Obesity medicine specialists, health providers, insurers and employers urged to make obesity treatment a right of all Americans

October 13, 2023

Media contact: National Consumers League – Nancy Glick, nancyg@nclnet.org, 202-823-8442 NCOA –Simona Combi, Simona.combi@ncoa.org, 571-527-3982

Washington, D.C. – With growing evidence that U.S. adults with obesity feel stigmatized and ignored by their health care providers, the National Consumers League (NCL) and National Council on Aging (NCOA) today urged health professionals, insurers and employers to join a national movement to define quality obesity care as a right for every American.

Taking the case directly to health professionals on the front lines in delivering obesity care, NCL and NCOA used The Obesity Society’s annual meeting in Dallas October 14-17 to announce plans to provide Americans with an Obesity Bill of Rights.  Today, over 100 million adults are living with obesity[1] (42 percent of the public), yet only 10 percent get help from medical professionals.[2] An Obesity Bill of Rights has the potential to transform obesity care by empowering Americans to demand the respect of their health providers and to be screened, diagnosed, and effectively treated for their obesity based on medical treatment guidelines.

“For too long, adults with obesity have encountered a healthcare system that works against them. They are stigmatized, discriminated against, not treated with respect by their health providers, and confront significant obstacles in receiving the care they deserve. ” said Sally Greenberg, Chief Executive Officer of the National Consumers League. “This must change; we need an overhaul of the health system, and we believe an Obesity Bill of Rights can drive this transformation.”

Because this change will only happen if there is agreement on a set of basic rights that ensure adults with obesity receive respectful, timely, and effective obesity care, NCL and NCOA unveiled www.Right2ObesityCare.org, a new online engagement platform, so the nation’s health providers, insurers and employers can play a role in developing the Obesity Bill of Rights.  Right2ObesityCare.org explains the purpose and research-driven process and encourages a wide range of health professionals – from obesity medicine specialists and physicians to dietitians, nutritionists, exercise physiologists, health educators, and mental health professionals – to contribute their ideas.

Town Halls Chart the Obstacles for Adults with Obesity and Their Providers

Along with hearing from health professionals, the Obesity Bill of Rights will be informed by the insights of both adults with obesity and their health providers who participated in four town hall meetings that NCL and NCOA hosted across the country. Held in senior centers and churches in

California, Delaware, Mississippi, and Oklahoma between June and August 2023, the town halls involved more than 250 older adults, community leaders, and local clinicians who laid bare a healthcare system that is inhospitable to delivering quality obesity care.                                                        

When asked to share their experiences, older adults attending the town halls spoke of feeling invisible when seeing a health provider, not being listened to, and being treated with disdain when they initiated conversations about their obesity. At the same time, physicians described feeling inadequate to provide obesity care due to the limited time for counseling, not enough training in obesity management, inadequate coverage and reimbursement for obesity care, and needing better tools to help patients recognize obesity risks. This confirms research that finds adults with excess weight often feel unwelcome in the doctor’s office or believe that seeking help for obesity signifies moral failure. [3]

“This is a chronic condition that no one wants to talk about,” said Ramsey Alwin, NCOA President and CEO. “For several decades, NCOA has worked to empower older adults to better manage their chronic conditions. To break down barriers related to obesity, we held town halls that allowed both older adults and their health providers to relay their lived experiences. What we learned is that encouraging more people to seek obesity care requires an investment in science-based, easy-to-understand, accessible information about obesity; a healthcare system that encourages informed decision-making and patient-centered care; and effective public policy that requires health plans to provide access to the treatments deemed appropriate by the health provider, including lifestyle interventions, FDA-approved weight loss medications, and bariatric surgery.”

Mobilizing for Change
With the townhalls as a guidepost, NCL and NCOA are now leading a rigorous process to finalize and release the Obesity Bill of Rights to the medical community and public before the end of 2023. The process includes hosting a meeting of top experts to review a preliminary draft with recommendations for refinement. NCL and NCOA will also seek feedback from specialists in minority health, aging, and rural health, as well as health professionals and other stakeholders who offer advice through the online engagement platform.

