NCL comments on Proposed Rule – Fish and Shellfish; Canned Tuna Standard of Identity and Standard of Fill of Container

November 21, 2023

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, 202-207-2831

The National Consumers League recently submitted comments regarding the Proposed Rule, “Fish and Shellfish; Canned Tuna Standard of Identity and Standard of Fill of Container.” We believe that the Proposed Rule, when implemented, will modernize the standard of identity for “canned tuna,” 21 C.F.R. § 161.190 (“canned tuna SOI”), to require an accurate measure and declaration of weight, and to allow for “safe and suitable” ingredients to provide manufacturers with the flexibility to keep up with changing consumer tastes.

###

About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

Guest Blog: Standardizing portions could help stem the obesity epidemic

By Deborah A. Cohen, MD, MPH

The past few decades have seen dramatic changes in the food environment and food behaviors, all resulting in the epidemics of obesity and diet-related chronic diseases.  About 72% of American adults are overweight or obese and more than half have diet-related chronic diseases. Our research shows that the food environment actually encourages people to eat impulsively and markets twice as much food as people need to maintain a healthy weight.  Our diets are largely influenced by the relative supply and availability of different food products, by marketing, and by other factors we aren’t even aware of.1-3  Restaurants are among the largest risk factors for a poor diet.

Here’s a rather shocking statistic: most Americans dine out between 4-5x per week and, on average, spend 55% of all their food dollars on meals and snacks away from home.4,5  The problem is that away-from-home meals are often inferior in nutritional quality to meals prepared at home – they tend to be higher in salt, fat, and calories, and lower in fruit, vegetables, and whole grains; they also typically include 2-3 times more calories than we need to maintain a healthy weight.6,7  Indeed, portion sizes have been increasing substantially over the past three decades.8

When people dine away from home, their ability to control portion sizes, and thus caloric intake, is limited. Studies demonstrate that we all eat more when we are served more. 9,10   As portion size increases, calories go up. The results are stunning:  Laboratory based studies in both adults,11,12 and children13,14 show that when larger portion sizes are served, calories go up as much as 30% with no differences in self-reported hunger.  So eating out – which we do a lot more than we used to – is a major contributor to weight gain and increases the risk of obesity and chronic diseases.6 Multiple studies support the association between frequency of meals consumed in restaurants and the risk for overweight.15-18

My research looks at how portion sizes can be made transparent and predictable with the hope that this would have an enormous benefit for America’s obesity crisis. Smaller, standardized portions are a practical and feasible solution to help stem the obesity epidemic.

Portion control has also proven to be an effective measure to reduce the amount – and therefore the harm – of alcohol consumption.19,20 Alcoholic beverages are classified by the percentage of alcohol content and the U.S. government defines a standard drink as containing 0.6 oz. of alcohol. Standard drink sizes are 12 ounces for a standard beer, 5 ounces for a glass of wine, and 1.5 ounce shot of 80 proof spirits.  These standard portion sizes allow us to measure a standard drink and to limit the risk of inebriation. Many states mandate that alcohol be served in standard portions; twelve states also require that larger portions of alcohol carry a higher price.21  Applying these principles to food could be an enormous aid, since people are not reliably able to judge what constitutes an appropriate individual portion just by looks.22-24 Standard portions are also a necessity for medications.  Many consider food as “medicine”, so applying portion standards to food is a natural extension that could improve health outcomes. That was our goal.

Piloting the Solution: Standardized Portions

Under a National Institutes of Health funded planning grant, my colleagues and I  developed guidelines for standard portions .  With input and guidance from an advisory board composed of nationally recognized nutrition researchers, we set calorie limits for meals at 700 calories each for lunch and dinner, 500 calories for breakfast and 200 calories for snacks.  We separated meal components into appetizers (150 calories), soups (150 calories), dressings and salads (150 calories), plain entrees (200 calories) for breakfast, lunch and dinner, mixed entrees (350 calories), non-starchy sides (100 calories), starchy sides (150 calories), beverages and desserts (100 calories).25

We conducted a pilot study with three local restaurants in Southern California. We incentivized these establishments to create an alternative menu to their usual offerings, providing meals in quantities that met the above caloric guidelines. We offered restaurants a $2000 participation fee as well as paying for all the costs of the menu development and printing, and purchasing gift cards to offer customers as part of the evaluation. The restaurants created new “Balanced Portions” menus, which included 6-8 items from their regular menu. The meals were not intended for weight loss purposes, but are only designed to prevent unintended overconsumption.

We began our pilot project by  asking restaurant managers to identify which menu items were the most popular. The project did not change any preparation or recipes. Not surprisingly, even though we would be reducing the quantity of some items served and increasing the quantity of others, none of the restaurants were interested in reducing the price of any item for offering less.

One restaurant did not want to change the price or the quantity, we plated the calorically set portions and then had them pack the remaining food for carry out.   (see Figure 1, top menu.) When we measured the original food quantities, in most cases the amounts served were double the guidelines for a single meal, so leftovers were sufficient for a second meal. The meal was marketed as “Dinner today, Lunch tomorrow”.

