After decades of lobbying, the US government has finally launched action to warn consumers about the dangers of ultra-processed foods, including your potato chips, granola bars, cereals, frozen pizzas, and more store-bought breads.
As we reported last year, there is growing scientific evidence linking these ultra-high-processed foods, or UPF, ranging from obesity, diabetes, hypertension, depression, anxiety, and autoimmune disorders. As my colleague Marina Borotnikova explained in December, exactly what is classified as UPF is not complete and the category may be too broad, but there is still a growing desire for consumers to clarify what we are buying and eating.
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Earlier this year, to address the rising burden of these chronic diseases, the US Food and Drug Administration (FDA) under former President Joe Biden proposed a new policy that requires food producers to add new nutritional labels to the front of most packaged foods, warning consumers about the high fats, sodium and sugars commonly found in UPFS. The new Department of Health and Human Services Secretary Robert Kennedy Jr. could continue this work. He called UPFS “poison” and promised reform.
A small number of countries in Latin America and Europe have already introduced similar packaged nutrition labels. In 2020, Mexico passed a law requiring a variety of warning labels for all packaged food and beverages. The label contains a black stop signed person indicating whether the product has excess sugar, sodium, or saturated fat. Chile was the first country to pass such a law in 2012. The UK has similar systems in place, but companies are not legally required to add warnings to their products.
The US may be behind the nutritional alert game, but the good news is that similar efforts elsewhere are effective in raising consumer awareness of UPF's nutritional risks and pressure manufacturers to create healthy products.
These labels allow consumers to make more informed decisions about what they eat without infringing on their right to eat what they want. However, while nutrition experts have welcomed the FDA's proposed policy changes, the addition of warning labels to packaged products has not been shown to reduce the very realistic burden of chronic disease. This requires systematic changes.
Are warning labels effective?
Much of the real-world evidence explaining the impact of packaging frontline nutrition labels comes from Latin American countries. They have long been pioneering UPF research and regulation, partly due to the high burden of chronic diseases associated with UPF consumption, and the spread of UPF pushed traditional foods, explained Vanessa Kut, a public health and nutrition researcher at the University of Sao Paulo, Brazil.
In around 30 Latin American countries that added a frontline nutritional warning to the packaging, public health researchers have found that well-designed labels can help consumers get more information about the content of products they buy. “We've seen a lot of people living in the world,” said Marissa Hall, assistant professor at the University of North Carolina's School of Global Public Health. “Labeling also sees places that help people understand what their food is and understand which products are nutrient-rich.”
A 2024 study of almost 3,000 households in Chile found that consumers purchased significantly fewer labeled products with sugar, calories, sodium and fat, reducing sugar consumption by 36.8%, reducing calorie intake by 23%, reducing saturated fat consumption by 21.9% and 15.7%.
However, not all studies report these effects. Another Brazilian study found that the “Warning: Ultra-Highly Handled Food” label significantly improved the ability of consumers to identify which products are UPF, but did not affect health buying intentions or perceptions of health.
Another advantage of nutrition labels on packaged foods is that UPF manufacturers create market pressure to make healthier foods, Hall explained. After Chile implemented the warning labeling method, the proportion of sugar-rich UPF products fell to 80-60%, while sodium-rich products fell from 74% to 27%.
A similar scheme in New Zealand and the Netherlands allowed companies to display logos indicating their product's health if certain nutritional requirements were met, leading companies to quickly reformulate their products. One study found that salt in grain products was reduced by 61% in New Zealand, and 20% of the products were reformulated in the Netherlands after the introduction of a labeling scheme.
The FDA's proposed nutrition labels are not the same as those used in Latin America. In Chile and Mexico, businesses should use bold, black stop-shaped icons on the front of the package, telling whether the product is high in fat, sugar or sodium. If the package has three stop signs, all three will be higher.
The FDA version consists of a small black and white box similar to the existing nutrition fact box already shown on the back of the packaged food, but is placed on the front. These boxes indicate whether low, medium or high levels of saturated fat, sodium and sugar have been added to the product.
Therefore, US labels can show that the product is high in salt but low in sugar, leaving it to the consumer to determine whether it is good or bad. Context percentages can be helpful, but comparing such trade-offs is not necessarily intuitive. “When you understand all these different nutrients, I'm worried that people are confused about how health of the overall product is,” Hall said.
Others are far more critical of the FDA's proposed nutrition label. Senator Bernie Sanders said the label “is pathetic and has to be improved substantially.” He suggested that the UPF warning label should be more similar to the FDA-mandated warning label for cigarettes, which explicitly states a list of fatal lung disease, heart disease, cataracts, bladder cancer, and other conditions. (A federal judge in Texas blocked the FDA's mission earlier this year to request a graphic warning of the health risks of smoking.)
The warning label improved consumer perceptions in the study, but this has not been translated into improved overall health outcomes. Chile introduced a nutritional warning label in 2012, but the obesity rate continues to rise from about 68% in 2010 to 79% in 2022. The Chilean government has even introduced other measures to reduce UPF consumption. For example, by increasing the tax on sugar drinks from 13% to 18% in 2014.
In Mexico, which introduced the labeling order in 2020, the rate of childhood obesity fell slightly from 38.2% in 2020 to 37.3% the following year, while the number of diabetes patients rose from 15.7% in 2020 to 18.2% in 2022.
It may simply be too early for public health officials to observe improvements in obesity and other chronic disease rates. What's clear is that we'll need more than a nutritional label to create a food environment where everyone can eat healthy, nutritious foods.
“What more should we do to make America healthy again?”
Research in Latin American countries reports that UPFS's frontline warning labels are effective in raising consumer awareness, but this is actually just a small step in the right direction. To actually reduce UPF consumption and improve health, real systemic changes are needed.
Over 20 million Americans live in the food desert without consistent access to healthy foods. These areas tend to be low-income and rural communities with a shortage of food retailers and a shortage of transport to get there. According to one study, untreated or minimally processed foods are more than twice as expensive as UPF per calorie.
Real success requires improving health education in schools, improving the quality of school lunches, ensuring that everyone can actually afford fresh, healthy foods.
It remains unclear what will happen to the FDA's proposed laws under the Trump administration. It appears Kennedy wants to take on UPF as part of his Make America Healthy crusades once again. He now wants the FDA to ban certain additives, dyes and chemicals currently used in UPF.
What do experts recommend? Aside from mandating Packaged Goods warning labels, the FDA also needs to regulate other marketing claims made by UPF companies on their products, Hall argued. For example, many products claim to be “100% all natural.” Hall's research shows that many consumers incorrectly assume that no sugar has been added to their products. However, this can be false because there is no standard or legal definition of “natural.”
The UPF nutrition label is just the beginning, along with other policy changes, such as banning certain food dyes. “It takes a small step,” Baker said. And while she and many hope that Kennedy's “food is a drug” outlook will lead to change, many fear that federal staff and budget cuts in the Trump administration will hinder efforts.
