The Institute of Medicine (IOM) has released the first phase of its report on front-ofpackage (FOP) rating systems and symbols for food products and recommends that the nutrients of greatest concern to consumers—calories, saturated fats, trans fat, and sodium—as well as serving size, should be highlighted, with calorie-count and serving-size information displayed prominently. According to IOM, “The inclusion of total calories is one way to emphasize the importance of calories in the diet and may help consumers identify lower calorie foods and track the number of calories consumed, . . . [while] serving size information may help consumers better visualize realistic serving sizes and put that portion into context with the other foods and beverages they are consuming.”

Sponsored by the Centers for Disease Control and Prevention and the Food and Drug Administration (FDA), the report, titled “Examination of Front-of-Package Nutrition Rating Systems and Symbols: Phase 1 Report,” examines and compares 20 different FOP nutrition rating systems. Among the FOP systems reviewed were programs developed by food companies such as General Mills, PepsiCo and Kellogg; the governments of Australia, Great Britain, and Sweden; and the American Heart Association. Phase 2, expected to conclude in 2011, will assess consumers’ use and understanding of FOP symbols and determine which rating systems best promote public health.

The principles guiding the report’s approach included the following: (i) “A wellbalanced, high-quality diet consistent with the Dietary Guidelines for Americans is essential for the health of Americans, and front-of-package labeling is one tool among many geared toward helping Americans make healthful choices”; (ii) “Frontof- package systems will focus on nutrients or food components that are most strongly associated with diet-related health risks affecting the greatest number of Americans”; (iii) “The information highlighted in front-of-package systems will be consistent with the Nutrition Facts panel”; and (iv) “Front-of-package systems will apply to as many foods as possible.”

According to the report, the authors’ deliberations were also informed by these findings: (i) “Obesity, cardiovascular disease, type 2 diabetes, and certain types of cancers are the health risks affecting the greatest number of Americans that are also most strongly associated with diet”; and (ii) “Americans consume too many calories, saturated fats, trans fat, and added sugars; too much sodium; and too little Vitamin D, calcium, potassium, and fiber.”

The Center for Science in the Public Interest (CSPI) criticized the report for not advocating disclosures about the amount of added sugars. CSPI Executive Director Michael Jacobson was quoted as saying, “Unfortunately, without disclosing the amount of added sugars, a soft drink with that labeling would look pretty good because it has no fat and virtually no sodium.” Jacobson also maintained that FDA should just ban trans fat altogether instead of highlighting it on FOP labels. He appeared to endorse a red-yellow-green color coding system, but noted that industry was unlikely to support such symbols. “Companies don’t want their less healthful products clearly labeled as such, but that’s the kind of system that would most benefit consumers,” he said.

Meanwhile, food nutrition professor Marion Nestle responded to the report by commenting that the IOM “did a terrific analysis of current FOP schemes,” noting how confusing they can be to consumers because different programs result in different ratings for similar products. She opined that trans fat information seems unnecessary since it has been removed from most packaged food, but thought IOM erred by rejecting the idea that information about added sugars would be useful. According to the report, the addition of sugars to food products is best reflected in a rating system that highlights calories per serving. See CSPI Press Release, News from the National Academies, and Food Politics, October 13, 2010.