The other two pilot restaurants were not interested in packing up extra food, so they created an alternative menu by selecting menu items that already met the guidelines. The owners came up with new prices comparable to other selections on the menu. At yet another restaurant, the regular menu only included entrees and sides, so to get variety, people needed to order several large dishes. The new menu allowed people to get variety with one order. In all cases we requested that each meal contain at least one cup of vegetables. We piloted this with 3 restaurants: First Szechuan Wok, Dave’s Deli & Catering, and Delhi Belly. (Figure 1)

Once we verified the quantity of food to be plated as a serving size, we sent the meals out for calorimetry (measures calories) to verify that the calories would be <700.  All the meals met the criteria. We then held a training session for restaurant staff and provided written guidelines on food to be plated for each menu item. We provided restaurants with measuring cups and kitchen scales so they could meet the guidelines. The plates were full, as we generally increased the quantity of vegetables and reduced the quantity of meats and starchy sides. The restaurants all passed the training session.

Feedback from Customers. Once the menus were launched and made accessible to patrons, we invited customers to provide feedback on the menus and their experience and offered them gift cards from the restaurant for their participation, whether or not they ordered from the Balanced Portions Menu.

Overall, the feedback on the alternative Balanced Portions menus from customers was positive. We conducted in-person and phone interviews with 33 customers (56% ordered from the Balanced Portions menu) who dined at one of the three restaurants. Findings from the one-on-one interviews revealed that 16 of the 18 customers who ordered from the Balanced Portions expressed satisfaction with their meals and shared that they “would love” to see Balanced Portion menus offered at other restaurants. In addition, the availability of Balanced Portions menu may help them reduce food waste, maintain healthy eating habits, and meet recommended dietary guidelines. Interestingly, among those who ordered from the regular menu, one participant described the portions as “very generous” and more than half reported going home with leftovers.

However, some of the interviewees expressed concerns regarding cost and thought lowering the prices and offering more Balanced Portion menu options may encourage more people to opt for standardized portions. Some participants thought eliminating to-go options and offering smaller portions at lower prices would be most  appealing.

Adherence to Portion Sizes. We also assigned a research assistant (RA) to be a “secret shopper.” The RA ordered Balanced Portions meals to-go and then carefully measured each component with measuring cups and kitchen scales to determine adherence to the guidelines previously issued. In all but one case, the restaurants were adherent to the guidelines. At Delhi Belly they did give a little extra rice, and we advised the owner to be serve a bit less rice.

Conclusion: Our results were very promising.  We concluded that it is highly feasible for restaurants to offer meals with standard portions that reduce the risk of overconsumption, overweight and obesity associated with dining out. We also concluded that we will need more attention to the issue of Balanced Portions menus over time to inform future rollouts at a national level.  Furthermore, understanding the impact on customer attitudes and behavior will provide critical insights into how to scale this in the future. This research is a rewarding and promising first step, full of opportunities to effectively address the obesity crisis and its connection to eating food outside of home.

