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Prepared by the Hunter College NYC Food Policy Center
The following is a resource guide with information about added sugar in food and beverages, including institutional sugar policies, pouring rights contracts, and added sugar warning labels. This guide accompanies the May 12, 2021 discussion, “Making Progress on Added Sugar.” To watch the discussion, see here.
Sugar Overview
Facts & Data
- Dietary sugar comes in two forms: naturally-occurring and added. Naturally-occurring sugars, such as lactose from milk products and fructose from fruits, are found naturally in these foods. Added sugars are any types of sugar that are added to food during processing or preparation, including white sugar added to coffee, honey added to granola, and high fructose corn syrup added to fruit juices.
- In 2015, the World Health Organization recommended that free sugars (sugars added to foods and beverages by manufacturer, cook or consumer, and sugars present in honey, syrups, and fruit juices) should account for less than 10% of total energy intake.
- The American Heart Association recommends a daily sugar intake of no more than 6 teaspoons (25 grams, or 100 calories) for women, and 9 teaspoons (36 grams, or 150 calories) for men.
- According to the USDA, American adults, on average, consume more sugar than the recommended daily intake. In 2017-2018: The average adult woman consumed 15 teaspoons per day, and the average adult man consumed 19 teaspoons per day.
- During the COVID-19 pandemic, sugar consumption has been scrutinized even more. Sugar consumption has been linked to an increased risk of certain diet-related diseases. Many of these diseases, such as diabetes and obesity, are then linked to increased risk of severe illness from the virus.
- Food industries that rely on sugar have a history of funding research to attempt to avoid culpability in the American obesity epidemic and potentially improve companies’ public image.
- In the 1960s, the Sugar Research Foundation, today known as the Sugar Association, paid scientists to do research on sugar and fat and then selected the research that minimized the link between sugar and heart health to be published.
- Two of the largest soda companies, the Coca-Cola Company and PepsiCo, sponsored research done by 95 different health organizations from 2011 until 2015.
Resource Websites
- American Heart Association – Sugar
- The Center for Science in the Public Interest Resource Library – Sugar
- World Health Organization – Sugars and dental caries fact sheet
- Get the Facts: Added Sugars – CDC
- The CDC Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages
- The Sugar Association
- Added Sugar in the Diet – Harvard School of Public Health
- 2015-2020 Dietary Guidelines – US Department of Health and Human Services
- The Bitter Truth: Sweeteners are Making Many Americans Sick – US Right to Know
- How Does Too Much Sugar Affect Your Body? – WebMD
Publications
Scholarly Journals
- Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents (Pediatrics 2019)
- Adolescent Sugar-Sweetened Beverage Intake is Associated With Parent Intake, Not Knowledge of Health Risks (American Journal of Health Promotion 2018)
- Was There Ever Really a “Sugar Conspiracy”? (Science 2018)
- Sugar Addiction: Is it Real? A Narrative Review (British Journal of Sports Medicine 2017)
- Guidelines to Limit Added Sugar Intake: Junk Science or Junk Food? (Annals of Internal Medicine 2017)
- Sponsorship of National Health Organizations by Two Major Soda Companies (American Journal of Preventive Medicine 2016)
- Global, Regional, and National Consumption of Sugar-Sweetened Beverages, Fruit Juices, and Milk: A Systematic Assessment of Beverage Intake in 187 Countries (PLOS One 2015)
- Why Sugar Is Added to Food: Food Science 101 (Comprehensive Reviews in Food Science and Food Safety 2015)
- Dietary Sugars Intake and Cardiovascular Health (Circulation 2009)
Newspapers & Magazines
- Covid Surge Hits Sugar Demand (Financial Express 2021)
- During COVID-19 Lockdown, What’s Happened to Sugar Consumption? (Digital Journal 2020)
- America’s Deadly Sugar Addiction Has Reached Epidemic Levels (Healthline 2019)
- The Sugar that Saturates the American Diet Has a Barbaric History as the ‘White Gold’ that Fueled Slavery (New York Times 2019)
- The Sweet Danger of Sugar (Harvard Men’s Health Watch 2017)
- 50 Years Ago, Sugar Industry Quietly Paid Scientists To Point Blame At Fat (NPR 2016)
- How the Sugar Industry Shifted Blame to Fat (New York Times 2016)
- Nearly 60% Of Calories, 90% Of Added Sugars In US Diet Are From ‘Ultra-Processed’ Foods (Forbes 2016)
Reports
- Global Market Report: Sugar (International Institute for Sustainable Development 2020)
- Guideline: Sugars Intake for Adults and Children (World Health Organization 2015)
Books
- The Case Against Sugar by Gary Taubes (2016)
- Salt Sugar Fat by Michael Moss (2013)
- Sugar: A Bittersweet History by Elizabeth Abbott (2011)
Documentaries
Podcasts
- Soda Policy: What’s on Tap (Eating Matters 2016)