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About NCL

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. The organization’s 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.

About NCOA

The National Council on Aging (NCOA) is the national voice for every person’s right to age well. We believe that how we age should not be determined by gender, color, sexuality, income, or ZIP code. Working with thousands of national and local partners, we provide resources, tools, best practices, and advocacy to ensure every person can age with health and financial security. Founded in 1950, we are the oldest national organization focused on older adults. Learn more at www.ncoa.org.

[1] 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.

[2] 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

[3] Gunther S, et al. Barriers and enablers to managing obesity in general practice: a practical approach for use in implementation activities. Qual Prim Care. 2012; 20: 93-103

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.

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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.

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.

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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)

Nancy Glick

Consumers need accurate product names and labeling of plant-based meat products

Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

With mounting information that plant-based diets are generally better for people’s health and the environment, many consumers are giving “meatless meats” a try.

About two-thirds of Americans consumed “plant-based meat alternatives” – or PBMAs – in the past year, with 20 percent eating them at least weekly, according to an August 2021 survey from the International Food Information Council (IFIC).[1] As a result, current estimates put the market for PBMAs at $1.4 billion – up from $962 million in 2019[2] –and a Bloomberg Intelligence Report predicts a 500 percent increase in global sales of plant-based foods globally by 2030.[3]

It is easy to understand consumers’ excitement about meatless products that closely resemble the look, feel and taste of burgers, sausages, deli meat and other products made from beef, pork, chicken, eggs and seafood. Polling shows consumers’ top reason for buying these products is the perceived healthfulness of PBMAs. The most sought-after benefits consumers cite are heart health and a good source of high quality and complete protein.

Yet, the reality is that plant-based meat products vary in their formulations, nutritional content and can be high in saturated fat and sodium. These products are often packaged in the same way as their animal protein counterparts and routinely sold next to the meat section in supermarkets. Thus, consumers need clarity in labeling to ensure product names, descriptions and packaging are not misleading and consumers have the qualifying terms to make informed decisions.

As the agency that regulates plant-based foods in the US, the Food and Drug Administration shares this viewpoint. Later this year, FDA will issue draft guidance on the labeling of plant-based milks and plant-based alternatives to “animal-derived foods” (meats) under the umbrella of the agency’s Nutrition Innovation Strategy. The strategy addresses the need for FDA to modernize its regulatory approach for new categories of foods, like PBMAs, developed through the latest technologies.

In developing its draft labeling guidance, FDA has sought information on a range of issues related to labeling, including whether consumers understand terms like “milk” when used in the name of plant-based alternatives and are aware of the nutritional differences between traditional meat and dairy products and their plant-based substitutes. In response, the agency has received thousands of comments from industry groups, manufacturers, academic institutions and professional societies offering their viewpoints. However, the National Consumers League contends that the consumer’s voice must be articulated and heard. Unless the information needs of consumers are clearly defined, FDA’s goal of labeling for transparency and clarity will not be realized.

To provide the consumer perspective, especially regarding decisions about plant-based meat alternatives, in November 2021 NCL and the Academy of Nutrition and Dietetics (AND) convened a panel of experts to assess consumers’ needs for accurate naming, labeling and claims on the package of PBMAs. Comprising regulatory specialists, market researchers, consumer advocates and food industry leaders, the panel also addressed how some key principles laid out in FDA’s Nutrition Innovation Strategy – a common nomenclature, accurate naming and labeling, and elements that assure honesty and fair dealing — can be applied to improve consumer understanding, perception, and decision-making of PBMA products.

In the near future, NCL will issue a full report of the findings of the expert panel and the implications for consumer education efforts and public policy. However, the need to articulate the consumer perspective on labeling PBMAs shouldn’t wait. Therefore, NCL has translated the consensus from the expert panel into a blueprint for FDA and the food industry.