  1. Milliman RE. Using background music to affect the behavior of supermarket shoppers. Journal of Marketing. 1982;46(3):86-91.
  2. Milliman RE. The influence of background music on the behavior of restaurant patrons. Journal of Consumer Research. 1986;13(2):286-289.
  3. Curhan RC. The relationship between shelf space and unit sales in supermarkets. Journal of Marketing Research. 1972;9:406-412.
  4. Kant AK, Whitley MI, Graubard BI. Away from home meals: associations with biomarkers of chronic disease and dietary intake in American adults, NHANES 2005-2010. Int J Obes (Lond). 2015;39(5):820-827.10.1038/ijo.2014.183
  5. Saksena MJ, Okrent AM, Anekwe TD, et al. America’s Eating Habits: Food Away From Home. In. Wash, DC: USDA; 2018:https://www.ers.usda.gov/webdocs/publications/90228/eib-90196_summary.pdf?v=98073.90222
  6. Lin BH, Frazao E. Away-from-home foods increasingly important to quality of American diet. ERS/USDA. 1999;http://www.ers.usda.gov/Publications/AIB749/.
  7. Rosenheck R. A systematic review of a trajectory towards weight gain and obesity risk. Obes Rev. 2008;9(6):535-547.
  8. Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA. 2003;289(4):450-453.
  9. Rolls BJ, Roe LS, Meengs JS. Larger portion sizes lead to a sustained increase in energy intake over 2 days. J Am Diet Assoc. 2006;106(4):543-549. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16567150
  10. Diliberti N, Bordi PL, Conklin MT, Roe LS, Rolls BJ. Increased portion size leads to increased energy intake in a restaurant meal. Obes Res. 2004;12(3):562-568. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15044675
  11. Rolls BJ, Morris EL, Roe LS. Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr. 2002;76(6):1207-1213. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12450884
  12. Kral TV, Roe LS, Rolls BJ. Combined effects of energy density and portion size on energy intake in women. Am J Clin Nutr. 2004;79(6):962-968. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15159224
  13. Rolls BJ, Engell D, Birch LL. Serving portion size influences 5-year-old but not 3-year-old children’s food intakes. Journal of American Dietetic Association. 2000;100:232-234.
  14. McConahy KL, Smiciklas-Wright H, Birch LL, Mitchell DC, Picciano MF. Food portions are positively related to energy intake and body weight in early childhood. . Journal of Pediatrics. 2002;140:340-347.
  15. Ayala GX, Rogers M, Arredondo EM, Campbell NR, Baquero B, Duerksen SC, Elder JP. Away-from-home food intake and risk for obesity: examining the influence of context. Obesity (Silver Spring, Md). 2008;16(5):1002-1008. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=18309297&site=ehost-live
  16. McCrory MA, Fuss PJ, Hays NP, Vinken AG, Greenberg AS, Roberts SB. Overeating in America: association between restaurant food consumption and body fatness in healthy adult men and women ages 19 to 80. Obes Res. 1999;7(6):564-571.
  17. Jeffery RW, French SA. Epidemic obesity in the United States: are fast foods and television viewing contributing? Am J Public Health. 1998;88(2):277-280.
  18. Hornick BA, Krester AJ, Nicklas TA. Menu modeling with MyPyramid food patterns: incremental dietary changes lead to dramatic improvements in diet quality of menus. J Am Diet Assoc. 2008;108(12):2077-2083. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=19027412&site=ehost-live
  19. Voas RB, Fell JC. Preventing alcohol-related problems through health policy research. Alcohol Research & Health. 2010;33(1-2):18-28. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2010-23622-003&site=ehost-live
  20. Anderson P, Chisholm D, Fuhr DC. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet. 2009;373(9682):2234-2246. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=19560605&site=ehost-live
  21. NHTSA. Preventing Over-consumption of Alcohol – Sales to the Intoxicated and “Happy Hour” (Drink Special) Laws http://www.nhtsa.dot.gov/people/injury/alcohol/PIREWeb/images/2240PIERFINAL.pdf. 2005.
  22. Levitsky DA, Obarzanek E, Mrdjenovic G, Strupp BJ. Imprecise control of energy intake: absence of a reduction in food intake following overfeeding in young adults. Physiol Behav. 2005;84(5):669-675. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15885242
  23. Levitsky DA, Youn T. The more food young adults are served, the more they overeat. J Nutr. 2004;134(10):2546-2549. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15465745
  24. Wansink B, Painter JE, North J. Bottomless bowls: why visual cues of portion size may influence intake. Obes Res. 2005;13(1):93-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15761167
  25. Cohen DA, Story M, Economos C, Ty D, Martin S, Estrada E. Guidelines for Standard Portions in Away-From-Home Settings In:2023.

The National Consumers League applauds the reintroduction of bipartisan legislation to give millions of Medicare beneficiaries access to safe and effective obesity treatments

July 21, 2023

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, 202-823-8442

Washington, D.C. – The National Consumers League (NCL) welcomes the reintroduction  of the Treat and Reduce Obesity Act (TROA) as a needed step to end outdated Medicare rules that leave millions of seniors with diagnosed obesity – particularly members of Black and Latino communities – vulnerable to disability, disease and premature death due to lack of access to the full range of treatment options.

Introduced by Senators Tom Carper (D-DE) and Bill Cassidy (R-LA) and Representatives Brad Wenstrup (R-OH), Raul Ruiz (D-CA), Mariannette Miller-Meeks (R-IA) and Gwen Moore (D-WI), TROA will end this regulatory logjam by expanding coverage under Medicare Part D to new FDA-approved anti-obesity medications, which are currently excluded under a policy dating back to 2003. TROA will also end Medicare Part B restrictions on intensive behavioral therapy (IBT) that limit the delivery of IBT to primary care providers and restrict the physical locations where this care can occur. Through TROA, clinical psychologists, registered dietitians and nutrition professionals will be able to provide IBT if an individual with obesity is referred by a physician.

At a time when the obesity rate among adult Americans exceeds 40 percent and is even higher among communities of color – virtually half of African Americans (49.6 percent) and 44.8 percent of Hispanics are living with obesity – passage of TROA could be a critical step in changing the trajectory of a disease that for too long has been overlooked and undertreated. The National Consumers League applauds TROA’s reintroduction in the 118th Congress and pledges our support to gain passage of this important legislation on an expedited basis.

###

About the National Consumers League (NCL)
The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

Consumer groups obtain TTB commitment to issue rulemakings on mandatory alcohol labeling

November 21, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 823-8442

Washington D.C. — A coalition of consumer groups today announced an important victory for the American public: the Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau (TTB) has agreed to issue proposed rules requiring standardized alcohol content, calorie, and allergen labeling on all beer, wine and distilled spirits products. TTB also agreed to begin preliminary rulemaking on mandatory ingredient labeling.

TTB’s decision comes after three national consumer organizations – the Center for Science in the Public Interest, Consumer Federation of America, and the National Consumers League – sued TTB on October 3, 2022, for failing to act on a 2003 petition to require alcohol labeling with the same basic transparency consumers expect for non-alcoholic beverages and food products. CSPI’s litigation department filed the complaint on behalf of the three organizations in the United States District Court for the District of Columbia.