- How Sweet It Is with Dr. Robert Lustig (Eating Matters 2015)
- Sugar: A Love-Hate Relationship (The Food Chain 2015)
Other
- Eating Excess Sugar Is Worse for You During COVID-19: 6 Ways to Cut It (Healthline 2020)
- Sugar-Sweetened Beverages & Sugar Taxes: An Overview, Index and Resource Guide (Hunter College NYC Food Policy Center 2020)
- The No BS Guide to Added Sugar (Healthline 2019)
- Facts on Sugar Drink Marketing (Center for Science in the Public Interest 2017)
Opinion
- Big Sugar Versus Your Body (New York Times 2018)
- Fight ‘Big Soda’ (New York Times 2016)
- The Sugar Lobby’s Sour Tactics (Washington Post 2015)
- Sound Science or Attack on Corn Syrup? Sugar Industry Can’t Have it Both Ways (CNN 2014)
- Big Sugar’s Sweet Little Lies (Mother Jones 2012)
- Coke Didn’t Make America Fat (Wall Street Journal 2009)
Online Discussion
Sugar at Institutions
Resource Websites
- Healthy Hunger-Free Kids Act – USDA
- Snacks & Sugary Foods in School: AAP Policy Explained – HealthyChildren.org
- Nutrition Standards for School Meals – USDA
- Healthy Food Environments – CDC
- Practice Greenhealth Healthier Hospitals
Research (Scholarly Journals)
- Association of a Workplace Sales Ban on Sugar-Sweetened Beverages With Employee Health (JAMA Internal Medicine 2020)
- Growing Momentum for Sugar-Sweetened Beverage Campaigns and Policies: Costs and Considerations (American Journal of Public Health 2017)
Sugar in Schools
- Added Sugars in School Meals and the Diets of School-Age Children (Nutrients 2021)
- Efficacy of a School-based Obesity Prevention Intervention at Reducing Added Sugar and Sodium in Children’s School Lunches: the LA Health Randomized Controlled Trial (International Journal of Obesity 2018)
- Sugar In School Breakfasts: A School District’s Perspective (Journal of Applied Research on Children 2015)
- Snacks, Sweetened Beverages, Added Sugars, and Schools (Pediatrics 2015)
- Solid Fat and Added Sugar Intake Among U.S. Children: The Role of Stores, Schools, and Fast Food, 1994–2010 (American Journal of Preventive Medicine 2013)
- Childhood Obesity: Problems and Solutions (Journal of Physical Education, Recreation & Dance 2013)
- Associations Between the Perceived Presence of Vending Machines and Food and Beverage Logos in Schools and Adolescents’ Diet and Weight Status (Public Health Nutrition 2011)
- School Food Environments and Practices Affect Dietary Behaviors of US Public School Children (Journal of the American Dietetic Association 2009)
- A National Study of School Food Policies and Environment: School Food Policies Affect Beverage Consumption at School, but Student Characteristics and Behaviors Also Matter (Journal of the Academy of Nutrition and Dietetics 2008)
- School Food Environments and Policies in US Public Schools (Pediatrics 2008)
- Exclusive Beverage Arrangements in U.S. and Canadian Schools: A Review of Practices and Policy Perspectives (Journal of Foodservice 2005)
Sugar-sweetened beverages in schools
- The Association Between Sugar-sweetened Beverage Availability in School Vending Machines and School Staff Sugar-sweetened Beverage Consumption (Preventive Medicine Reports 2020)
- Parents’ Demand for Sugar Sweetened Beverages for Their Pre‐School Children: Evidence from a Stated‐Preference Experiment (American Journal of Agricultural Economics 2020)
- Adolescents’ Beverage Choice at School and the Impact on Sugar Intake (European Journal of Clinical Nutrition 2015)
- Banning All Sugar-sweetened Beverages in Middle Schools: Reduction of In-school Access and Purchasing But Not Overall Consumption (Archives of Pediatrics & Adolescent Medicine 2011)
- Existence and Predictors of Soft Drink Advertisements in Pennsylvania High Schools (Journal of the American Dietetic Association 2006)
- Soft Drinks in Schools (Pediatrics 2004)
Policy effects on sugar consumption in schools
- Breaking Habits: The Effect of the French Vending Machine Ban on School Snacking and Sugar Intakes (Journal of Policy Analysis and Management 2017)
- The Growing Political Movement Against Soft Drinks in Schools (Medical Student JAMA 2002)
Sugar in Hospital Food
- Hospitals Lead by Poor Example: An Assessment of Snacks, Soda, and Junk Food Availability in Veterans Affairs Hospitals (Nutrition 2019)
- An Intervention to Increase Availability of Healthy Foods and Beverages in New York City Hospitals: The Healthy Hospital Food Initiative, 2010–2014 (Preventing Chronic Disease 2016)
- Understanding Hospital Cafeterias: Results From Cafeteria Manager Interviews (Journal of Public Health Management and Practice 2014)
- The Ethics of Hospital Cafeteria Food (American Medical Association Journal of Ethics 2013)
- Healthy Hospital Food Initiatives in the United States: Time to Ban Sugar Sweetened Beverages to Reduce Childhood Obesity (Acta Paediatrica 2013)
- Hospital Food: A Survey of Patients’ Perceptions (Clinical Nutrition 2003)
Sugar in Correctional Facilities
- Food in Correctional Facilities: A Scoping Review (Appetite 2019)
- Ultra-processed Foods Consumption Among Inmates in a Women’s Prison in São Paulo, Brazil (Revista Española de Sanidad Penitenciaria 2018)