The following are the seven priorities for labeling, naming and marketing plant-based meats alternatives that are in the best interest of consumers:

  1. Establish a definition for the category of “plant-based meat alternatives” that will unite all stakeholders
    Today, many brands, companies and organizations define the term “plant-based” differently and there is not collective agreement on definition of a “meat alternative.” Since these terms represent an entire class of food products, 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 or is better/healthier than the traditional animal protein product. Even when the label states the product contains no meat or eggs, consumers are influenced by the brand name, especially if the packaging and content on the website, social media platforms and in ads shows 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 must make clear in its guidance that nutrition/health claims must undergo review by the FDA through a petition process 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.

  1. Address the nutritional composition of the PBMAs in FDA guidance
    In Canada, regulation of PBMAs includes 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 and address concerns, such as allergenicity with labeling requirements to flag known allergens, such as soy.
  2. Educate consumers about the nutritional composition of plant-based protein alternatives

It is in the public interest for FDA and the US 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.

Plant-based meat alternatives are a popular and valued part of our food supply. That 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.


[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. Accessible at: https://gfi.org/marketresearch/

[3] Fortune. Plant-based food sales are expected to increase fivefold by 2030. August 11, 2021. Accessible at: https://fortune.com/2021/08/11/plant-based-food-sales-meat-dairy-alternatives-increase-by-2030/

Food insecurity among African and Hispanic American communities in America

By Nailah John, Program Associate

Millions of Americans struggle with food insecurity—defined as limited or uncertain access to sufficient, nutritious food. People experiencing severe food insecurity skip meals or go hungry because they lack financial resources to purchase food. Food insecurity is associated with harmful consequences to physical and mental health, along with adverse behavioral and academic outcomes.

With millions of Americans out of work since mid-March 2020 due to COVID-19, low-income families and communities of color, who were already at risk for food insecurity, face even greater hardship. In March and April 2020, 48 percent of African American households and 52 percent of Hispanic households experienced food insecurity, according to data published in the American Journal of Public Health. Over many decades, discriminatory policies and practices have caused African American communities to be more likely to live in poverty, face unemployment, and have fewer financial resources, like savings or property, than their white counterparts.

Food deserts, which are common in low-income areas, have contributed to the crisis of food insecurity. Food deserts are regions where people have limited access to healthy and affordable food. In these areas, people’s nutritional options are often limited to cheaper, high-calorie, and less nutritious food. In eight of the 10 counties in the U.S. with the highest food insecurity rates, more than 60 percent of the residents are African American. Associate Professor of Kinesiology and Nutrition at Northern Illinois University, Odoms-Young, said “it is really not surprising when you consider the drivers of food insecurity: income, employment. It is also an accumulation of disadvantages that happens. I don’t think people always recognize that accumulation—how disadvantages can accumulate over generations and cause those disparities in wealth.”

African American and Hispanic American populations are disproportionately enrolled in the government Supplemental Nutrition Assistance Program (SNAP). This benefits over 35 million Americans. The Biden Administration recently allocated $1 billion to the SNAP benefits distributed each month, which will increase the food stamp benefits of approximately 25 million people. Food insecurity, unfortunately, continues to be a major problem in America, exacerbated by the effects of the pandemic, from the lack of access to reduced-cost school meals to high rates of unemployment.

Access to nutritious food is essential to creating a more healthy, sustainable, and productive society. It is, therefore, crucial that we continue to advocate for African American and Hispanic communities, which are most at risk for food insecurity.

Nancy Glick

2021 NCL Food Policy Priorities

Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

With the enactment of the American Rescue Plan, the new Biden Administration will bring about important changes to overcome one of the most urgent problems caused by the COVID-19 pandemic: millions of Americans are facing hunger in the U.S. and many of them are children. According to the latest Household Pulse Survey from the Census Bureau, over 25 million people do not have enough food to eat some of the time or often.[1]

Yet, this is just one of the food-related challenges encountered during the pandemic. About 110,000 restaurants have closed permanently[2], retail food prices went up an average of 3.4 percent in 2020[3], and the amount of food waste, estimated at between 30-40 percent of the food supply before the pandemic[4], has grown exponentially. Additionally, and unrelated to the pandemic, the recently released 2020-2025 Dietary Guidelines for Americans underscores an explosion of obesity and diet-related diseases in America. Some disturbing findings are that 6 in 10 adults have one or more diet-related chronic diseases and seven percent of children and teens have been diagnosed with high blood cholesterol levels.