Based on evidence that alcohol is a significant source of empty calories and increases the risk of certain cancers, alcohol use disorders, traffic accidents, and severe injuries, the 2003 petition specifically called for listing the amount of alcohol and calories per serving, the percent alcohol by volume, the serving size, the number of standard drinks per container, and other needed information to make fully informed drinking decisions. These consumer groups also petitioned for an ingredients listing on all alcoholic beverages, something that is a standard feature for other food products and particularly important to those with allergies or other chemical sensitivities.

As a result of the lawsuit, TTB committed to publishing three rulemakings covering mandatory nutrient and alcohol content labeling, mandatory allergen labeling, and mandatory ingredient labeling within the next year.

In addition to the lawsuit, the groups applauded the House and Senate Appropriations Committee for including report language in the FY23 Financial Services and General Government bill urging the agency to take action on this critical rule.

“This is a groundbreaking day for consumers,” said Sally Greenberg, Executive Director of the National Consumers League. “Consumer advocates have been trying for 19 years to get this far. Now there is light at the end of the tunnel. We thank the TTB for finally taking this action and look forward to working closely with the agency, the industry, and other consumer advocates to make sure this is done right and that consumers are the winners.”

“All we have requested over these two long decades is the kind of information that consumers expect when purchasing other foods and beverages,” said Peter Lurie, Executive Director of the Center for Science in the Public Interest. “We hope TTB can move quickly on this long overdue action.”

Better labeling requirements for alcoholic beverages will allow consumers to make more informed decisions,” said Thomas Gremillion, Director of Food Policy at Consumer Federation of America. “Consumers have a right to consistent, reliable, and relevant information about the products they buy. For too long, the alcohol industry has kept consumers in the dark, and TTB’s announcement is an important step forward.” 

The 2003 citizen petition was submitted to the Treasury Department by CSPI, CFA, and NCL and a coalition of 66 other organizations and eight individuals, including four deans of schools of public health.

###

About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit https://nclnet.org.

NCL applauds federal agency’s decision to require mandatory labeling on all alcoholic beverages

November 18, 2022

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, (703) 298-2614

Washington D.C. — Today the National Consumers League hailed the decision by the Alcohol and Tobacco Tax and Trade Bureau (TTB), the federal agency that oversees alcohol labeling, to require mandatory labeling on all alcoholic beverages as a “great consumer victory.” NCL is grateful to the agency for this welcome – albeit long overdue – decision.

In 2003, NCL and other consumer groups filed a petition calling on TTB to provide consumers with robust nutritional information about the alcoholic beverages they drink. Today, 19 years later, the agency acted to grant the petition. The November 17 letter from TTB can be viewed here.

NCL and other consumer groups pursued two avenues this year to get movement on the labeling of alcoholic beverages: filing a lawsuit this past fall against the agency and working with Congress.

NCL also thanks the Senate and House Appropriations Committees for their inclusion of language in the Fiscal Year 2023 Financial Services and General Government Funding Bill that urges the agency to move toward mandatory nutritional labeling of alcoholic beverages.

###

About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit https://nclnet.org.

National Consumers League releases its Top Food and Nutrition Policy Priorities for 2022

July 20, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC – At a time of significant change in the food industry, the National Consumers League (NCL) today released a food policy agenda to improve food safety, reduce sodium in the diet, achieve better portion control, increase transparency in food and beverage labeling, and promote a more sustainable food system. Additionally, NCL is calling for a national strategy to ensure there will be an ample supply of safe infant formula products in the US along with aggressive regulatory oversight.

“Currently, over 335 million people live in the US, and all are consumers who deserve to be represented in the regulation of the foods and beverages they consume and serve to their families,” said Sally Greenberg, NCL’s Executive Director. “Especially now when technology is changing food production, food safety protocols, and the composition of novel and reformulated foods and beverages, NCL will speak for consumers on strengthening the food safety system, filling the gaps in food labeling, alleviating food insecurity, and reducing food waste.”

Addressing serious food safety lapses and areas where regulation has not caught up to changes in food production, manufacturing, and market trends, NCL’s agenda concentrates on 11 priorities where education and changes in public policy will have a direct and positive impact on the American public:

1. Strengthen the Food Safety System

As the Food and Drug Administration (FDA) moves forward with its New Era of Smarter Food Safety Blueprint, NCL will press FDA to finalize its Food Traceability Proposed Rule, enabling rapid traceback to the source of a contaminated food. Similarly, NCL will stress the need for the U.S. Department of Agriculture (USDA) to modernize poultry safety rules and update food safety rules, such as expanded pathogen testing in meat and poultry products and updated safe handling instructions label for these products.

2. Ensure the Safety and Availability of Infant Formula

The critical shortage of infant formula in the U.S. requires a national strategy to ensure there will be an ample supply of safe infant formula products in the US along with aggressive regulatory oversight of the safety protocols at U.S. manufacturing facilities. NCL will also advocate for policies that increase the number of companies manufacturing infant formula, and changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program that allow for more flexibility in the range of infant formula products available through WIC.

