instead of that
of the grandchildren.
[Laughter.]
She's not too happy with that.
Also the back panel, and, again, you can't see it, but it indicates here
a serving size is one of these cookies.
It is a 50-calories per serving size or 50 calories per cookie, and it
shows zero fat and zero saturated fats and all those nice kinds of things that
we're trying--attempting to do.
Well, I've got to admit that the initial product sales were
absolutely phenomenal. They went right
off the charts. It was one of the
biggest successes in the food industry I guess at that time.
The product also was very profitable. Consumer reaction was highly favorable, and instead of product
cannibalism, which we talk about in the industry, where you replace one product
with another--it takes the former one out.
Sales of all of our crackers and cookie products increased, those in the
low-fat and zero-fat, as well as the regulars.
And we were heros.
Incredible.
All right. But then came
the so-called Snackwell syndrome. I
titled this Snackwell's a misunderstood product. Well, why was Snackwells misunderstood?
The consumers felt that low- or no-fat products were healthier
and lower in calories, and they were disappointed to learn that they were not
lower in calories. And there was a
tendency to overconsume the product, as you have heard many times this morning
already.
What were the lessons that were learned in that particular
exercise? Well, most importantly, the
consumer recognizes, understands, and reacts to nutritional trends and
information. That's a key element,
particularly for companies that are making products. The consumer will purchase healthier products that meet perceived
needs.
Healthier products need a clearly identifiable point of
differentiation to be marketed, again the underlying theme. And, of course, every effort must be made to
avoid the chance of misleading the consumer.
And I had one other picture, which I'd thought I'd like to share with
you. It happens to be the sugar-free
Snackwells, but most importantly what I wanted to point out is a line
underneath sugar-free on the front panel that says not for weight control. Keep that in mind when we're trying to
differentiate between overt and not so overt misleading of the consumer.
Okay. To get to the
point today, weight management. Weight
management products also need points of differentiation. Important points of differentiation for
weight management products are calorie reduction per serving, available calorie
reduction per serving, because I am convinced that available calories are going
to start becoming part of our lexicon.
Serving size reduction, I still feel that's important, not to the extent
of going to our mini-Oreos, but something less than the ordinary Oreo. Serving size packaging I think is important,
despite my colleague from Illinois. I
did graduate from Illinois many, many years ago. I can understand why Illinoisans eat corn, even if it's old.
[Laughter.]
I also sense the subtle change over from those high vertical
narrow cylinders of silage to horizontal.
That's all part of getting more food into animals. Anyway, weight management education is
something that is suffering, and it's an area that I think companies can make
as a point of differentiation.
Well, that implies there's something wrong with what we're
doing, and I don't want to overdo that; but there are some things I think that
we could nudge along a little bit.
First of all, serving size.
The way we put serving sizes on labels today, I don't think it's
compelling enough. It's not prominent
on the nutrition panel. The reader is
overwhelmed by all the other data that's on that panel. It's not displayed on the front panel, where
people read mostly. The number of
servings per package is not prominently displayed. That's buried. And many
products have individual pieces that could be a serving size but are totally
consumed routinely, and we need to address that issue.
Calories also I think needs, an the prominence of calories,
needs fixing. I don't thin the consumer
is really fully aware of the liability of overconsuming calories. I don't think it's well understood, and
that's something we should bring to the party.
The calories are not prominently displayed on the nutrition label, even
though they're there. The consumer is
overwhelmed by all the other data I've just mentioned. They're not displayed on the front
panel. They're not immediately related
to serving size in a way that's very prominent. And it sort of leaves the impression that calories aren't
important, which I don't think is a message we're trying to get across,
particularly now.
So what would motivate industry to produce weight-management
products? Well, obviously, I think what
we need to do when specifically targeting weight management through labeling,
the serving size and the calorie content of the product per serving are the
most important pieces of information the consumer requires.
And I think industry would be motivated to produce more
weight-management products if they can use this information to differentiate
themselves from other products that are in the store. Whoop. Hit the wrong
one. I'm sorry. That should go
away. Let's try it. Good.
So, what motivators do we need to work on? Obviously, I say calories. The total calories per container should be
highlighted much more than it is. I
think that would give the impression if I eat this whole thing, I'm going to
get 800 calories. The effect of
overeating calories could be illustrated somehow with a cartoon portraying the
activity needed to work off the calories per serving. This is tying the excess calories to what it takes to get rid of
them, and I--better people than me will work out this, I'm sure. But a hundred calories could, in fact, be
related to 2,000 steps a day more or 500 calories means you have to run a mile
to get rid of them. Those are the kinds
of highlighting I think that are important in calories.