- Evaluation of the Nutritional Quality of Commissary Foods Offered in American Women’s Prisons (Journal of Correctional Health Care 2018)
- Lack of Healthier Food Alternatives Can Compromise Inmate Health – Letter to the Editor (American Journal of Public Health 2015)
- Good and Healthy: Foodways and Construction of Identity in a Women’s Prison (The Howard Journal of Criminal Justice 2014)
- Factors Contributing to Poor Physical Health in Incarcerated Women (Journal of Health Care for the Poor and Underserved 2013)
Correctional facility diet effects on health
- Female Inmates with Diabetes: Results from Changes in a Prison Food Environment (Women’s Health Issues 2015)
- Metabolic Improvement of Male Prisoners with Type 2 Diabetes in Fukushima Prison, Japan (Diabetes Research and Clinical Practice 2007)
- Oral Health Status of a Federal Prison Population (Journal of Public Health Dentistry 1990)
Sugar in the Military
Other Publications
Books
- Prison Food in America by Erika Camplin (2016)
- Healthy Kids, Smart Kids: The Principal-created, Parent-tested, Kid-approved Nutrition Program for Strong Minds and Healthy Bodies by Yvonne Sanders-Butler (2005)
Reports
- Carbonating the World (Center for Science in the Public Interest 2016)
- Food Systems in Correctional Settings: A Literature Review and Case Study (World Health Organization 2015)
- Challenging the Soda Companies: The Los Angeles Unified School District Ban–A Report Prepared by the Center for Food and Justice (Occidental College Urban and Environmental Policy Institute 2002)
- Banning Junk Food and Soda Sales in the State’s Public Schools: A Public Policy Case Study (The California Endowment 2006)
Other
- New York City hospital food
- Prison Commissary Lists
- Federal Bureau of Prisons Commissary Shopping List (2011)
- Alaska Department of Corrections Commissary Items
- Arkansas Department of Corrections Commissary List
- Colorado Department of Corrections Canteen Product Listing
- Connecticut Department of Correction Commissary Order Form
- Florida Department of Corrections Male Canteen Menu
- Florida Department of Corrections Female Canteen Menu
- Hawaii Department of Public Safety Commissary Price Lists (MuckRock 2020)
- Iowa Prison Industries’ Central Canteen Catalog
- Kansas Department of Corrections Commissary Menus
- Pennsylvania Department of Corrections Commissary Lists
- Texas Department of Justice Commissary Top Selling Items
- Washington Department of Corrections Commissary Items for Sale
- Initiatives/programs outside of NYC
In the News
General
Schools
- Soda at School? More Districts are Just Saying No (Public School Review 2021)
- Schools Urged to Comply with New Sugar Limit for Beverages (The Gleaner 2020)
- Cutting Back on Sugar by Serving White Milk for School Lunches (Alaska Play Every Day campaign 2018)
- Why There is So Much Sugar in Your Kid’s School Breakfast (Civil Eats 2015)
- New School Health Rules Will Banish Soda Marketing, Too (Bloomberg 2014)
- Study Links Healthy Weight in Children With Tough Snack Laws (New York Times 2012)
- Boston High School Students Drinking Fewer Sugary Beverages (Harvard School of Public Health press release 2011)
- 10 Years Later, School Still Sugar Free and Proud (CNN 2008)
- Big Soda’s Sticky End (Bloomberg 2006)
Hospitals
- NYC Health + Hospitals Eliminates All Sugary Drinks From Its Facilities System-Wide (NYC Health + Hospitals press release 2020)
- Sugary Drink Ban Tied to Health Improvements at Medical Center (New York Times 2019)
- Get Sugary Drinks Out of Hospitals (Salon 2018)
- Sugary Foods, Drinks: Banned in Hospitals? (Healthline 2018)
- Sugary Shakes in the Hospital Aren’t Good Medicine (New York Times 2018)
- Healthy Hospital Food: A New Approach to Patient Recovery (Hunter College NYC Food Policy Center 2016)
- NYC Has Embarked on a Healthy Hospital Food Initiative that is Being Coordinated Through its Department of Health (Food Management 2013)
- IU Health Eliminates Sugary Drinks from Hospitals (Fox 2013)
- Mission: Nutrition Brings Healthier Food and Drink Options to Seattle Children’s (Seattle Children’s On the Pulse 2012)
- Chicago Hospital Group to Drop Sugar-sweetened Drinks (Chicago Tribune 2012)
- Hospital Food Often Unhealthy (The Hospitalist 2012)
- Dartmouth-Hitchcock Medical Center Won’t Sell Sugar-sweetened Drinks (New Hampshire Union Leader 2011)
Correctional Facilities
- South Woods State Prison inmate sues over high-sodium, sugary foods (The Press of Atlantic City 2019)
- Prison Food and Commissary Services: A Recipe for Disaster (Prison Legal News 2018)
- Food for Thought: Prison Food is a Public Health Problem (Prison Policy Initiative 2017)
Pouring Rights at Public Universities
What are Pouring Rights?
“Pouring rights” is defined by the Oxford English Dictionary’s Lexico as, “The exclusive rights of a beverage maker or distributor to have its products sold at a particular venue, event, or institution.” Beverage companies will sign contracts with locations and institutions (notably universities) to have exclusive rights to the sale of drinks at that particular place.