All these problems affect the lives of all Americans, which is why the National Consumers League (NCL) will intensify our education and advocacy in 2021 to advance healthier eating, improve food safety, reduce food insecurity, and address food waste.

We focus our efforts on where we can have the most impact, taking action to:

1. Elevate portion control and balance as a consumer issue

NCL will advance the Dietary Guidelines’ recommendation to achieve a healthy balance of food choices by emphasizing the importance of portion control and ensure consumers know the recommended daily intake of calories is 2,000 per day. We also want to encourage greater use of “My Plate,” a plan developed by the U.S. Department of Agriculture (USDA) to help consumers personalize their portions for various food groups—what and how much to eat, based on one’s age, sex, height, weight, and physical activity level.[5]

2. Reduce excess sodium in the diet

NCL is greatly concerned that Americans on average consume 50 percent more sodium per day than recommended by the Dietary Guidelines. Because this increases the risk for hypertension, heart disease and heart attacks, and stroke, we will advance the goal set by the Food and Drug Administration (FDA) to lower sodium intake to 2,300 milligrams (mg) per day and encourage consumers to flavor foods with herbs and spices instead of salt, and use the Nutrition Facts label to choose products with less sodium, reduced sodium or no salt (sodium) added.

3. Improve the labeling of alternative sweeteners

NCL applauds FDA’s decision to include “Added Sugars” on the recently updated Nutrition Facts label but we remain concerned about how novel sweeteners are labeled. Therefore, NCL is supporting a Citizen’s Petition to FDA to ensure transparent labeling of substitute sweeteners and has joined with other consumer groups in urging FDA to stop misleading claims, such as “No Added Sugars,” “Zero Sugar,” and “Reduced Sugars.” These claims imply the new product is healthier than the original, without disclosing that the sugar reduction resulted from reformulating with artificial substances and sugar alcohols.

4. Make alcohol facts labeling mandatory

Since 2003, NCL and 75 other consumer, public health, medical and nutrition organizations have pressed the federal agency that regulates alcoholic beverages—the Treasury Department’s Bureau of Alcohol and Tobacco Tax and Trade (TTB)—to issue rules requiring an easy-to-read, standardized “Alcohol Facts” label on all beer, wine, and distilled spirits products. Currently, TTB has opted for voluntary labeling and the result is that many products remain unlabeled or carry incomplete labeling information. We are not giving up! In 2021, NCL will step up the fight to ensure complete labeling information on alcoholic beverages.

5. Require labeling of caffeine content

FDA considers 400 mg of caffeine per day as the amount not generally associated with dangerous side effects. An 8-ounce cup of coffee has about 95 mg of caffeine, a 12 ounce can of Coca-Cola has 34 mg, high caffeine drinks may have 160 mg for 16-ounces. The FDA only requires food labels to disclose that there is added caffeine in the food or beverage. This makes it hard for consumers to stay within the recommended limit because they don’t know how much caffeine is in the foods and beverages they consume. For this reason, NCL strongly believes that all products containing caffeine should be required to list the amount of caffeine per serving and per container and we will push for that requirement.

  1. Modernize food standards of identity

“Standards of identity” establish recipes for what a food product must contain, how it must be proportioned, and sometimes how it must be manufactured. However, many food standards are now 75 and even 80 years old and out of date. This is why NCL supports FDA’s action plan to modernize food standards of identity, but we are also calling attention to several food products—such as olive oil, Greek yogurt, and canned tuna—where issuing new or updated standards of identity are needed now.

