Abstract
Background: To help consumers make healthier choices, the US Food and Drug Administration (FDA) has been charged with developing a front-of-package label (FOPL) to appear on US packaged foods and beverages. One option being explored is the use of "high-in" FOPLs for added sugar, sodium, and saturated fat using a threshold of ≥20% of the recommended daily value (%DV) per portion/serving size to define "high-in". While research has addressed what FOPL designs are most effective at visually communicating "high-in", less attention has been paid to the nutrient profile model (NPM) used to decide which products should receive these labels. In addition, several established regional NPMs already exist that identify products that are high in nutrients of concern, but it is unclear how these compare to the FDA's %DV approach. Methods: We used a dataset of 51,809 US products from Mintel's Global New Products Database to examine how the FDA's current definition of "high-in" compares to three established regional NPMs: the Canadian NPM, the Pan American Health Organization (PAHO) NPM, and Chile's NPM. Results: Overall agreement between the four NPMs was 51% for foods and 72% for beverages, with highest agreement in categories such as sweetened sodas (87%), and lowest agreement in categories such as bread (14%) and salty snacks (29%). The Canadian NPM showed the highest agreement to the FDA "high-in" criteria while the Chilean and PAHO models had lower agreement. For many food categories, the FDA's definition of "high-in" would require the fewest products to carry a "high-in" label. This issue was particularly pronounced in categories that tend to be served in small portions (e.g., salty snacks, bars), but disappeared or reversed for categories that are served in larger portions (e.g., frozen and non-frozen main dishes). Conclusions: The NPM chosen has important policy implications for an FOPL system's ability to identify unhealthy foods and incentivize companies to reformulate products. Based on these results, the FDA should consider using a stronger NPM similar to those used elsewhere in the Americas region when deciding the final thresholds for "high-in" for US packaged foods and beverages.