Chobani-AADEPresentation 07.31

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AMERICAN ASSOCIATIONOF DIABETES EDUCATORS

ANNUAL MEETING August 5, 2017

THE CHANGING MARKETPLACEThe Nutrition Facts Label,

Evolving Consumer Values, and Putting Sugars in Context

DR. ROBERT C. POSTSenior Director

Chobani Nutrition Center

CONFIDENTIAL AND PROPRIETARY

DISCLOSURE

Conflict of Interest (COI) and Financial Relationship Disclosures:

Presenter: Employed by Chobani, LLC; Member ‐‐ Foundation for Food and Agriculture Research; International Food Information Council Board of Directors; Society for Nutrition Education and Behavior Foundation Board of Trustees; Editorial Board, Thompson’s Guide to US Food Labeling Law.

No COI/Financial Relationship Disclosures Relative to Presentation

Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity.


OBJECTIVES

Identify the upcoming changes to the Nutrition Facts Label (NFL) for foods and beverages sold to consumers

Describe the evolving consumer demands for values‐based label information that goes beyond the NFL

Identify the challenges and opportunities for diabetes educators in educating around carbohydrates, fibers, and sugars given these new values

State the issues around added sugars and the context for discussing them in a way that aligns with science‐based recommendations from the Dietary Guidelines for Americans

Today we will…

THE NEW NUTRITION FACTS LABEL

The nutrition label is one tool to implement the Dietary Guidelines for Americans. It’s a unique reflection of

the US marketplace consumer values advances in nutrition and health

and public health policy priorities.

Very recent changes were made to the requirements.



In May 2016, FDA updated the format and content of the NFL for the first time in over 20 years.

A new design and content was introduced to:

– Reflect new scientific information, including the link between diet and chronic diseases (e.g., heart disease, obesity)

– Make it easier for consumers to make better, informed food choices

The effective date is not yet determined, but will likely be 2020 or 2021 to comply with other major food labeling updates (e.g., GMO disclosure on food labels).

A Brand New Label is Coming in the Next Few Years

1

2

NEW!

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You’ll See New Serving Sizes, Daily Values, Nutrients, and More

More prominent calorie and serving size + new RACCs for several foods

New added sugars information

Addition of vitamin D and potassium (+ removal of

vitamin A and C)

New % Daily Values (DVs) (+ separate DVs for

products intended for infants, children and pregnant/lactating

women)

New definition for what qualifies as “dietary fiber”


Old Updated/New

Vitamin A 5000 IU 900 mcg RAE

Vitamin C 60 90 mg

Vitamin D 400 IU 20 mcg (800 IU)

Vitamin E 30 IU 15 mg

Vitamin K 80 120 mcg

Riboflavin 1.7 1.3 mg

Niacin 20 16 mg NE

Thiamin 1.5 1.2 mg

Vitamin B6 2 1.7 mg

Folate 400 mcg 400 mcg DFEBiotin 300 30 mcg

Pantothenic acid 1 mg 5 mg

Vitamin B12 6 2.4 mcg

CHANGES IN NUTRIENTS ‐ UPDATED RDI’S


Old Updated/New

Calcium 1000mg 1300 mg

Phosphorus 1000mg 1250 mg

Magnesium 400mg 420 mg

Zinc 15mg 11 mg

Selenium 75mcg 65 mcg

Copper 2mg 0.9 mg

Molybdenum 70mcg 45 mcg

Chromium 120mcg 35 mcg

Chloride 3400mg 2300 mg

Potassium 3500mg 4700 mg

CHANGES IN NUTRIENTS ‐ UPDATED RDI’S


Nutrient DRV (Updated/New)

Total Fat 78 g

Saturated Fat 20 g

Cholesterol 300 mg

Total Carbohydrate 275 g

Sodium 2300 mg

Dietary Fiber 28 g

Protein 50 g

Added Sugars 50 g (New)

CHANGES IN NUTRIENTS ‐ UPDATED DRV’S


SERVING SIZES UPDATED TO REFLECT SERVINGS ACTUALLY CONSUMED TODAY

Serving sizes are the amount of food on whichNutrition Facts and nutrient claims are based.

They do not reflect recommended portions.

They reflect the amounts people are actually eating of that food or beverage today.


UPDATED SERVING SIZES AND NEWLABELING REQUIREMENTSFOR CERTAIN PACKAGE SIZES

• Changes to ~20% of Reference Amounts Customarily Consumed (RACCs) ‐‐ means changes to serving sizes to reflect how people eat and drink today.

• Amended definition of “single‐serve container”: packaged foods typically eaten in one sitting will declare calorie and nutrient information for the entire package, e.g., a 20‐ounce bottle of soda labeled as one serving not multiple servings.