7. Revise the definition of the term “healthy” and front of pack food labeling symbols

Currently, a food can be labeled “healthy” if the amount customarily consumed is low in fat, low in saturated fat, contains less than 480 mg of sodium, has a limited cholesterol, a significant amount of fiber, and at least 2 additional beneficial nutrients such as vitamins A, C, D, calcium, iron, protein or potassium. This will change because FDA recently modified how low fat will be calculated. While NCL supports this step, we will press FDA to address if and how added sugar content is calculated and will encourage FDA to adopt a “Traffic Light” labeling system to depict “healthy” on the front of the package.

8. Strengthen the food safety system

NCL will work individually and as a member of the Safe Food Coalition to make improvements in the nation’s food safety system. Priorities include finalizing FDA’s Food Traceability Proposed Rule, which would establish a standardized approach to traceability recordkeeping; expanding pathogen testing in meat and poultry products; and updating safe handling instructions labels for these products.

9. Reduce the amount of food waste

Every year, about 90 billion pounds of food goes uneaten in the US, with huge environmental and food insecurity consequences. To change this food waste crisis, NCL will raise awareness of food loss and waste and inform consumers about how they can reduce food waste in their homes and when they go out to eat.

10. Increase funding and access to federal nutrition programs

NCL will work to make permanent the 15 percent Supplemental Nutrition Assistance Program (SNAP) benefits increase now included in the American Relief Plan, while also pressing for additional funding for the National School Lunch and Breakfast Program.

Conclusion: Advancing a policy agenda that ensures transparent food labeling, improves the safety and quality of the foods people eat, reduces food insecurity, and addresses food waste is essential to improving American’s lives. The stakes are high and NCL is committed to making a difference for consumers


[1] U.S. Census Bureau. Household Pulse Survey. May 20, 2020

[2] National Restaurant Association. COVID-19 Restaurant Impact Survey V. December 2, 2020

[3] U.S. Bureau of Labor Statistics. Consumer Price Index Summary. March 10, 2021

[4] Food and Drug Administration. Food Loss and Waste. February 23, 2021

[5] The National Confectioners Association “Always a Treat” consumer education campaign is one example of how portion control can be easily utilized to control calorie consumption and achieve the dietary patterns recommended in the Dietary Guidelines. As part of this campaign, leading chocolate and candy companies have pledged that half of their individually wrapped products will be available in sizes that contain 200 calories or less per pack.

Vitaminwater making bold claims

Since its founding in 1899, NCL has been on the look-out for product claims that may be deceptive or misleading. So when we came across a few advertisements about vitaminwater recently, we were shocked to see that the company that manufactures vitaminwater, Glaceau (a Coca-Cola company), is suggesting that its products can keep you healthy or pre-empt the need for flu shots!

In a formal complaint filed with the Federal Trade Commission in February 2011, NCL is pointing to print and television advertisements that suggest vitaminwater can replace flu shots or prevent illness and prey on consumers’ health concerns to sell a high-calorie product:

“These advertising claims are not only untrue; they constitute a public health menace. Stopping these vitaminwater claims, which contradict information by the Centers for Disease Control and other public health authorities, should be a top FTC priority,” stated Sally Greenberg, Executive Director of NCL.

The NCL complaint also urged the FTC to halt deceptive label statements for vitaminwater that describe the product as:

According to NCL, the statements are deceptive because the products on which they appear are not simply made from vitamins and water, but are made with crystalline fructose or other forms of sugar, and contain 125 calories per bottle.

“Two-thirds of Americans are overweight or obese; the last thing people need is sugar water with vitamins you could get from eating a healthy diet, or by taking a vitamin pill, Greenberg stated.

The FTC should act now, during cold and flu season, to stop vitaminwater’s outlandish claims,” she said.

Read NCL’s letter to the FTC here, or tell vitaminwater what you think of its ads here.

Sweetened with what? Lack of transparency and misleading claims make reducing added sugars confusing

Many of us are probably trying to heed the advice of the U.S. Food and Drug Administration (FDA) to reduce our consumption of added sugars. FDA has made “Added Sugars” content per serving a mandatory line on the Nutrition Facts label and has established a Daily Value of 50g of added sugars based on a 2,000 calorie a day diet. FDA’s actions, however, have had some unintended consequences.

