Toward more comprehensive food labeling.

n engl j med 371;3 nejm.org july 17, 2014 193 urgently needed, and likely to make an important contribution to consumer behavior. But I believe they don’t go far enough — additional labeling requirements can do more to influence food choices, reduce obesity, and promote health. More than two decades ago, during my tenure as FDA commissioner, our team had the opportunity to design the nowiconic Nutrition Facts label, which was mandated by Congress in the Nutrition Labeling and Education Act of 1990.1 The law gave the FDA the authority to require food manufacturers to list the amounts of fat, cholesterol, sodium, carbohydrate, and protein contained in their products and to place those amounts in the context of a typical daily diet (by means of the “% Daily Value”), on the basis of realistic serving sizes. The agency was also required to develop standards for health claims such as “lite” and “low sodium.” We understood then that reducing the incidence of dietrelated disease and associated mortality was one of the most significant contributions we could make to public health. Our goal was not to dictate behavior, but to give people accurate, easy-to-read information that encouraged them to make healthier food choices. Nothing in the legislation specified what the label should look like, but we knew that it had to employ the science of graphic design to nudge behavior. In the lingo of marketers, it had to “pop.” That was not an easy task, considering that we needed to present standardized information on many thousands of products, from candy bars to cereal boxes to frozen dinners. And we had to reach busy shoppers facing aisles and aisles of choice (a grocery store carries, on average, almost 43,000 items, according to the Food Marketing Institute2). We eventually developed a label of such clarity that it won the Presidential Award for Design Excellence in 1997. The design is specified in great detail, from typeface and size to color (often stark black and white) to the width of the lines used to separate information. A majority of consumers have said that they use the label when they shop.3 The FDA’s proposed updates to the Nutrition Facts label represent the first significant revision since its launch and provide a critical opportunity to influence the course of the obesity epidemic.4 Over the past decade, we have learned a great deal about Toward More Comprehensive Food Labeling