New Serving Sizes ‐ Examples

Carbonated, noncarbonated beverages, water, coffee, tea: 8 fl oz12 fl oz

Milk, fruit juices nectars, and fruit drinks (without alcohol): (New) 8 fl oz

Yogurt: 8 oz 6 oz

Ice cream: 1/2 cup 2/3 cup

Bagels, toaster pastries, muffins (excluding English muffins): 55 g 110 g

Fruits used primarily as ingredients, e.g., avocado: 30 g 50 g

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MULTI‐SERVING PACKAGED FOODS/BEVERAGES

“Dual column” labels for calories and nutrient

information “per serving” and “per package” on certain larger packages likely to be consumed in one or multiple servings, e.g., multi‐pack

muffins; 24‐ounce bottle of soda; or a pint of ice cream.

Intended to Assist Consumer Confusion



Use of the NFL was highest in the 1990’s (65%), but usage has declined since.1

Today, only ~50% of general consumers regularly use the NFL.2

34% use the label “most of the time”

15% use the label “always”

The Revisions Aim to Assist Consumers, But NFL Usage is Declining

1. NPD Group’s National Eating Trends® Service. 2014 Feb.2. FDA CFSAN. 2014 FDA Health and Diet Survey. 2016 May.

WHY THE DECLINE?Consumers are now looking at other values – beyond the NFL – when they’re purchasing.

NEW EVOLVING CONSUMER DEMANDS


Consumers’ Perception of “Healthy” Has Become More Complicated

NEW EVOLVING CONSUMER DEMANDS MOVE BEYOND THE NUTRITION LABEL


They Now See Non-Nutritional Aspects as Determinants of Healthiness

If two products have the same Nutrition Facts panel, which is likely to be healthier?


SOURCE: IFIC Food & Health Survey, 2017 CONFIDENTIAL AND PROPRIETARY


And They Look for Other Labeling Claims to Guide Their Purchases

0% 20% 40% 60%

No added hormones or steroids

Natural

Raised without antibiotics

Pesticide‐free

Non‐GMO

Organic

Locally‐sourced

Sustainably‐sourced

None of the above

Buy foods and beverages because they are advertised on the label as…

Eat at restaurants because they advertised their foods and beverages as…

SOURCE: IFIC Food & Health Survey, 2017

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Health is Important, But So is Safety, Social Impact, Locality, and MoreTop 10 Culinary Trends for 2017

SOURCE: NRA 2017 Culinary Forecast

The Consumer Value Driver Plate

SOURCE: Deloitte Food Value Equation Survey 2015

LIFESTYLE NUTRITIONLIFE‐STAGE NEEDS

JOYENJOYMENTFULFILLMENT

PERSONALIZATION/ CUSTOMIZATION

ACCESSIBILITYVARIETYCHOICE

SUSTAINABILITYENVIRONMENTALSTEWARDSHIP

FOOD WASTEFAIR TRADE



No Artificial Ingredients is Equally Important as Less Sugar & More Whole Grains

SOURCE: FMI U.S. Grocery Shopper Trends, 2017



GMO food is dangerous

Processed foods are unhealthy

Organic food is more nutritious

Non‐caloric sweeteners cause obesity

Only calories from sugars, carbohydrates, and fats are likely to cause weight gain

Processed foods affect our immune systems

And more…

And Nutrition Myths are Common Among Consumers



Their “Nutritious” Choices Don’t Always Align with Experts’ Choices



Yet Health Professionals Are Still Trusted Sources of Nutrition Information




And Consumers Want More Guidance and Information Around Nutrition

SOURCE: FMI U.S. Grocery Shopper Trends, 2017

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The Key is Aligning Science-Based Advice with Consumer Values

“Building trust isn’t just giving consumers more science, more research or more information... it’s about demonstrating that you share their values when it comes to topics they care about most, like safe food, quality nutrition, outstanding animal care and environmental stewardship.”

Center for Food Integrity

BRIDGING THE GAP:

Educating Around Carbohydrates


BRIDGING THE GAP: EDUCATING AROUND CARBOHYDRATES

Carbohydrate DRV has been reduced from 300g to 275g (from 60% to 55% of calories*).

This allows for a new, higher DRV for total fat (now 35% of calories*) 35% represents the upper end of the Acceptable Macronutrient

Distribution Range (AMDR) for fat.

The change aligns with the latest scientific perspective that typesof fat are more important than limiting total fat.

The NFL Features a New Carbohydrate Daily Reference Value (DRV)

*Based on a 2,000 calorie diet

55% of daily calories

TOTAL CARBOHYDRATES

KEY TAKEAWAYThe new DRV doesn’t indicate a need to limit carbohydrates, but rather an opportunity to include more healthy fats in the diet. It should be viewed as a reference amount, not an

intake requirement.