As far as serving sizes are concerned, there serving sizes could
and should be reduced by industry, not as I said from the mini-Oreo to--the
regular Oreo to the mini-Oreo, but something that's somewhat less than what the
Oreo is today, for example.
Serving sizes need to be individually wrapped. That's an expensive proposition, and I
certainly like the idea of the colored chips to differentiate between serving
sizes. But there may be ways that we
could reduce that expense by eliminating some of the interior packaging costs.
Could products be differentiated by category, based on a number
of calories per serving? This is an old
idea that's been kicking around, but I think it's worth looking at again, even
color coding it. For example, a serving
size that was a hundred calories per serving might be green. One that is 200 calories per serving size
might be yellow, and then red identifying those at 400 more calories per
serving.
I think another thing that would motivate industry to make more
management, weight management products, a good hard look at standards of
identity. Some standards of identity
need to be revised or eliminated.
Standards of identity reduce the manufacturer's ability to use novel and
innovative ingredients and processes to produce products lower in fat and
calories with the same or superior attributes.
I give, for example, cheeses that require minimum amounts of
milk fat to qualify for the name. It
would be possible to lower the fat content several grams without the loss of
taste, but we'd still need to sell it as cheeses, if we could. Ice cream has been mentioned a few
times. That calls for specified solids
and butterfat levels, but we have the capability right now to change the type
of fat from saturated to polyunsaturates and such. Higher protein levels could be put in there quite easily.
And the thing that we're missing most is the fact that it could
not be called ice cream at this time.
Health claims. That's
been talked about a awful lot today.
Approval of health claims needs to be accelerated and expanded, and I
know there's an effort going on from the July 10th interim guidance
documentation. There isn't any question
that that could be expanded and approvals accelerated. My personal view is that companies who
invest in claims substantiating should receive some proprietary use of the
claim. If a company has put a lot of
money into a claim substantiation, they should have something just as simple as
a six-month lead time, or one-year lead time on the claim before everybody has
access to it.
Nutrition quality claims is something I think we need to look
at. Well, we talk about health claims
and then their relationship to disease, nutrition quality claims may not
necessarily be tied to any kind of disease, and we need to explore the
nutrition quality guidelines for reducing calories. And I've jumped from the idea to a possible outcome. This product needs government guidelines for
reduction of calories. Or this product
needs government guidelines for weight management foods. I think there's a germ of idea that should
be pursued. Of course, every company
would like a seal of approval from the government on their product, and would the
FDA ever consider a seal of approval for foods for weight management. That implies, of course, we know what the
weight management food is, and that hasn't been worked out yet I guess.
Education. That's the
thing that has not been enforced or induced to the extent necessary, and
there's no question that manufacturers can bring a lot to the party on weight
management education once we decide what the message is.
Obesity is caused by excess intake of calories and or
insufficient activity to burn off these excess calories. That's the message that's got to come in
some form, and we're going to talk about that later I guess.
How do products fit into an overall weight management
program? That's the piece of education
that manufacturers can do. How much activity
expenditure is required to work off the calories that we're talking about. And, again, that's a possibility that we can
do on our packages quite well.
And so, I may be out of the realm of understanding here totally,
but from my perspective at least what we need is an FDA industry consumer panel
to identify the voluntary, and I underscore the word "voluntary"
consumer weight-management messages appropriate for packaged goods,
particularly for adolescents, because I think if we can get to the adolescent
about what it is and what happens to excess calories, we're going to have a
generation of people that are far more slim as you indicated today. And also parallel to that, of course, would
be an FDA-FTC industry consumer panel that identified voluntary consumer weight
management messages appropriate for advertising. Remember there's a distinction between those two.
As an example of a little farther out of the box thinking, we
might consider support of the America on the Move Initiative, generated out of
Colorado. You may all be aware of that,
where overweight was purported to be caused by small imbalances of calories
ingested versus expended over extended periods of time. And their key was about a hundred calories a
day will result in this--in a pound year of increased weight over
maintenance. And so they are
recommending a reduction of the caloric intake of a hundred calories, I think
75 was mentioned before--a hundred calories per day to maintain body weight.