3. Make Alcohol Facts Labeling Mandatory

Since 2003, NCL and the Center for Science in the Public Interest have taken the lead in pressing the federal agency that regulates most alcoholic beverages – the Treasury Department’s Bureau of Alcohol and Tobacco Tax and Trade Bureau (TTB) – to issue rules requiring an easy-to-read, standardized “Alcohol Facts” label on all beer, wine and distilled spirits products. Because this

labeling now appears on hard ciders, wine coolers, certain beers and other products regulated by the FDA, NCL, CSPI and the public health community are stepping up the fight to make mandatory alcohol labeling a reality.

4. Reduce Excess Sodium in the Diet

Because Americans on average consume 50 percent more sodium per day than is recommended, NCL will continue to raise awareness of the goal set by FDA to lower sodium intake to 2,300 milligrams (mg) per day and encourage consumers to use the Nutrition Facts label to choose products with less sodium, reduced sodium or no sodium added.

5. Require Labeling of Caffeine Content

While FDA considers 400 mg of caffeine per day as the amount not generally associated with dangerous side effects, the agency only requires food labels to disclose whether there is added caffeine in the food or beverage, not the total amount. Therefore, NCL is calling for new policy requiring all products containing caffeine to list the amount of caffeine per serving and per container.

6. Ensure Transparency in the Labeling of Plant-Based Meat Alternatives

In June 2022, NCL released a new report, Education and Transparency in Labeling Plant-Based Meat Alternatives: A Consumer-Focused Agenda to Improve Understanding and Decision-Making of Plant-Based Meats, which lays out seven priorities for regulatory action, including the requirement that labels on PBMAs are standardized and clarify the protein source and that nutrition/health claims for these products undergo FDA review and are supported by available scientific evidence. 

7. Improve the Labeling of Alternative Sweeteners

Although NCL applauds FDA’s decision to include “Added Sugars” on the recently updated Nutrition Facts Label, the organization supports a Citizen Petition to ensure transparent labeling of substitute sweeteners and is urging FDA to stop misleading claims, such as “No Added Sugars” and “Zero Sugar,” that imply the product is healthier than the original without disclosing that the sugar reduction resulted from reformulating with artificial substances and sugar alcohols. 

8. Modernize Food Standards of Identity

Because many “standards of identity” – recipes for what a food product must contain and how it is manufactured – are now 75 and even 80 years old and out of date, NCL supports FDA’s action plan to modernize food standards of identity. However, NCL urges FDA to focus on several food products where updating SOIs will lead to healthier offerings, such as olive oil, Greek yogurt, and canned tuna.

9. Improve Federal Nutrition Education and Food Labeling Policies by Elevating the Role of Portion Control and Balanced Food Choices, Revising the Definition of “Healthy,” and Developing Uniform Front of Pack Nutrition Rating Symbols

NCL is implementing a three-phased strategy to improve nutrition education and food labeling policies, which entails: 1) education and advocacy that emphasizes portion control and ensures consumers know the recommended daily intake of calories is 2,000 per day, 2) furthering FDA’s efforts to define the term “heathy” on food labels by addressing if and how added sugar content is calculated; and 3) encouraging FDA to adopt a “Traffic Light” labeling system to depict “healthy” foods on the front of the package.

10. Increase Funding and Access to Federal Nutrition Programs

NCL’s advocacy to enhance the Supplemental Nutrition Assistant Program (SNAP) during the COVID-19 pandemic helped to increase access to healthy food to people in need. Now, NCL is working with partners to broaden the public health impact of SNAP by reducing the eligibility requirements, strengthening the nutritional goal for SNAP and providing incentives for healthier foods sold in retail establishments.

11. Reduce the Amount of Food Waste

Because about 90 billion pounds of food goes uneaten every year in the US, NCL is working to help the nation meet the goal of reducing food waste by 50 percent by 2030. As such, we will continue working with USDA, FDA and the Environmental Protection Agency (EPA) to raise awareness of food loss and waste and inform consumers of how they can reduce food waste in their homes.

###

 

About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

A New Patient-Centered Action Agenda calls for people with obesity to have the same rights and access to care as people with other chronic diseases

July 7, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC— The National Consumers League (NCL) today released A New Patient-Centered Obesity Action Agenda: Changing the Trajectory of Obesity Through Patient Empowerment, Health Professional Intervention and Supportive Government Policies, a new report with a blueprint to change how Americans think about obesity, empower people with obesity to get the best care, and afford those with obesity the same access to care as adults with other serious chronic diseases.