The agency’s decision to include “Added Sugars” on the Nutrition Facts label has created a marketing incentive for food and beverage manufacturers to replace added sugars with alternative or substitute sweeteners.  Leading brand name products bear prominent claims such as “No Added Sugars,” “Zero Sugar,” and “Reduced Sugars,” implying that the new product is healthier than the original without disclosing how the sugar has been reduced. As detailed in a recent Center for Science in the Public Interest (CSPI) letter and an industry citizen’s petition filed with the FDA (Docket No. FDA-2020-P-1478), consumers have little idea that when they purchase a no/reduced sugar product, they may be buying a food that contains alternative sweeteners, highly processed, or artificial substances.

Most of us following the FDA’s advice aren’t looking to load up on combinations of new-fangled sweetening agents, sugar alcohols and other synthetic substances. CSPI’s January 9, 2020 letter asks that FDA enforce standards for nutrient content claims related to added or reduced sugar. We support that request.

The petition was filed by the Sugar Association, whose members are clearly concerned about competition from alternative sweeteners. But their complaint to the FDA makes a strong case for transparency by citing products that make no/reduced added sugars on the front label, but fail to disclose that sugars have been replaced by other sweeteners—many unfamiliar, some artificial, and some with known glycemic index effects. For example:

  • Rebel Ice Cream claims “No Sugar Added” but is sweetened with Erythritol, Chicory Root Fiber, Vegetable Glycerin, and Monk Fruit;
  • Kool-Aid Jammers claim “Zero Sugar” but are sweetened with Sucralose and Acesulfame Potassium;
  • Oikos Greek Yogurt claims “No Added Sugar and No Artificial Sweeteners” but contains Stevia and Chicory Root Fiber;
  • Quest Nutrition’s Hero Blueberry Cobbler Bar claims “1g” of sugar but is sweetened with Allulose, Erythritol, Sucralose, and Steviol Glycosides (Stevia);
  • Snack Pack Juicy Gels claim “Sugar Free” but are sweetened with Sucralose;
  • ONE Maple Glazed Doughnut Bar claims “1g” of sugar but is sweetened with Maltitol, Vegetable Glycerin, and Sucralose;
  • Snack Pack Chocolate Pudding Cups claim “Sugar Free” but are sweetened with Sorbitol, Maltitol, Sucralose, and Acesulfame Potassium;
  • Welch’s Fruit Snacks claim “Reduced Sugar” but are sweetened with Chicory Root Fiber and Maltitol Syrup;

The petition, among other steps, urges FDA to require that such substances be clearly disclosed as a “sweetener” in the ingredient list. That step seems reasonable to insure transparency and ensure that consumers know what they are purchasing.

The petition also calls for action against outright misleading claims regarding sugar content. The CSPI letter and industry petition blows the whistle on deceptive claims like these:

  • The reduced sugar version of Skippy peanut butter has 1/3 less sugar than its traditional counterpart but has more calories and fat per serving than the regular version. Despite having 1g less added sugars, the reformulated product provides 20 more calories per 2 tablespoon serving. The claim on the front label is misleading because it implies that the reformulated version is healthier due to the reduction in added sugars when the reformulated version is higher in calories.
  • Welch’s Fruit Snacks Reduced Sugar version claims 25 percent less sugar than the original version. The claim is predicated upon a reduction in the serving size of the reformulated version of the product. The original version has a serving size of 25.5g while the Reduced Sugar version has decreased to 22.7g.
  • Oikos Triple Zero blended Greek Yogurt makes a “0 Added Sugar” claim but has more calories per serving than the company’s regular Greek yogurt. The zero added sugars product, which is sweetened with Stevia Leaf Extract, has 120 calories per serving while the company’s original version has 110 calories per serving.

Statements like these turn the supermarket aisle into a minefield of misleading claims that are not good for consumers who are trying to sort out health values. We urge the FDA to prohibit misleading labeling of alternative sweeteners in processed foods and beverages and to grant the citizens’ petition for greater transparency in food labeling when it comes to these artificial sweeteners.