Resource Websites
Research (Scholarly Journals)
- Pouring Rights Contracts and Childhood Overweight: A Critical Theory Perspective (Journal for Specialists in Pediatric Nursing 2006)
- Soft Drink Vending Machines in Schools: A Clear and Present Danger (American Journal of Health Education 2006)
- School Soda Contracts: A Sample Review of Contracts in Oregon Public School Districts (Community Health Partnership 2004)
- The Problems of Pouring-Rights Contracts (Duke Law Journal 2003)
- Soft Drink Pouring Rights (North Carolina Medical Journal 2002)
- Pouring Rights (Dental Assistant 2002)
- Eighth District: Pouring Rights Overflow (New York State Dental Journal 2001)
- Soft Drink “Pouring Rights”: Marketing Empty Calories to Children (Public Health Reports 2000)
Awareness
- University Stakeholders Largely Unaware and Unsupportive of University Pouring Rights Contracts with Companies Supplying Sugar-sweetened Beverages (Journal of American College Health 2021)
- Awareness and Opinions About Sugar-sweetened Beverage Policy in a University Setting (MS thesis, University of Iowa 2019)
Economic benefits to pouring rights contracts
Other Publications
Books
- Coca-Globalization: Following Soft Drinks from New York to New Guinea, Chapter 7: Pouring Rights by Robert J. Foster (2008)
- Food Politics: How the Food Industry Influences Nutrition and Health, Chapter 9: Pushing Soft Drinks: “Pouring Rights” by Marion Nestle (2007)
Conferences/talks/presentations
- Pouring Rights with Tim Richardson and Jim Tyrrell (2019 Passenger Terminal Conference)
- Sweet Persuasion: Soft Drinks, School Funding, And Children’s Health (2004 American Agricultural Economics Association meeting)
Podcasts
In the News
- ECU Selects Minges Bottling Group for Exclusive Pouring Rights (East Carolina University News 2020)
- CU’s Pouring Rights Contract with Pepsi Pushes Out Local Brands (5280 Magazine 2019)
- Pouring Rights Contract for Soft Drinks Pending at Mohegan Sun Arena (Times Leader 2019)
- Soda Company Pouring Rights Contracts: Exposed! (Food Politics by Marion Nestle 2018)
- The Biggest College Rivalry in America: Coke Versus Pepsi (MuckRock 2018)
- Pouring Rights: Academic Misconduct (Crossfit Journal 2017)
- Coca-Cola Signs $15.4M Pouring Rights Deal with UCLA (Atlanta Journal-Constitution 2013)
- Pepsi Distributor Buying ‘Pouring Rights’ at UO (Washington Times 2014)
- 80 Percent of Public Schools Have Contracts With Coke or Pepsi (Mother Jones 2012)
- Pepsi Wins Exclusive Beverage Contract at University of Arkansas (Arkansas Times 2012)
- Pepsi Gets 10-year Pouring Rights at UNK (Kearney Hub 2009)
- Pouring Rights Scoreboard: Sponsorships are Ruled by a Complicated Mix of Agreements (Beverage Industry 2003)
Student Opposition
- University of California, Berkeley – 2019-present
- Equity & Sustainability are Impeded by UC Berkeley-PepsiCo Partnership (The Daily Californian op-ed 2020)
- UC Berkeley Needs to Reevaluate its Pouring Rights Contract with PepsiCo (The Daily Californian op-ed 2019)
- Instagram: @pouroutpepsi
- “Student-led EJ movement against @ucberkeleyofficial contract with @pepsico and big food”
- 476 followers (April 19, 2021)
- Website: https://pouroutpepsi.com/
- Johns Hopkins University – 2019-present
- Real Food Demands End to Contract with PepsiCo (The Johns Hopkins News-Letter 2019)
- Dining Implements Changes in Response to Student Groups’ Demands (The Johns Hopkins News-Letter 2019)
- Students Call for End to Hopkins-PepsiCo Contract (The Johns Hopkins News-Letter 2019)
- Facebook: Pour Out Pepsi
- “Student-led campaign to end Johns Hopkins University’s contract with PepsiCo”
- 59 followers (May 3, 2021)
- University of Massachusetts Amherst – 2019
- Why Does UMass Love Coke? Students Question Pouring Rights at Flagship Campus (Amherst Wire 2019)
- Petition to End Pouring Rights at UMass Amherst
- Facebook: Uprooted & Rising at UMass Amherst
- “We are a movement fighting for a future that will sustain and nourish generations to come, here and abroad. We are the UMass Chapter!”
- 15 followers (May 10, 2021)
- San Francisco State – 2015
- Pouring Rights Agreement Falls Flat as Students Rise Up (Golden Gate Express 2015)
- San Francisco State University Pouring Rights Contract Fizzles After Student Protests (Forbes 2015)
- San Francisco State Halts Sale of ‘Pouring Rights’ (Inside Higher Ed 2015)
- Enjoy Coke and Pepsi: San Francisco State Nixes Plan to Sell Campus ‘Pouring Rights’ to Soda Giants (NBC Bay Area 2015)
- SF State Forgoes Millions as It Drops Plans for Big Soda Contract (KQED 2015)
- San Francisco State vs. Pouring Rights Contracts (Food Politics by Marion Nestle 2015)
- Pouring Rights Walkout at San Francisco State University (RFC San Francisco 2015)
Added Sugar Warning Labels
What are Added Sugar Warning Labels?
Placed on the front of packaging, added sugar warning labels are graphics that draw attention to the amount of added sugar in a food product. Different types of warning labels have different amounts of information on them and have varying efficacy as deterrents to consumers. Some countries, such as Chile and Mexico, have taken legislative action to require warning labels on packaged food,, but these actions have been strongly opposed by the American food industry.
In New York City chain restaurants, foods that contain more than the recommended amount of sodium are required to include a small black and white salt shaker icon on the menu. Now, there is also a bill pending to require these restaurants to also include a warning for foods that are high in sugar.