And in thinking that through, for a 2,000-calorie per day
person, this represents a five percent reduction in the intake of
calories. Question: would the FDA allow a nutrition quality
guideline, recognizing such a reduction?
Obviously not on a product.
That's too small. But if it were
across a full line of products, would, in fact, a statement be able to be made
that would differentiate that line of products from other things. Worth considering.
Okay. Let's summarize
what I've talked about today real quickly, and I think I'm going to get you
almost on time.
The motivators to encourage weight-management food development.
Expand, accelerate, and diversify health claims; encourage single-serve
packaging and measurement devices, and by that I mean where we have large
containers with bulk product, perhaps the producer could put a one-serving size
scoop in it or something, just to give us some idea that when we pour the
cereals out in the morning, we're really getting four servings instead of
one. I think that would be
worthwhile. Encourage serving size
reductions; revise the standards of identity, where appropriate; utilize
nutrition quality guidelines to differentiate products for weight management;
explore weight-management education programs, especially for adolescents; and
continue enforcement on non-compliance.
And this is an issue that major companies, who are very responsible
have. If, in fact, we devise some of
these nuances on the packages, it's important for them that the FDA
particularly enforce those who are stepping over the line and abusing these
possibilities, because it does lose credibility for the entire food industry if
a segment of it, even though small, is not playing by the rules. And so, the request is for a level playing
field.
And then my last thought is to give you something to talk about
over lunch perhaps, I would say what about making a weight management facts
panel, wherein we would highlight calories per serving, possibly by color, as
indicated before, consider some simple energy expenditure characterization so
that people will understand the hundred calories means two thousand steps
extra, and include other relevant weight-management information; that is,
fat-calorie ratios or something. A very
small weight management facts panel, if you would in order to get the space
because space is expensive. Reduce the
nutrition facts panel to emphasize the macro ingredients as opposed to some of
the micro ingredients. And work with
industry to offer a weight management information, such as the America on the
Move, which, in fact is gaining in popularity, and I think the industry would
be very supportive of explaining that on their packages.
So what I've talked about today is obviously individual
observations. They all need study, and
that's been mentioned many times before, and obviously when we come up with a
result, it should be studied before it's implemented.
But I think we have a great challenge and opportunity to bring
something to the weight- management problem that we're dealing with today. And I thank you for your attention.
[Applause.]
DR. PHILIPSON: Thank you
very much. We're going to be meeting
back here at 1:00 p.m. Lunch is best
obtained at a big cafeteria in Nather [phonetic] Hall, which is directly
outside. When you get out of the
building, you just walk straight towards that building. There's a smaller cafeteria in the bottom of
this building, but we suggest, given the size of the audience, that people walk
over to the--to Nather Hall. Again,
we'll be back here at 1:00 p.m.
[Recess.]
A F T E
R N O O N
S E S S I O N
WHAT CAN BE LEARNED FROM EXPERIENCES WITH LOGOS
OR CERTIFICATION?--THE CASE OF THE
SWEDISH KEY
HOLE"
DR. PHILIPSON: Can
everyone please sit down? Can everyone
please sit down? We have two remaining
speakers before our two roundtables.
We're first going to hear from our Swedish colleagues, Åsa Brugård
Konde. She was a nutritionist at the
Swedish National Food Administration, and she's going to talk to us about the
labeling system they have developed in Sweden, which is sort of a dichotomous
labeling system. Her title is what can
be learned from experiences with logos or certification?--the case of the
Swedish key hole"
MS. BRUGÅRD KONDE:
Okay. First of all, I would like
to thank you very much for inviting me here.
It has been interesting to follow the preceding speakers, and, of
course, it's very stimulating for me and my colleagues at the Swedish National
Food Administration that you're showing such great interest in our symbol
labeling.
So it's a pleasure for me to tell you about it.
The symbol labeling started in 1989, and, before, two years
before that, a heart symbol was introduced in the northern part of Sweden,
where they had a project because of the higher coronary heart disease frequency
that they had in that part. And the key
hold labeling--no, the heart symbol was
a part of that project.
And it got so popular that it created a demand of a national
symbol. The symbol stands for low-fat
and fiber-rich products. And why did we
introduce this? Well, it's a way to
help the consumers to chose low-fat and fiber-rich products. It's also a way to
stimulate development of those products, and to facilitate the marketing of
them.