Issued as a call to action, the report was prepared in consultation with a panel of leading obesity specialists as a roadmap for overcoming one of the difficult challenges affecting US adults now living with obesity: despite significant advances in the understanding and treatment of obesity, only 10 percent of people with obesity get help from medical professionals,[1] meaning the disease remains largely undiagnosed and undertreated. Accordingly, only 30 million[2] of the estimated 108 million adults living with obesity[3] have been diagnosed with the disease and only around 2 percent of those eligible for anti-obesity medications have been prescribed these drugs.[4]

The consequences of undertreatment affect virtually every aspect of the healthcare system. Obesity not only has a negative impact on almost every aspect of health and well-being, but it worsens the outcomes of over 230 obesity-related chronic diseases, from type 2 diabetes and heart disease to some forms of cancer.[5] Accordingly, obesity is responsible for an approximately 300,000 premature deaths each year[6] deaths and costs the U.S. economy an estimated $1.72 trillion annually in direct and indirect costs.[7]

“Although obesity is one of today’s most visible public health problems, it is often ignored and discounted as a serious disease, resulting in a health crisis that has only worsened with time,” said
Sally Greenberg, NCL’s Executive Director. “This report focuses attention on the numerous public perception, provider and policy-related factors that preclude Americans with overweight and obesity from getting effective treatment and must be addressed if obesity outcomes are to improve in the US.”

To change the trajectory of the obesity epidemic, the report calls for a national mobilization to overcome the “human” factors– incorrect beliefs about the cause and treatment of obesity, prejudice towards people due to their size, lack of training for health providers, access barriers, and outdated government policies – that continue to prevent Americans from seeking and obtaining obesity care. Towards this end, NCL’s patient-centered action agenda identifies nine priorities for action:

  1. Redefine Obesity for the American Public as a Treatable Chronic Disease

Although the American Medical Association classifies obesity as a chronic disease requiring treatment, three-quarters of Americans believe obesity results from a lack of willpower. Thus, redefining obesity as a treatable chronic condition will provide a new context for health providers and patients to have a positive discussion about weight, leading to more people getting diagnosed and treated.

  1. Adopt Patient-First Language for Obesity

Unlike other chronic diseases where health professionals use people-first language that puts a person before a diagnosis, practitioners routinely use terms to describe obesity that can be off-putting and demoralizing. To change this situation, the National Consumers supports the agenda of the People-First Initiative launched by the Obesity Action Coalition, which advocates for widespread adoption of people-first language by practitioners in all healthcare settings.

  1. Make Combatting Weight Stigma a National Priority

Studies show that 40 percent of healthcare professionals –physicians, nurses, dietitians, psychologists and medical students – admit to having negative reactions based on a person’s size.[8]Addressing this pervasive problem requires a unified national initiative that makes the impact of weight stigma “real” for clinicians and the public and disseminates the latest information to health providers on strategies to reduce weight stigma.

  1. Elevate the Need for Physician Training in Obesity

A recent study of 40 US medical schools finds that 30 percent of these institutions provide little or no education in nutrition and obesity interventions while one third of schools reported no obesity education programs in place.[9] These findings underscore the urgency for US medical schools to change their priorities and develop curricula that comprehensively addresses the disease of obesity.

  1. Establish Excess Weight as a Vital Sign

Besides body temperature, blood pressure, heart rate and respiration, health providers routinely measure height and weight at each visit. Thus, if healthcare professionals were to calculate and provide patients with their Body Mass Index (BMI) at the time of the office visit, practitioners could have a tool to discuss excess weight when patients are most receptive to discussing their health status.  It is recognized that BMI is a crude measure and not the sole predictor of obesity but when combined with patient-friendly information that explains the level of weight and options for treatment, this interaction could initiate a positive, respectful conversation about obesity care.

  1. Provide the Tools for a Doctor-Patient Dialogue on Excess Weight

A major reason primary care providers (PCPs) are reluctant to provide obesity counseling is the lack of informational tools to have conversations with patients about their weight status and care options. Therefore, a unified effort to make available to PCPs evidence-based, patient-friendly content on obesity will facilitate a better dialogue between clinicians and patients and promote shared decision-making.

  1. Establish Coverage of Obesity as a Standard Benefit Across Insurers and Health Plans

Although employers and insurers are starting to cover treatment options for obesity in employee benefit packages, too many people continue to be denied coverage or face access barriers, such as step therapy and prior authorization, that delay treatment. Improving obesity outcomes therefore requires supporting legislative efforts, like the “Safe Step Act” that would require group health plans to provide an exception process for step-therapy protocols. It also necessitates collaboration among payers, providers, policymakers, and advocates to establish a standard, affordable benefit for the prevention and treatment of obesity that applies across plan types and payers.

  1. End Outdated Medicare Rules That Exclude Coverage for Necessary Obesity Care

Today, the many millions of Americans enrolled in the Medicare program are denied safe and effective obesity treatment due to outdated Medicare Part D rules that exclude coverage for FDA-approved obesity drugs and Medicare Part B policies that places undue restrictions on intensive behavioral therapy by allowing only primary care providers to deliver IBT and severely restricting the physical locations where this care can occur. Congress has the power to change this situation, which is why NCL has joined with the obesity, public health and nutrition communities is pressing for swift passage of the Treat and Reduce Obesity Act (TROA). The proposed legislation would expand Medicare coverage to allow access to IBT from a diverse range of healthcare providers while ending the exclusion for new anti-obesity medications that are improving the standard of care for adult Americans with obesity.