Resource Websites
Research (Scholarly Journals)
- Impact of Health Warning Labels on Selection and Consumption of Food and Alcohol Products: Systematic Review with Meta-analysis (Health Psychology Review 2020)
- The Bittersweet Truth About Sugar Labeling Regulations: They are Achievable and Overdue (American Journal of Public Health 2012)
Effect of warnings on consumers
- Pilot Randomized Controlled Trial Testing the Influence of Front-of-pack Sugar Warning Labels on Food Demand (BMC Public Health 2019)
- Impact of Warning Labels on Reducing Health Halo Effects of Nutrient Content Claims on Breakfast Cereal Packages: A Mixed-measures Experiment (Appetite 2021)
- Consumer Effects of Front-of-package Nutrition Labeling: an Interdisciplinary Meta-analysis (Journal of the Academy of Marketing Science 2020)
- Warnings as a Directive Front-of-pack Nutrition Labelling Scheme: Comparison with the Guideline Daily Amount and Traffic-light Systems (Public Health Nutrition 2017)
- Taxes and Front-of-package Labels Improve the Healthiness of Beverage and Snack Purchases: A Randomized Experimental Marketplace (International Journal of Behavioral Nutrition and Physical Activity 2019)
- Objective Understanding of Front-of-Package Nutrition Labels: An International Comparative Experimental Study across 12 Countries (Nutrients 2018)
Effect on parents
- Impact of Warning Labels on Sugar-sweetened Beverages on Parental Selection: An Online Experimental Study (Preventive Medicine Reports 2018)
- Health Warning Labels Correct Parents’ Misperceptions About Sugary Drink Options (American Journal of Preventive Medicine 2018)
- The Influence of Sugar-Sweetened Beverage Health Warning Labels on Parents’ Choices (Pediatrics 2016)
Restaurant menus and nutrition information
- Association Between Restaurant Menu Item Descriptions and Their Nutrient Content (American Journal of Preventive Medicine 2021)
- Short Run for a Long Slide: For Restaurant Menu Calorie Labeling, Knowledge Is Power (Circulation 2020)
- Response of the Public and Restaurant Owners to the Mandatory Menu Energy-labelling Implementation in Restaurants in Saudi Arabia (Public Health Nutrition 2020)
- Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research (Nutrients 2020)
- Estimating the Effect of Calorie Menu Labeling on Calories Purchased in a Large Restaurant Franchise in the Southern United States: Quasi-experimental Study (BMJ 2019)
- Online Randomized Controlled Trials of Restaurant Sodium Warning Labels (American Journal of Preventive Medicine 2019)
- A Meta-Analysis to Determine the Impact of Restaurant Menu Labeling on Calories and Nutrients (Ordered or Consumed) in U.S. Adults (Nutrients 2017)
- Nutritional Labelling in Malaysian Full Service Restaurant Menu (Journal of Asian Behavioural Studies 2017)
- Does Restaurant Menu Information Affect Customer Attitudes and Behavioral Intentions? A Cross-segment Empirical Analysis Using PLS-SEM (International Journal of Hospitality Management 2016)
- Restaurant Menu Labeling Policy: Review of Evidence and Controversies (Psychological Issues 2016)
- Changes in Children’s Meal Orders Following Healthy Menu Modifications at a Regional US Restaurant Chain (Obesity 2015)
- Systematic Review and Meta-analysis of the Impact of Restaurant Menu Calorie Labeling (American Journal of Public Health 2015)
- Restaurant Menu Labeling Use Among Adults — 17 States, 2012 (Morbidity and Mortality Weekly Report 2014)
- Peer Reviewed: Menu-Labeling Usage and Its Association with Diet and Exercise: 2011 BRFSS Sugar Sweetened Beverage and Menu Labeling Module (Preventing Chronic Disease 2014)
- Relationships Among Grocery Nutrition Label Users and Consumers’ Attitudes and Behavior Toward Restaurant Menu Labeling (Appetite 2013)
- A Test of Different Menu Labeling Presentations (Appetite 2012)
- Flies in the Ointment? Addressing Potential Impediments to Population-Based Health Benefits of Restaurant Menu Labeling Initiatives (Journal of Public Policy & Marketing 2012)
- Restaurant Operator’s Receptiveness towards Providing Nutritional Information on Menu (Procedia – Social and Behavioral Sciences 2012)
- What’s on the Menu? A Review of the Energy and Nutritional Content of US Chain Restaurant Menus (Public Health Nutrition 2012)
- Customer Perception on Nutritional Information in Restaurant Menu (Procedia – Social and Behavioral Sciences 2012)
- A National Approach to Restaurant Menu Labeling: The Patient Protection and Affordable Health Care Act, Section 4205 (Journal of the American Dietetic Association 2010)
- What Consumers Don’t Know Can Hurt Them: Consumer Evaluations and Disease Risk Perceptions of Restaurant Menu Items (The Journal of Consumer Affairs 2005)
Public perception of labels
- Do Consumers Think Front‐of‐Package “High in” Warnings are Harsh or Reduce their Control? A Test of Food Industry Concerns (Obesity 2018)
- Consumers’ Perceptions of Five Front-of-Package Nutrition Labels: An Experimental Study Across 12 Countries (Nutrients 2019)
- Warning Labels on Sugar-sweetened Beverages: An Eye Tracking Approach (American Journal of Health Behavior 2019)
- Sugar-Sweetened Beverage Warning Labels: Lessons Learned From the Tobacco Industry (Journal of the California Dental Association 2016)
- Environmental Interventions to Reduce the Consumption of Sugar‐sweetened Beverages and their Effects on Health (Cochrane Database of Systematic Reviews 2019)
- Nutritional Labelling for Healthier Food or Non‐alcoholic Drink Purchasing and Consumption (Cochrane Database of Systematic Reviews 2018)
Warning labels on sugar-sweetened beverages
- General and Specific Graphic Health Warning Labels Reduce Willingness to Consume Sugar-sweetened Beverages (Appetite 2021)
- Impact of Sugar-Sweetened Beverage Warning Labels on Consumer Behaviors: A Systematic Review and Meta-Analysis (American Journal of Preventive Medicine 2021)
- Warning Labels Reduce Sugar-Sweetened Beverage Intake among College Students (The Journal of Nutrition 2021)
- Experimental Studies of Front-of-Package Nutrient Warning Labels on Sugar-Sweetened Beverages and Ultra-Processed Foods: A Scoping Review (Nutrients 2020)