It was also necessary to create a common and credible symbol for
all industry and trade interests, because what had happened was that, as I
said, it was a demand of a national symbol, but we weren't--or the National
Food Administration weren't quick enough to do that. So the different food retailers started to have their own
symbols.
Well, I'll talk more about that later. The main principles for the labeling is that it should be low-fat
and fiber-rich food products, and that it's a better choice within different
food groups. So it's not the same
criteria for all groups, but it's different depending on the variation that you
can find within the group. And foods
that are naturally low-fat or fiber-rich are not labeled. And that's, for example, meat or fish and vegetables
may not be labeled.
The symbol may be used on food, on packages, and also on store
shelves. I think I have the wrong
version--all right. Never mind. I'm looking at that one.
The criteria for labeling are set by the National Food
Administration, and--but it's the manufacturers that are responsible for
fulfilling the specified criteria. The
symbol may be used without any charge or special commission, as far as they do
fulfill the criteria, and it is voluntary; it's not mandatory. And what I would like to add as well is that
it does not replace the nutrition facts on the packages. It is added to other information. It does not replace that kind of
information.
We have different criteria for different food groups, and I'm
not going to get into details about these--the criteria, because you can all
get a little brochure that I brought outside here, where you have all those
details.
But what is interesting is that there are, as I said, there are
different criteria. This means that you
can put labeling--the label on fat spreads, for example, which would be
impossible if it was according to the fat energy percentage, because the fat
energy percentage of fat spreads, even if they have lowered the fat percent as
such, is still a hundred percent of the energy from fat.
On fiber-rich products, the criteria are based either on whole
meal grain or on dietary fiber.
I don't know why if it's possible to get the right version,
because otherwise I will miss half of the presentation. This is the one that I sent you before.
MR. LEVITT: Yeah.
MS. BRUGÅRD KONDE: So if
we can get out of this one. Ah, but you
have the other one on your copies I think.
You have a lot of pictures, don't you?
Yeah, well, so it's a pity, because it was the opposite--it was this
version that I thought that you would get, and then I was going to show you the
pictures with the animation and everything.
[Laughter.]
And now, it's the opposite.
So, I'm sorry.
Well, I'll go on talking.
Unfortunately, I cannot tell you about all these--the pictures. The symbol may also be used on ready-made
dishes. And that was quite difficult to
make it in a way that it shouldn't--that it should be useful. But, and it's written in the regulation that
it should be a complete meal, and, with that, we mean a dish with meat, fish,
or a vegetarian alternative with potatoes, rice, or pasta and sauce and
vegetables. So this complete meal
should contain not more than 30 percent of the--the fat energy percent should
be less than 30.
For meals that are served in restaurants, there is a separate
rule to make it easier for the cooks and to calculate; and that was that 17
grams of fat in the portion could be committed, but not more than that. And that is good if the dish gives around
500K calories. That's equivalent to 30
percent of fat energy. But now we have
discovered that some restaurants serve very small meals, 200K or 300K calories,
and, in that case, 17 grams of fat is quite a lot. And the problem with such a dish is that you will not get
satisfied, and then you'll go and have a chocolate bar afterwards, and then you
haven't gained anything.
There is also a very new project, called Key Meal. Even in Swedish, we call it Key Meal, and
it's a development of the key hole for certified restaurants. This has come from one of the restaurant
chains that are serving meals in universities.
But now, it's getting spread in other chains as well. To be certified, the restaurants have to
have 75 percent of their staff educated.
They--the criteria are the same, but, as you can see, they have modified
the symbol. They need--the restaurants
have to have one key meal dish on the menu every day, and this thing is ruled
by something which is the called the Society of Key Meal. And we are collaborating with them.
Now, do this--the knowledge of the symbol lead to better dietary
practices? There have been quite a lot
of master theses done on the Key Hole labeling. Not many scientific articles published on it, but there are some,
and I'll tell you about the first two that were made in '96 and '99 by Lauschen
[phonetic] and Listner [phonetic]. The
first one was a 24-hour dietary recall.
And then they analyzed the fat and fiber intake, especially. They combined this with an open-ended
question on the meaning of the symbol.
And the result was that 62 percent understood the meaning of the symbol. But, in this first study, they couldn't see
any association between the symbol knowledge and the total fat intake.
However, there was a small association between the symbol
knowledge and a higher relative fiber intake.