  1. Create a Patients’ Bill of Rights for People with Obesity

For too long, people with obesity have been stigmatized, discriminated against, and have faced significant hurdles and burdensome requirements to receive care. Changing this situation will require giving people with obesity the knowledge, skills and confidence to be advocates for their best obesity care. Therefore, NCL’s patient-centered obesity action agenda calls for the creation of a Patients’ Bill of Rights for People with Obesity based on the recognition that obesity is a treatable disease and everyone with obesity deserves the same level of attention and care as those with other chronic conditions.

###

About the Report

To prepare the report, NCL partnered with the Obesity Care Advocacy Network (OCAN) to host a roundtable discussion in December 2021where public health specialists, leading professional societies, the minority health field and the obesity policy community assessed the state of the science on obesity today, the scope and cost of the disease in the US and the major barriers impeding quality obesity care with special attention to the “human” obstacles that keep people with obesity from seeking or obtaining treatment. Additionally, NCL conducted a literature review to gather additional insights, especially regarding how to change how people with obesity see themselves, so they become empowered to advocate for their care as patients with a chronic disease. Based on this assessment, NCL drafted the report, which was vetted by experts participating in the roundtable, and developed the policy recommendations included in the Patient-Centered Obesity Action Agenda.

 

About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

 

[1] Stokes A, et al. Prevalence and Determinants of Engagement with Obesity Care in the United States. Obesity. Vol. 26, Issue 5; May 2018, 814-818

[2] PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.

[3] Hales CM,, et al. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. Centers for Disease Control and Prevention. NCHS Data Brief. No. 360. February 2020.

[4] PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.

[5] Obesity Care Advocacy Network. Fact Sheet: Obesity Care Beyond Weight Loss

[6] Allison DB, et al. Annual deaths attributable to obesity in the United States JAMA 1999Oct 27 282(16)1530–8.

[7] Milken Institute (October 2018), “America’s Obesity Crisis: The Health and Economic Costs of Excess Weight.”

[8] Fruh SM, et al. Obesity Stigma and Bias. J Nurse Pract. 2016 Jul-Aug; 12(7): 425–432.

[9] Butch WS, et al. Low priority of obesity education leads to lack of medical student’ preparedness to effectively treat patients with obesity; results from the U.S. medical school obesity education benchmark study. BMC Med Educ 20, 23 (2020)

Consumers need transparency in labeling of plant-based meat alternatives

Agenda-Setting Report Identifies Seven Priorities for Regulatory Action

June 9, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC – As more plant-based meat alternatives (PBMAs) that closely mimic the look, taste, and cooking properties of traditional meat products enter the U.S. market almost daily, the National Consumers League (NCL) today released a report with seven priorities for regulatory action to ensure that labels of so-called “meatless meats” readily identify the protein source and inform consumers of the nutritional composition of each PBMA product.

Issued as the U.S. Food and Drug Administration (FDA) is developing draft guidance for food manufacturers on the labeling of plant-based milks and alternatives to animal-derived foods,
the report underscores the importance of consumer-focused labeling to sustain the growth of the plant-based meats category, which has been fueled by consumer optimism. Findings were informed by an expert panel meeting held in 2021 that explored a standard of identity for PBMAs and based on an assessment of the PBMA marketplace which NCL conducted in 2022 to identify action steps that will significantly impact public awareness and understanding of PBMAs and can be readily implemented.

Providing up-to-date information on the issues affecting the labeling of plant-based meat alternatives, the report – Education and Transparency in Labeling Plant-Based Meat Alternatives: A Consumer-Focused Agenda to Improve Understanding and Decision-Making of Plant-Based Meats –documents promising projections for PBMA sales in the U.S. and globally. Recent polling shows that two-thirds of Americans (65 percent) consumed plant-based meat alternatives in 2021, and two in five (42 percent) ate PBMAs at least weekly.[1] Due to consumer demand, the plant-based meat category delivered $1.4 billion in sales in the U.S. in 2021 – up from $962 million in 2019 [2] – and a Bloomberg Intelligence report projects a 500 percent increase in global sales of plant-based foods by 2030[3]. Moreover, a recent market analysis predicts a growth rate of almost 20 percent globally for plant-based meats between 2021 and 2026 if consumer interest in PBMAs continues to grow.[4]

Yet, the NCL report points to marketplace challenges for plant-based meat substitutes. Currently, many brands define PBMAs differently and there is a lack of clarity about how to use traditional meat, dairy, and egg terminology on product labels. Additionally, only half of Americans were “very” or “somewhat” familiar with PBMAs in 2020 and 30 percent had no knowledge, according to a Gallup survey.[5] This lack of understanding is concerning because new plant-based meats are unique in their formulations and processing techniques– meaning products can differ in calories, saturated fat, sodium content, and levels of protein, fiber, vitamin B12, zinc, iron, and other nutrients. Plant-based meats may also contain a food allergen depending on the source of the plant proteins in the product.

[1] International Food Information Council. Consumption Trends, Preferred Names and Perceptions of Plant-Based Meat Alternatives. November 3, 2021

[2] Good Food Institute. US retail market data for the plant-based industry.