- The Impact of ‘On-pack’ Pictorial Health Warning Labels and Calorie Information Labels on Drink Choice: A Laboratory Experiment (Appetite 2020)
- The Effect of Sugar-sweetened Beverage Front-of-pack Labels on Drink Selection, Health Knowledge and Awareness: An Online Randomised Controlled Trial (Appetite 2018)
- The Effect of Graphic Warnings on Sugary-Drink Purchasing (Psychological Science 2018)
- Simulating the Impact of Sugar-Sweetened Beverage Warning Labels in Three Cities (American Journal of Preventive Medicine 2018)
- It is Not All About Information! Sensory Experience Overrides the Impact of Nutrition Information on Consumers’ Choice of Sugar-reduced Drinks (Food Quality and Preference 2017)
- Effects of Plain Packaging, Warning Labels, and Taxes on Young People’s Predicted Sugar-sweetened Beverage Preferences: An Experimental Study (International Journal of Behavioral Nutrition and Physical Activity 2016)
- The Influence of Sugar-Sweetened Beverage Warnings: A Randomized Trial of Adolescents’ Choices and Beliefs (American Journal of Preventive Medicine 2016)
Label design
- How Should Sugar-sweetened Beverage Health Warnings Be Designed? A Randomized Experiment (Preventive Medicine 2019)
- Choosing a Front-of-package Warning Label for Brazil: A Randomized, Controlled Comparison of Three Different Label Designs (Food Research International 2019)
- Objective Understanding of Nutri-Score Front-Of-Package Nutrition Label According to Individual Characteristics of Subjects: Comparisons with Other Format Labels (PLOS One 2018)
- The Impact of Front-of-Package Label Design on Consumer Understanding of Nutrient Amounts (Nutrients 2018)
- Are Front-of-Package Warning Labels More Effective at Communicating Nutrition Information than Traffic-Light Labels? A Randomized Controlled Experiment in a Brazilian Sample (Nutrients 2018)
- Comparing Five Front-of-pack Nutrition Labels’ Influence on Consumers’ Perceptions and Purchase Intentions (Preventive Medicine 2018)
- Impact of Front-of-pack Nutrition Information and Label Design on Children’s Choice of Two Snack Foods: Comparison of Warnings and the Traffic-light System (Appetite 2017)
- Nutrition Warnings as Front-of-pack Labels: Influence of Design Features on Healthfulness Perception and Attentional Capture (Public Health Nutrition 2017)
Front-of-package nutrition labels, broadly
- Objective Understanding of the Nutri-score Front-of-pack Label by European Consumers and its Effect on Food Choices: An Online Experimental Study (International Journal of Behavioral Nutrition and Physical Activity 2020)
- Performance of the Front-of-Pack Nutrition Label Nutri-Score to Discriminate the Nutritional Quality of Foods Products: A Comparative Study across 8 European Countries (Nutrients 2020)
- Front-of-package Food Labels: A Narrative Review (Appetite 2020)
- Comparison of Front-of-pack Labels to Help German Consumers Understand the Nutritional Quality of Food Products (Ernaehrungs Umschau International 2019)
- Consumers’ Responses to Front-of-Pack Nutrition Labelling: Results from a Sample from The Netherlands (Nutrients 2019)
- Does Front-of-pack Nutrition Information Improve Consumer Ability to Make Healthful Choices? Performance of Warnings and the Traffic Light System in a Simulated Shopping Experiment (Appetite 2018)
Negative consequences
In the News
- Here Is What Sugar-Sweetened Drink Warning Labels May Do To Obesity (Forbes 2018)
- Warning Labels for Sugar Could Work, Says Study (Time 2016)
- Graphic Warning Labels on Sugary Drinks Linked to Reduced Purchases (Harvard Gazette 2018)
- Should We Put Graphic Warning Labels on Sugary Drinks? (Psychology Today 2018)
- Should Sugary Sodas Come with Warning Labels? (CBS 2016)
- NY Assemblyman: Put Warning Labels On Sugary Drinks (CBS 2014)
- California Lawmaker Proposes Sugar Warning Labels for Soda (KCRA 2014)
- Warning: Scary Warning Labels Work! (HBS Working Knowledge 2018)
- California Bill Requiring Warning Labels on Sodas, Sugary Drinks is Shelved (Los Angeles Times 2019)
- Monning’s Soda Labeling Bill Stalls in Face of Industry Opposition (Santa Cruz Sentinel 2019)
Opposition
NYC salt labeling
- NYC gets OK to Issue Salt-warning Fines as Lawsuit Continues (KSL 2016)
- New York City Health Board Backs Warning on Menu Items With High Salt (New York Times 2015)
- New York City Mulls Salt Warnings on Menus (CBS 2015)
Opinion
Other Resources
Reports
Podcasts
- Duke Sanford World Food Policy Center: The Leading Voices in Food
Online Discussion
Policy
- CSPI Comments to FDA Re: The Declaration of Added Sugars on Honey, Maple Syrup, and Certain Cranberry Products (Center for Science in the Public Interest 2018)
- Testimony in Support of Council Bill 17-0152 (Baltimore) (Center for Science in the Public Interest 2018)
- Memorandum of Support for Warning Labels on Sugar-Sweetened Beverages (Center for Science in the Public Interest 2016)
- Bill No. A10172: Requires Sugar-sweetened Beverages to be Labeled with a Safety Warning (New York State Assembly 2014)
- Menu Labeling Legislation: Options for Requiring the Disclosure of Nutritional Information in Restaurants (Public Health Law Center 2008)
- Petition To Require Health Messages on Soft Drinks Containing High-fructose Corn Syrup and other Caloric Sweeteners (Center for Science in the Public Interest 2005)
Similar Policies Outside the USA
Australia
- In 2011, the Australian federal government rejected a recommendation to enact traffic light front-of-package labelling on packaged foods. The government rejected the recommendation despite overwhelming support from public health advocacy groups and consumers.
- In 2007, the Department of Education in the state of Western Australia began a traffic light labeling policy to determine the healthiness of various foods. Foods that are “red” are not permitted in school cafeterias. This policy is still successfully going on today.
- Since the 2011 rejection, there have been some renewed calls to introduce traffic light labeling legislation on a federal level, but as of 2021 no Australia-wide labeling laws have been passed.