And the fatty acid quality of their diets, of those who knew the symbol,
was also better.
Three years later, they made a food frequency questionnaire, and
with the same kind of open description of meaning. That means that they didn't have to--they didn't have any
alternatives. They had to invent the
responses themselves. This time 65
percent understood the meaning, and both women and men with the knowledge of
the symbol seemed to have adopted the low-fat message, and the women also had
adopted the fiber-rich message.
The--one year ago, there was another study. This one is only in Swedish until now. I think they will publish something in
English as well, but now we only have a report in Swedish. Here, you can see that 72 percent
knew--associated the symbol with low-fat.
This time it was that they had--the--all these alternatives to
respond. Only 31 percent knew that it
is fiber rich. And 33 percent thought
it is low in calories. And that is
often true, but it's not really the meaning of the symbol.
As you can see, it's also quite many that think that the symbol
means ecological. And that, I think, is
because of the green color.
[Laughter.]
Now, do they use this symbol while shopping? Well, 44 percent doesn't say that they
do. It's always or often, and about as
many do it sometimes in general. But
for the products they asked, it was lower.
So probably it's other products that they buy with the symbol, perhaps
ham or other--I don't know what kind of products, but not very much milk,
bread, or fat spreads. Fat spread is a little
bit more than the other two.
Now, what impact has the Key Hole labeling had in Sweden? On product development, I would say
definitely yes, it has had an impact.
When it was introduced, for example, those who are producing cheeses
said that it wouldn't be possible to make delicious cheeses with less than 17
grams of fat. And now you can find a
lot of those products. And there
are--it is very much used, and you can more and more products with the symbol.
Does it have an impact on the purchasing practices? Difficult to say. The studies I told you about say that the consumers use the
symbol when they are purchasing. So,
probably it has. What is interesting is
that you can--I think it's the last year--you can see more and more of the
symbol in this kind of publicity. You
can see it even on the front page, at least you're sitting in the front
here. I'll put these things so that you
can look at them afterwards if you want.
So and I think those--the food retailers and the industry have
much more money than we have to study the consumers. And since they are using the symbol so much, there must be a
reason for them to do it.
This can also be said to be a sign that there is an increase in
consumer demand for low-fat and high-fiber rich product. But, of course, there may also--even if we
hadn't had the Key Hole labeling in Sweden, it could have been the same
situation. I don't know.
A negative impact that the key hole labeling may have is that it
can encourage overeating of low-fat products.
I mean, even if the cheese is--has 17 grams of fat, it's still a lot of
fat. And if it has--if the Key Hole
symbol makes you eat slices instead of one, then it's no good.
Does the knowledge have an impact on the behavior? Probably, but we can't be sure of that. There are some shortcomings with the present
criteria that I would like to share with you so that if you're going to
introduce a similar symbol, you won't make the same mistakes as we have made.
The first one, which is very evident now, is that there are
products with very high levels of sugar.
For example, fruit, yogurts, and breads. Although they fulfill the criteria for low-fat, but if they are
very rich in sugar, they are not nutritious food, actually. And the same thing
is with the breakfast cereals, which may have a high fat content, even if they
are also fiber-rich.
A perhaps even worse thing can be that the message is--can be
misleading. We don't know enough about
this. There is a student right now who
is trying to make a study on this. If
the consumers may believe that the lean sausage, which contains less than 15
grams of fat, perhaps they'd believe that that's a better choice than to buy
fresh meat or fish, which is probably much lower in fat.
And, as I said before, the green color associates to
ecologically produced products. So
that's also an advice; that if you're going to introduce a symbol, a similar
symbol, don't take the green color.
The National Food Administration has now decided that we should
make a revision, and very unpredictable overview or revision. We're going to look at the limits for sugar
and salt contents. Some of the ready-made dishes are very--contain a lot of--a
high amount of salt. And that's, of
course, not good, either. There should
be some exclusion criteria for sugar rich or sodium-rich products for the not
only restaurants meals, as I've written here, but, as it's written in your
copies, for ready-made dishes I think we need to add more criteria to make it
better. We may put energy levels,
maximum, minimum. We may put something
on carbohydrate content because, up to now, it says it need--it has to be a
carbohydrate content, but perhaps that could be only maccaroni. I don't know.
