'No fat' or 'no sugar' label equals no guarantee of nutritional quality

The work, which appears in the most recent issue of the Journal of the Academy of Nutrition and Dietetics, rekindles an ongoing debate on what United States regulators consider healthy labeling, as producers and interest groups grapple over rules on nutrition claims on packaged foods and ready-to-drink beverages -- and consumers contend with how to rationalize a purchase and make healthier choices.

"In many cases, foods containing low-sugar, low-fat or low-salt claims had a worse nutritional profile than those without claims," explained lead investigator Lindsey Smith Taillie, a research assistant professor in the department of nutrition at UNC's Gillings School of Global Public Health. "In fact, in some cases, products that tend to be high in calories, sodium, sugar or fat may be more likely to have low- or no-content claims."

For example, a three-cookie serving of reduced-fat Oreos contains four-and-a-half grams of fat compared to seven grams in a serving of full-fat Oreos, but both still contain 14 grams of sugar per serving, which could provide the appearance that the low-fat version is "healthy." Chocolate low-fat milk is another example. It has the lower fat content but it is higher in sugar relative to plain milk and higher in sugar and fat relative to other beverages.

The issue stems, in part, from the U.S. Food and Drug Administration allowing packaged food and beverage manufacturers to assign labels in different ways for different foods.

As with the examples above, if you are a consumer trying to make a healthy choice, you assume reduced means a healthier product. But that product only has to be reduced in reference to the original food of the same product for that specific nutrient -- a reduced-fat cookie, for example. That cookie could also contain higher sugar or sodium, so if consumers are only relying on the reduced claim, they could potentially end up with a less healthy cookie. "Essentially, reduced claims are confusing because they are relative and only about one nutrient," said Taillie.

Foods with a low claim are equally, if not more, confusing, but for different reasons. The FDA allows a low-fat label on food if that food has less than three grams per reference amount customarily consumed, or RACC. However, that reference point varies across product categories. For example, the RACC for brownies is 40 grams, whereas the RACC for cheesecake is 125 grams.

"A low-fat brownie could have three grams of fat per 40 grams, whereas a low-fat cheesecake" would have to have three grams of fat per 125 grams. So if a consumer were trying to find a lower-fat option for a dessert, the low-fat brownie would have relatively higher fat than the low-fat cheesecake."

After looking at data that included more than 80 million food and beverage purchases from more than 40,000 households from 2008 to 2012, Taillie and her colleagues at the UNC-Duke USDA Center for Behavioral Economics and Healthy Food Choice Research found that 13 percent of food and 35 percent of beverage purchases had a low-content claim (including no, free, low or reduced) and that low-fat was the most common claim, followed by low-calorie, low-sugar and low-sodium.

Investigators also looked at the groups who were more likely to purchase foods that made these statements. While differences in purchasing patterns by race/ethnicity were not statistically significant, non-Hispanic white households were most likely to buy products with a low-calorie claim and Asian households purchased more foods with low-fat or low-sodium claims. Non-Hispanic black households were the least likely to purchase food groups with any low-content claim.

There was also a connection between socioeconomic status and food purchases. Researchers found that high-and middle-income level households were more likely to purchase food and beverages with low-content claims.

A key question for future research, said Taillie, will address how these claims affect consumer choice and how claims interact with other common strategies, such as sales or price promotions, to influence purchasing behavior and ultimately, dietary quality.