Resource Websites
- Traffic Light Food Labelling (Australian Medical Association)
- Healthy food choices – Western Australia Department of Education
- Victorian Government’s Healthy Choices guidelines
- Policy Paper: Labelling of Sugars on Packaged Foods and Drinks
In the News
- Western Australia Schools Adopt Traffic Light Food Labeling System (Hunter College NYC Food Policy Center 2018)
- Traffic Light Food Scheme ‘Improving Kids’ Health’ in Western Australia: Report (Food Navigator 2018)
- Australian Government Rejects ‘Traffic Light’ Labelling (Australian Food News 2011)
- Traffic Light Labelling Debate Heats Up in Australia (Food Navigator 2011)
- Food Labelling App Takes Bite Out of Industry (Australian Broadcasting Corporation 2011)
- Most Australians Support Traffic Light Labels (Victorian Health Promotion Foundation 2010)
Research
- Are Australians Ready for Warning Labels, Marketing Bans and Sugary Drink Taxes? Two Cross-sectional Surveys Measuring Support for Policy Responses to Sugar-sweetened Beverages (BMJ 2019)
- Submissions to the Australian and New Zealand Review of Food Labelling Law and Policy Support Traffic Light Nutrition Labelling (Australian and New Zealand Journal of Public Health 2012)
- Traffic Light Food Labelling in Schools and Beyond (Health Education Journal 2011)
- Impact of ‘Traffic‐light’ Nutrition Information on Online Food Purchases in Australia (Australian and New Zealand Journal of Public Health 2011)
Canada
- In 2018, Health Canada proposed front-of-package warning labels for packaged foods, which would specifically target foods high in sugar, sodium, and saturated fats.
- As of 2021, a redesigned Canadian food label has not happened.
Resource Websites
- Toward Front-of-Package Nutrition Labels for Canadians
- Consultation on proposed front-of-package labelling
In the News
- Food Labelling — Where Do We Go From Here? (Food in Canada 2021)
- Health Canada Wants to Make Sure You Know Your Food is High in Sugar, Sodium and Saturated Fat (Global News 2018)
- Proposed New Federal Food Packaging Labels Target Salt, Sugar and Fat (CBC 2018)
Research
- Results of Applying the Canadian Proposed Front-Of-Pack Labelling Regulations to Chain Restaurant Menu Items (Current Developments in Nutrition 20200
- Cross-Sectional Analysis of Calories and Nutrients of Concern in Canadian Chain Restaurant Menu Items in 2016 (American Journal of Preventive Medicine 2020)
Chile
- Starting in the late 2000s, Chilean doctors and public health experts began to talk more openly about the rising rate of obesity in the country, spurring the country’s lawmakers to begin what the New York Times calls a “war on obesity.”
- Chile’s warning label legislation also came with new rules about advertising unhealthy products to children and selling them at schools. The law passed in 2012, but was not put into effect until 2016.
- The labels black octagonal stop signs, which say:
- “Excess of Sugar”
- “Excess of Saturated Fat”
- “Excess of Sodium”
- “Excess of Calories”
- Chile’s legislation was some of the most daring of its kind in the world, and has led to movements in other countries to require similar labeling.
Resource Websites
- Institute for Health Metrics and Evaluation – Chile
- Los chicos explican los Altos (Soprole 2016)
- Chile – Labeling & Marking Requirements (International Trade Administration)
In the News
- In Sweeping War on Obesity, Chile Slays Tony the Tiger (New York Times 2018)
- Front-Package ‘Excess Of’ Labeling, Chile (Hunter College NYC Food Policy Center 2016)
Research
- Development of the Chilean Front-of-package Food Warning Label (BMC Public Health 2019)
- Responses to the Chilean Law of Food Labeling and Advertising: Exploring Knowledge, Perceptions and Behaviors of Mothers of Young Children (International Journal of Behavioral Nutrition and Physical Activity 2019)
- Structural Responses to the Obesity and Non‐communicable Diseases Epidemic: Update on the Chilean Law of Food Labelling and Advertising (Obesity Reviews 2018)
Ecuador
- The Ecuador Ministry of Health implemented the nutritional traffic light label in 2014, requiring all packaged foods to have a front-of-package label alerting customers to levels of sugar, salt, and fat.
In the News
Research
- The Effect of ‘Traffic-Light’ Nutritional Labelling in Carbonated Soft Drink Purchases in Ecuador (PLOS One 2019)
- Use, Knowledge, and Effectiveness of Nutritional Traffic Light Label in an Urban Population from Ecuador: A Pilot Study (Globalization and Health 2019)
- Awareness, Comprehension, and Use of Newly-Mandated Nutrition Labels Among Mestiza and Indigenous Ecuadorian Women in the Central Andes Region of Ecuador (Food and Nutrition Bulletin 2016)
- A Qualitative Study of Consumer Perceptions and Use of Traffic Light Food Labelling in Ecuador (Public Health Nutrition 2016)
France
- In 2017, the French government recommended use of the Nutri-Score front-of-package labeling system for prepackaged food sold in grocery stores.
- Similar to the traffic-light labeling system found in the United Kingdom, the Nutri-Score label uses colors ranging from green to red to signify the healthiness of a product. These colors correspond to a rating, A → E (A being the best, E being the worst)
- The label is also called the 5-Colour Nutrition Label or 5-CNL.
- The governments of Germany, Belgium, the Netherlands, Luxembourg, and Spain have since followed France’s lead and recommended use of the label.