And we could put perhaps a criteria that says that it has to
contain a certain amount of dietary fiber, or what I would like more perhaps
vegetables, because many of those products--ready-made dishes that you can buy
frozen don't contain much vegetables, and, to be a good dish, they would.
We are also going to look at the possibilities to use labeling
of recipes in booklets and in this kind of publicity, because, until now, it's
not. It's only permitted for recipes
for restaurants. And we even have a
book that I will leave for you.
Unfortunately, it's all in Swedish, but perhaps you ask Tomas Philipson
to translate the recipes if you look at the pictures and find them appetizing.
But what is happening now is about what happened when the symbol
labeling started, because one of the pictures that I missed now since we have
the late--we don't have the latest version on the PowerPoint--was how--there
were two different symbols that the food retailers had started with, and that's
why we got the Key Hole symbol. And
now, they are also starting with their own symbols, since they are not allowed
to use the Key Hole on recipes. So I
think we will have to rethink about that.
And the reason why it's not permitted on recipes for consumers is that
it is--we have believed that perhaps they will change one of the ingredients
and then the--it won't be fulfilling the criteria. But that I think we have to rethink of that.
Perhaps we should introduce labeling of naturally lean meat and
fish, because we can't just think that people know. There have also been suggestions of putting the label on fruit
and vegetables, but I think people know that fruit and vegetables are good food
without even if we don't put the label on them. And if we do start that labeling, there will be a lot of
difficult things to solve on--for example, ketchup, should it be labeled or
not? And many of that kind of products.
Perhaps we should include new food groups, salads, like coleslaw
or potato salad or dressing, are products that may be in the future could get
the label.
The symbol needs to be developed. We need to increase the credibility of this symbol. One thing is to revise the criteria, as I
just described. Another is to increase
the control. There is very little
control actually done on the Key Hole.
And I don't think that the products that are selled in the stores that
we would find any problems with those.
But for the meals served in restaurants, I think that they may be a lot
of meals that are getting--that--where the restaurants are putting the label on
foods which are not fulfilling the criteria.
There is also a discussion if we should continue with the same
system that the authority are having the criteria and the manufacturers are
responsible for fulfilling them, or if we should have a similar system as with
the Key Hole labeing; that there should be a certification. That will be also discussed during the
coming year.
We are also now discussing in Sweden the possibilities to
introduce differentiated taxes as a way to combat the overweight or the obesity
that is increasing in Sweden, as well as here.
And if the Key Hole gets really good, I mean, if we change the criteria
in a good way, perhaps it could also be used as a tool for these differentiated
taxes so that all foods that fulfills the criteria for Key Hole labeling could
also have a lower tax.
In the future perhaps the Key Hole could become a common
European or international symbol for helping consumer making informed choices.
So my conclusions are that the Key Hole labeling is very
widespread and well known, both among manufacturers and consumers. You have to remember it's one of several
important tools for making conscious choices, and there is an increased
interest among manufacturers and retailers and restaurants, but the revision is
necessary in many aspects. Thank you
for listening.
[Applause.]
"MARKETING THE LABEL TO CONSUMERS"
DR. PHILIPSON: Okay,
we're going to conclude the individual speakers with Allison Kretser, who is
with--the Director of Scientific and Nutrition Policy at the Grocery
Manufacturers of America. She--her talk
is entitled Marketing the Label to Consumers.
MS. KRETSER: Great. Good afternoon. I'm delighted to be here this afternoon. I know that I spoke at the first FDA
meeting, and so any of those comments I won't be resharing today; a little I
will go back over.
First of all, I wanted to share GMA's Statement of Commitment on
this issue; that the food and beverage industry is committed to helping to
arrest and reverse the growth of obesity around the world.
Achieving this goal will require multiple strategies, the
integrated efforts of many sectors, and long-term resolve. And the industry is committed to doing our
part, and will support others in doing theirs.
And this is an issue where our member companies are collectively
working, discussing, trying to see where we best can leverage our expertise in
helping to arrest the growth.
Our member companies GMA helps to facilitate on various
different issues of concern to the industry.
An example that I work on is food allergen management. So, collectively, the industry works and
looks at best practices. They don't do
it in isolation. And this issue of
overweight and obesity you do have the commitment of this industry to work
together.
We want to continue to provide industry leadership to promote
science-based efforts that positively impact critical nutrition and public
health issues. We want to ensure that
the global food and beverage industry is a positive force, and is a valid and
responsible partner in addressing the obesity issue.