[3] Fortune. Plant-based food sales are expected to increase fivefold by 2030. August 11, 2021

[4] ResearchandMarket.com. Plant-Based Meat Market-Global Industry Analysis (2018-2020) & Growth Trends and Market Forecast (2021-2026). January 11, 2022

[5] Gallup. Four in Ten Americans Have Eaten Plant-Based Meats. January 28, 2020

 

“Plant-based meat alternatives are a popular and valued part of our food supply,” said Sally Greenberg, NCL’s Executive Director. “This is why the public needs regulatory policies that ensure the labels on these products are accurate, complete, and provide the qualifiers necessary for consumers to understand what they are purchasing.”

As the agency that regulates plant-based foods in the U.S., FDA shares this viewpoint and has sought information on a range of issues to issue draft guidance on the labeling of plant-based foods. Therefore, NCL prepared the report to articulate the consumer’s voice on PBMA labeling and lay out a blueprint for FDA and the food industry to ensure the information needs of the public are addressed. Specifically, the report identifies seven priorities for labeling, naming, and marketing plant-based meats alternatives that are in the best interest of consumers:

  1. Establish a definition for “plant-based meat alternatives” that will unite all stakeholders. Because brands define the term “plant-based” differently, FDA guidance should define what constitutes a “plant-based meat alternative” to promote consistency in labeling across the category.
  2. Ensure brand names are not deceptive. NCL’s position is it is a deceptive practice to use brand names for PBMAs that suggest a product contains meat, seafood, or eggs when none is present. Even when the label states the product contains no meat or eggs, consumers are influenced by the brand name, especially if packaging and promotional content feature pictures and iconography of animals or the type of meat.
  3. Require that labels on PBMAs are standardized and clarify the protein source. For labels of PBMAs to be transparent, the naming and labeling of PBMAs must be uniform and consistent and ensure that consumers can readily identify the protein source. Accordingly, FDA should require that all labels and advertisements for PBMAs must:
  • Use a common name that links the protein source and the form, such as “soy burger.”
  • Make clear that the product contains some animal protein in addition to plant-based proteins like soy. Qualifying terms can include “plant-based” and “made from plants.”
  • Make clear when the PBMA contains no meat. These terms can include vegan,” “meatless,” “vegetarian,” “veggie,” and “veggie-based” as well as “plant-based” and “made from plants.”
  • Place the phrase “contains no meat,” “contains no poultry,” or “contains no eggs” on the principal display panel of vegan PBMAs near the common name and in letters at least the same size and prominence as shown in the product’s common name.
  • Not use pictures, icons, or vignettes on the packaging, in marketing materials or in advertising that suggests nutrition superiority or that the product is the same as the comparable meat product.
  1. Regulate health/nutrition claims for PBMAs. Consistent with how FDA regulates the health claims allowed on traditional food products, FDA guidance must make clear that nutrition/health claims must undergo agency review and there must be significant scientific agreement that the claim is supported by available scientific evidence.
  2. Ensure website, social media, and advertising content for PBMAs conforms to what is on the product label. The guidance must make clear that FDA considers websites and social media to be an extension of the product label, meaning the claims and information that PBMA manufacturers put online must conform what FDA allows on the label.
  3. Address the nutritional composition of the PBMAs in FDA guidance. In Canada, proposed guidelines for plant-based protein foods would include nutritionally required amounts of vitamins and mineral nutrients that must be added to the PBMA product and a minimum limit of total protein content, among other requirements. While NCL supports this approach, FDA should at least recommend levels of key vitamins and nutrients in its guidance.
  4. Educate consumers about the nutritional composition of plant-based protein alternatives. It is in the public interest for FDA and the U.S. Department of Agriculture – along with nutrition societies – to conduct education programs that explain the nutritional composition of plant-based protein food products. This will allow consumers to make informed decisions based on science-based information.

About the Report

To prepare the report, NCL built on the deliberations of an online expert panel meeting – Meeting Consumers’ Needs for Modernizing Food Standards of Identity: General Principles for Naming and Labeling Plant-Based Meat Alternatives – co-hosted by NCL and the Academy of Nutrition and Dietetics (AND) in November 2021. Exploring whether new standards of identity (SOI) for PBMAs could lead to better labeling of these meat substitutes, the meeting started with a review of the U.S. market for PBMAs and featured breakout sessions where regulatory specialists, market researchers, consumer advocates and food industry leaders debated the need for a standard of identity for PBMAs and discussed consumers’ needs for education and labeling of PBMAs.

The November 2021 meeting produced consensus that there is not enough evidence to support a standard of identity for PBMAs and in fact, that a SOI could hamper innovation within this new category of plant-based foods. Yet, the meeting generated important insights on the need for consumer education about plant-based meats, a common nomenclature for describing PBMAs, and transparency in labeling so consumers will know the composition of the products they buy. Thus, when FDA announced plans to issue draft guidance on PBMAs in 2022, NCL used the deliberations from the November 2021 meeting as the foundation for developing recommendations for how FDA can ensure labels of PBMA products meet consumers’ needs. The final step was a literature review NCL conducted in March and April 2022 to add marketplace data on PBMAs and apply lessons learned from consumer research, voluntary labeling initiatives, legislation passed in different states label PBMAs, and labeling rules for PBMAs proposed or instituted in other countries.

Read the report here.

###

About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.