- Italy opposes the use of Nutri-Score labeling.,
Resource Websites
- Nutri-Score – Santé Publique France
- Le dispositif Nutri-Score – Infographie pédagogique
- Video is in French: Click settings on bottom of video → Subtitles/CC → Auto-translate → Choose language to translate to (English)
- Nutri-Score: Nutrition Labeling System presentation from the European Commission
In the News
- Kellogg Introduces Nutri-Score in France (Food Navigator 2020)
- NutriScore, a Front-of-Pack Labeling System, Implemented in France (Hunter College NYC Food Policy Center 2018)
- Nutri-Score Labelling Comes into Force in France (Food Navigator 2017)
- France Becomes One of the First Countries in Region to Recommend Colour-coded Front-of-pack Nutrition Labelling System (World Health Organization 2017)
- 5-C NutriScore to be France’s Official Nutrition Label (Food Navigator 2017)
Research
- A Randomized Controlled Trial Evaluating the Relative Effectiveness of the Multiple Traffic Light and Nutri-Score Front of Package Nutrition Labels (Nutrients 2019)
- Association of the Dietary Index Underpinning the Nutri-Score Label with Oral Health: Preliminary Evidence from a Large, Population-Based Sample (Nutrients 2019)
- The Policy Dystopia Model Adapted to the Food Industry: The Example of the Nutri-Score Saga in France (World Nutrition 2018)
- Front-of-pack Nutri-Score Labelling in France: An Evidence-based Policy (Lancet Public Health 2018)
- Development of a New Front-of-pack Nutrition Label in France: the Five-colour Nutri-Score (Public Health Panorama 2017)
- Nutri-Score: Evidence of the Effectiveness of the French Front-of-pack Nutrition Label (Ernaehrungs Umschau International 2017)
Mexico
- In late January 2020, Mexico passed an amendment to the General Labeling Specifications for Prepackaged Foods and Non-Alcoholic Beverages–Commercial and Health Information to add front-of-package warning labels to high-sugar foods.
- This legislation was directly inspired by a similar law in Chile.
- The labels are a black octagonal stop sign, with one or more of the following statements:
- “Excess Calories”
- “Excess Sugars”
- “Excess Saturated Fats”
- “Contains Caffeine – Avoid in Children”
- “Contains Sweeteners – Avoid in Children.”
- The labeling requirements took effect in late 2020, amid the COVID-19 pandemic, and led to pushback from the United States, Canada, Switzerland and the European Union.
Resource Websites
- USDA Report – Mexico Front of Pack Labeling Warning Signs
- Institute for Health Metrics and Evaluation – Mexico
In the News
- New Warning Labels Now Required on Packaged Foods (Mexico News Daily 2020)
- Mexico’s new warning labels on junk food meet supersized opposition from U.S., EU (Reuters, 2020)
- INSP Mexico: Food Warning Labels in Mexico- A Public Health Achievement (Association of Schools & Programs of Public Health 2020)
- Mexico Anti-obesity Activists Win Fight for Food Warnings (Associated Press 2020)
- Publication in the Federal Official Gazette of the Draft Amendment to the Mexican Official Standard 051 Concerning Labeling Requirements for Prepackaged Foods and Non-alcoholic Beverages (Hogan Lovells 2019)
- Mexico to Require Nutritional Warnings on Front-of-Package Labeling (Hunter College NYC Food Policy Center 2019)
Research
- Mexico Adopts Food Warning Labels, Why Now? (Health Systems & Reform 2020)
- Predicting Obesity Reduction after Implementing Warning Labels in Mexico: A Modeling Study (PLOS Medicine 2020)
United Kingdom
- In 2013, The UK began voluntary use of traffic-light nutrition labeling on packaged food sold in grocery stores. The labels are colored red (high), orange (medium), or green (low), like a traffic light.
- The labels include information about total fat, saturated fat, salt, and sugar, including total amount per serving and percentage of the recommended daily intake.
- The labels are not currently mandatory, so about one third of products on shelves do not have this front-of-package labeling.
Resource Websites
- Guide to creating a front of pack (FoP) nutrition label for pre-packed products sold through retail outlets
- Guide to Traffic Light Labelling – University of Aberdeen
- Front of pack nutritional labelling – Food Standards Scotland
- Front of pack labelling – NIDirect
In the News
- Teenagers Campaign for ‘Traffic Light’ Labels on Food Packaging (The Guardian 2020)
- Call for Mandatory Traffic Light Food Labels (The Times 2018)
- What are Traffic Light Food Labels and is it Compulsory to Put them on Food Packaging in the UK? (The Sun 2018)
- Food Packaging ‘Traffic Lights’ to Signal Healthy Choices on Salt, Fat and Sugar (The Guardian 2013)
- Consistent Food Labelling System is Rolled Out Across UK (BMJ 2013)
Research
- Building on the Success of Front-of-pack Nutrition Labelling in the UK: a Public Consultation (2020)
- A Randomized Controlled Trial Evaluating the Relative Effectiveness of the Multiple Traffic Light and Nutri-Score Front of Package Nutrition Labels (Nutrients 2019)
- UK Consumer Perceptions of a Novel Till-receipt ‘Traffic-light’ Nutrition System (Health Promotion International 2018)
- Reds are More Important than Greens: How UK Supermarket Shoppers Use the Different Information on a Traffic Light Nutrition Label in a Choice Experiment (International Journal of Behavioral Nutrition and Physical Activity 2015)
- The European Commission Considers the UK Traffic Light Nutrition-Labelling Scheme as Voluntary Nutritional Information and Not a ‘Non-Beneficial’ Nutrition Claim (European Journal of Risk Regulation 2014)
- Adoption of Voluntary Front of Package Nutrition Schemes in UK Food Innovations (British Food Journal 2010)
- The Acceptability to Stakeholders of Mandatory Nutritional Labelling in France and the UK – Findings from the PorGrow Project (Journal of Human Nutrition and Dietetics 2010)
- Impact of Front-of-pack ‘Traffic-light’ Nutrition Labelling on Consumer Food Purchases in the UK (Health Promotion International 2009)
- Comprehension and Use of UK Nutrition Signpost Labelling Schemes (2009)