What is our commitment?
Our commitment includes providing consumers with products to meet their
health needs and goals. We have
innovative product research, and research into nutritious products. We are assessing portion size and
packaging. There's a lot of innovation
that is going on in that--in both areas.
I think you'll see change coming; is on the way.
Our industry is committed to responsible advertising and
marketing practices. And we're
supporting health and wellness activities for employees.
And we know that parents serve as role models. As they become engaged at the workplace,
they can take that and bring that back to their families, as well.
On the issue of the label, there's a few things that--areas that
I would like to discuss today. The
first is on qualified health claims; that food choices are not a black and
white decision, but it's a matter of finding the right balance. Qualified health claims provides a new tool
for improved nutrition communication that will help to drive product
innovation. Point of purchase we know
that that's helpful. As consumers read
about information in their newspapers, in magazines, if they see something on
an advertisement, then that can be reinforced on the label.
We need to focus on empowering consumer choice, and not dictating
purchases. We feel that the visual
rankings that are under consideration for qualified health claims, whether or
not a letter grade or perhaps some type of color coding for the use of
qualified health claims would cover--would carry over to the entire food. So that if you had a B-grade, a C-grade, you
know, what would be that impact to the consumer thinking about the food, the
entire food. And it negates the point
of giving consumers the information to make their own choices.
GMA submitted comments to the food guide pyramid revision
process, and we are calling for a harmonization of servings and portion
sizes. We know that the differences to
the consumer between a serving, what represents a serving, what represents a
portion; it's been discussed this morning.
It's unclear to consumers, and it's confusing. And we support that servings should correspond to common
household measurements. That's easily,
the consumer relates to that.
Serving size, as referenced on the food label, should be aligned
with the dietary guidelines and the food guide pyramid. And one of the things that the food industry
has done is put the food guide pyramid on labels. We've seen that. We know
that the pyramid is recognized by 80 percent of consumers. So now, we need to take it a step further so
that we can begin to relate from the food label how that positions to the
pyramid, so it increases the opportunity for the food and beverage industry to
communicate recommendations to consumers.
And you can cross reference how a serving fulfills the food
guide pyramid recommendation directly to the consumer, so if you have a product
like a casserole, you could then quickly see that if you had a portion of that
food, then you'd have, you would have met two grains, half a meat, and one
vegetable, as just one example. But
that would begin to help provide some dietary guidance further.
In the area of nutrient content claims, the industry feels that
incremental, but industry wide reductions in calories, fats, sodium can have a
resounding impact on consumer health.
Currently, we have reduced, it's 25 percent, you know, a minimum of 25
percent before you can use the word reduced, but sometimes what happens is the
consumers sees that. If they see
reduced sodium soups, we do not have a high market volume in those products
because it's perceived perhaps for only those individuals that have been given
dietary instructions that they need to reduce their sodium intake, and they
already have a chronic disease in place.
Those are the individuals who typically do look for those types of
products. If there were smaller
incremental changes, we could begin to make a significant impact for all
Americans.
Labeling changes could also provide new industry incentives to
improve their nutritional profiles, even, in fact, if we could say 10 percent
calorie reduction versus a 25 percent reduction. We know it's on--you know, you don't have to hit a home run every
time you eat one particular product. A
base hit can add up and get some runs in there as well.
Another area in the nutrient content claim area is the 50-gram
rule, and it applies to foods that have a smaller reference amount customarily
consumed of less than 30 grams. So
one-ounce foods, which fall to 20 grams, have--it's very difficult to be able
to make a low calorie claim, because it's based on, you must, even though the
food, the serving size is 30 grams, you have to meet it on a 50-gram
basis. So you'd have to have only 24
calories per serving instead of what the actual criteria is for low-calorie,
less than or equal to 40 calories. The
same is true on the low-fat. That it's
a little bit tighter. So the
restrictive standards have had limited opportunities to market low-calorie or
low-fat foods in these types of products.
We've heard a little bit about next steps in the consumer
research and what we want to look at.
We know that consumer understanding is based on accurate and clear
messages, and we feel very strongly that as we look at how can the food label
change, we need to make sure that consumer research is done so that we
understand how does the consumer see these changes or additions to the food
label. So GMA will be--has commissioned
consumer research to gauge consumer understanding of calories, serving, and
single- and multiple-serve packaging.
