Challenging Dogma

...Using social sciences to improve the practice of public health

Sunday, April 29, 2007

New Food Labels and Calorie Count are Ineffective: The FDA Needs to Change Its Strategies on Obesity Prevention - Alex Hsi

The increasing prevalence of obesity has been regarded as a major pandemic in developed and developing countries (1). United States has the highest rates of obesity in the developed countries. From 1980 to 2002, obesity has doubled in adults and overweight prevalence has tripled in children and adolescents. From 2003-2004, "children and adolescents aged 2 to 19 years, 17.1% were overweight...and 32.2% of adults aged 20 years or older were obese”(2). The fast increasing population of obesity and overweight become a major social issue in the United State. In order to reduce the prevalence of obesity, policies and campaigns are created by local and federal agencies. The FDA (The Food and Drug Administation) released, on March 12, 2004, the final report of its Obesity Working Group. In this report, the FDA proposed that the way to control weight was through keeping calorie balance. The calorie in must be equal to calorie out. The FDA enhanced food labeling to display calorie information more prominently and used meaningful serving sizes. Also, FDA asked food providers, which included food industries and restaurants, to provide the nutritional information to consumers (3). FDA believed people would use the nutritional information provided by food labels to choose better food and keep the calorie balance.

However, food labels never worked as well as FDA believed. Before the FDA’s report released in 2004, the Nutrition Labeling and Education Act (NELA), which took effect in 1994, has been enacted for more than a decade (4). Under NLEA, food labeling was mandatory for most processed foods. It required manufacturers of packaged foods to display the Nutrition Facts panel to list the key nutrients and serving sizes (5). In the other word, the FDA’s campaign on “Calorie Count” was actually based entirely on an old policy. The main problem of the labeling policy was that it did not reduce the increasing percentage of obesity. Although many people declared that food labels helped them in choosing healthy food and several researches found statistical correlations between label uses and dietary intake (6), the increases of obesity in the past decade was accelerating. Data from the National Health Interview Survey (NHIS) suggested that adult obesity has increased continuously since the NLEA enforcement which went up from 18% in 1995 to 23% in 2003 (7). The FDA, in their report, admitted that “Despite reports of a positive correlation between label use and certain positive dietary characteristics, the trend toward obesity has accelerated over the past decades”. Therefore, it became very questionable if the FDA new campaign will stifle the trend of obesity. The campaigns of “Calorie Count” and “Enhanced Food Labels” are just derivatives from their old and ineffective predecessor. The FDA is still using the same logic as it has done decades ago.

What are the reasons that food labels could not work well as the FDA expects. We need to reevaluate calorie count and food labels in socioeconomic perspectives, not just scientific perspective which the FDA uses, to find out why it is not and will not be effective against obesity.

Ineffective Application on Health Belief Model
The first problem of food labels and calorie count is that the FDA believes that consumers’ behavior is determined by an objective logical thought process (8). In health belief model, person’s beliefs on susceptibility to the disease and the availability and the effectiveness of action determine what action they will take (9). Therefore, the FDA assumes that people acknowledge obesity to be a major threat to health and want to prevent it. Researchers of the FDA did lots of scientific analyses and found the calorie balance in human body. Consumers should be educated to keep calorie in and calorie out at equilibrium. Food labels can provide the nutritional information for people to count calories more easily. Once people take actions on keeping calorie balance, the obesity is prevented. In the other word, the FDA is trying to lower barrier of behavior change and increasing the availability and effectiveness of new behavior.

The health belief model has been criticized by many scholars and researchers. It has limited ability to account for variance in behaviors that relate to attitude and belief (10). Its fundamental assumption is that health is highly valued. It also assumes that people behave logically. However, both assumptions are not correct. For example, some individuals choose vegetable over meat because their religious beliefs make them do it. Although they have a healthy dietary, it has nothing to do with health or health belief model. Also, people with obesity may keep on eating high-calorie food because they simply want to enjoy food and not to be restricted. Health belief model fails when individual has low cognition on healthy problem or does not behave logically. Therefore, it is the first reason that food labeling is not effective on preventing obesity. If people do not want to eat healthy, they would discard any information that the labels provide. Even if the FDA makes the label cover the entire package, the customers will not read it. Since food labels can not grab their attention, customers definitely do not participate the calorie count.