Since, NLEA has been in existence since the early '90s, we have seen a
growth in the number of single-serve packages that wasn't an issue when NLEA
was first implemented. So now, it's
time to take a look and see how whether or not we can find ways to enhance the
message about the caloric content of those products, moving forward.
The other area that is a huge void is helping Americans to
balance the calories in and the calories out, and how to balance that total
equation of what they eat against what they do.
We heard a little bit about that this morning, and I know Bob
mentioned whether or not you would have if you had a hundred-calorie food, and
what you would have to do to burn off that hundred calories. We have great reservation about moving
forward with something like that because you don't have to burn all the energy
that you consume. You need the fuel for
your body to function. And so that
would be very misleading to the consumer if they had an entree that they
thought that they would--you know, they had to go out and run it off, their
slice of pizza that I had for lunch today.
It's the excess. And so we hope
that, through this consumer research, we can begin to be--to capture how to
communicate that information and use it to help consumers.
Marketing the message.
Nutrition education is about more than the label, but it can serve as a
springboard for other efforts. The
industry is committed to leverage product marketing across all segments to
amplify the health and nutrition message, and, again, getting that message
about energy balance. And we can do
that through labeling, marketing, and advertising, retail displays within
supermarkets, that whole channel.
Consumer education campaigns.
Public service announcements, web sites, and brochures. And, as HHS moves forward with their
Healthier U.S. Initiative, and their campaign in getting the word out to
consumers, the industry is committed to helping to use our collective reach to
helping Americans. Thank you.
[Applause.]
DR. PHILIPSON: Thanks
for that. We're a little ahead of
schedule, but while I propose we take a break until 2:00 p.m. Before so, I wanted to thank Rich Cannady,
who is actually the main organizer of this conference, not me. He basically pulled the whole thing together
and should be acknowledged as the main organizer. Me, myself and Peter Pitts [phonetic] and others who will be
moderating the afternoon helped him do it.
But without Rich, this wouldn't be possible. So I suggest we take a break, and we'll back at 2:00 p.m. with
our two panels.
[Recess.]
FOOD PACKAGING AND LABELING
DR. PITTS: Your
seats. The feature is about to
begin. Good afternoon. My name is Peter Pitts. I am the Associate Commissioner for External
Relations at the Food and Drug Administration, and welcome to the expert views
panel on food packaging and labeling.
I am going to introduce the panel in neither left, nor right
order. I'm going to introduce them
based on the piece of paper that I have in front of me. So, when I mention your name, just smile and
nod to the crowd. I note immediately to
my right, to your left, is Carol Tucker Foreman, of the Consumer Federation of
America; Julie Caswell, Department of Resource Economics, University of
Massachusetts, Amherst; Ron Henry, Senior Financial Officer, Program Officer,
Robert Wood Johnson Foundation; Bill Dietz, my colleague from the CDC; Sue
Borra, from the International Food Information Council--IFIC is so much easier;
Bob Earl, from the Nutrition the Policy, National Food Processors Association;
Rudy Nayga, Professor of Department of Agriculture Economics, Texas A&M;
Brian Wansink, Director of Food and Brand Lab, University of Illinois; Karen
Miller-Kovach, Chief Scientist, Weight Watchers, International; Susan Cummings,
MGH Weight Center, American Dietetic Association; Bob Smith, R.E. Smith
Consulting; Asa Brugard Konde, Swedish National Food Administration; and
Allison Kretser, Grocery Manufacturers Association.
A couple of ground rules before we get started. Panelist, we have three minutes per
panelist, and we have 13 panelists; that's 39 minutes. Let's call it 40 minutes to make the math
easy. If we stick to three minutes,
we'll have just under an hour for conversation and comments, so let's try to do
that.
Also, when we do turn the questions to the audience, I would ask
you, and I'll remind you, if you please identify yourself, your affiliation, as
well as who you are directing your question to. That way, the audio record will assist us in the
transcripts. I'm going to ask the
panelists to address three major questions:
The first is: what are
the messages suggested by the available data that are likely to affect weight
gain, weight management, or weight loss?
Second: how might those
messages be communicated through labeling?
And lastly: what are the
pros and cons of communicating through labeling the messages that the data
suggest?
So why don't we begin all the way down at the end, my right,
your left, and it'll be interesting.
DR. WANSINK: What I'm
going to do is reiterate a little bit of what I said in the talk that relates
to these three questions.