Lack the Consideration of Social and Environmental Factors
Since the FDA’s campaign of food labeling and calorie count bases mainly on HBM, it also lacks the consideration on other social and environmental factors which have strong influences on dietary. Those factors can come from advertising, socioeconomic status and peer influence.

1) Advertising
Advertising is one of the strongest stimuli which can change public’s value and behaviors (11, 12). In U.S., 98% of households have televisions and adults spend an average of 2 hours per days watch TV. They are exposed to TV commercials at least 6 min per hours (12). Unfortunately, fast food restaurants has spent 98% of its advertising budgets on TV ads. Therefore, adults in U.S. are highly exposed to fast food commercials. In contrast to the food labels that customers have to read the information on it, TV ads actively send fast food information and stimulation to their receivers. Those commercials could influence the viewer’s choice toward higher-fat or higher-energy food on a level which surpasses the education from the FDA.

2) Socioeconomic Status
Education level and income has been determined to have strong associations with health status (14). Different income and demographic groups have different values and priorities on health behaviors. Food label has been reported to bring benefit to only one demographic group: non-Hispanic white female (7). The influence of labels on other demographic groups was not observed. Also, prize of food has been account for one major factor that influences food consumption (15). Therefore, socioeconomic status can not be ignored in preventing obesity. However, the FDA’s plans did not consider it. Both Food labeling and calorie count work on the individual level. The disregard of social inequalities in health would be an obstacle to the effectiveness of FDA’s campaign.

3) Peer Pressure
Individual has the inclination to adopt certain behavior patterns or attitudes in the social group which he felt obligation. This psycholgical motivation is usally appearant on children and teenagers. Also, teeangers have a inclination to oppose authority from parents and teachers. The FDA’s policy never considered influences from peers which can drive individuls to ignore labels and choose high-calorie food and drink that would be considered cool within the group.

Lack the Stimuli to Force People Change Their Dietary
There are three groups of strategies for effecting changes in human’s behavior: 1) empirical-rational strategies; 2) normative-re-educative strategies; 3) power-coercive strategies (16). Food labels and calorie count are in the first group. The empirical-rational strategies are assumed that men are rational and would follow a logical self-interest if they have the knowledge. So, the FDA provides customers lots of information of calories and other nutrition and beleives that customers would learn from the labels and choose low-calorie diet in order to improve their health. However, this kind of strategies is not enough. Since people are not always rational and motivate logically by self-interest, they may not choose food based on improving health. Strong stimuli are required to force people change their dietary.

The FDA needs to apply its strategies more on normative-re-educative approaches and power-coercive approaches. Normative-re-educative approaches focus on socio-cultural norms and their interactions with individual’s value. Robert Chin and Kenneth Benne stated “Men does not passively await given stimuli from his environment in order to respond. He takes stimuli as furthering or thwarting the goals of his ongoing action”. So, by enforcing normative-re-educative approaches, individuals can be driven by stimuli from socio-cultural norms and environment to change their behavior.

Also, power-coercive approaches could be used. Power-coercive approaches are defined as enforcement from greater power toward less power. FDA, a federal agency, could use strategies involving more on law or administrative policy, like the policies they made on alcohol and drugs, to change people’s behavior.

The new campaign of the FDA in 2004 is a revision of old food-labeling policy. The old food labels did not prevent nor slow the increase of obesity population in U.S. Since 2004, The FDA has started educating on how to choose nutritional food and count calorie in order to balance calorie-in and calorie-out. However, the FDA’s endeavor may not be effective in obesity prevention. It has made the new plans based on Health Belief Model and believes it can stimulate logical behavior change in the dietary of people in United States . However, HBM is criticized to be unrealistic in analyzing human behaviors and lack social and environmental factors. In order to improve health and prevent increasing obese population in U.S., a plan which includes socio-environmental factors and strong stimuli to direct behavior change is required. Food labeling and calorie count are ineffective. FDA has to change its conceptions on public health and made a better policy.

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