Yet Many Consumers Are Limiting “Bad” Carbs and Are Opting for “Better” Versions

SOURCE: New Nutrition Business 10 Key Trends in Food, Nutrition & Health 2017.

“BAD” CARBS:High sugar

Refined grains(e.g., white flour)

Over‐processed grains

(e.g., cereals)

“GOOD” CARBS:High fiber

Whole grainsAncient grains



Help clients understand what the total carbohydrate value on the NFL means for their diet/food choices (e.g., it is a reference, not a limiting prescription).

Discuss clients’ views of “good” versus “bad” carbs, and dispel myths as needed.

Teach clients how preferred grain/vegetable‐based options can factor into their daily carbohydrate requirements.

Education Tips: Aligning Consumer Needs & Values Around Carbohydrates


GOODvs. BAD

BRIDGING THE GAP:

Educating Around Fiber

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BRIDGING THE GAP: EDUCATING AROUND FIBER

Fiber DRV has increased from 25g to 28g. New value aligns with Institute of Medicine (IOM) findings that

14g fiber/1,000 kcal is associated with the greatest reduction in cardiovascular disease risk.

The dietary fiber value on the NFL can now only include: Intrinsic/intact fiber found in plants

Added fibers that have a proven beneficial effect on human health.*

Fiber Has a Higher DRV and a New Definition

28 g daily*

*Fibers qualifying towards this amount:

• Beta‐glucan soluble fiber• Psyllium husk• Cellulose• Guar gum• Pectin• Locust bean gum• Hydroxypropylmethylcellulose

DIETARY FIBER

KEY TAKEAWAYUsing the new %DV on the NFL helps consumers reach the

ideal 28g of fiber a day, using sources that are truly beneficial to their health.



While Consumers Value Fiber, They Also Need Recognizable Ingredient Lists

SOURCE: 2017 Label Insight Ingredient Confusion Study

TAKEAWAY:Added fibers on the label could confuse consumers because

they do not recognize what these ingredients

are.



Educate clients on the need to aim for 28g of fiber a day for heart health.

Help clients recognize beneficial fibers on the ingredient list to prevent needless avoidance. This includes education around FDA‐recognized fibers:

• Beta‐glucan soluble fiber• Psyllium husk• Cellulose• Guar gum• Pectin• Locust bean gum• Hydroxypropylmethylcellulose

Education Tips: Aligning Consumer Needs & Values Around Fiber


BRIDGING THE GAP:

Educating Around Added Sugars


BRIDGING THE GAP: EDUCATING AROUND ADDED SUGARS

Added sugars are the sugars or syrups added to foods and beverages when they are processed or prepared.

Added Sugars: Defined

EXAMPLES OF ADDED SUGARS:

HoneySugar Maple Syrup Fruit Juice Concentrate

Isolated Lactose

In Preparation

At the Table


PRESERVATION

Prevents spoilage in jams and jellies by attracting water to prevent

microbial growth

↑ shelf life


Sugar has an important and necessary role in food safety and taste:

Added Sugars Provide Essential Functions to Foods & Beverages

PALATABILITY

Rounds out the taste of naturally tart or acidic, nutrient‐dense foods

Examples: fermented dairy, tomato sauce/soup, cranberry juice, etc.

↓ acidity

TENDERIZING

They absorb moisture to create tender cake/bread crumb

↑moisture

LEAVENING

They “feed” yeast, aiding in bread rising

↑ rising

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Naturally‐occurring sugars and added sugars are chemically identical and have the same effect in the body.

But the difference is the form in which they occur: Naturally‐occurring sugars often exist in nutrient‐dense forms (e.g.,

sucrose/fructose in fruit, lactose in milk).

While many foods that are high in added sugars provide extra calories with few or no essential nutrients.

Consuming high amounts of added sugars can thus increase calorie intake and displace essential nutrients. Excess calories add weight.

Why Are Added Sugars a Concern and Not All Sugars?

Naturally‐occurringfructose, sucrose

Naturally‐Occurring Sugars(with high nutrient density)

+ fiber + potassium+ vitamin C

Added granulated

sugar

Added Sugars(with low nutrient density)

Few extra nutrients



Added sugars will now be included as a subset of “total sugars.” This information is provided to assist consumers in selecting

foods that contribute to a more nutrient‐dense diet.

The DRV for added sugars has been set to <10% of calories per day. Rationale for this level is it is difficult to meet nutrient needs

within calorie limits if you consume more than 10% of your total daily calories from added sugars.

Aligns with guidance in the 2015‐2020 Dietary Guidelines for Americans.

The New NFL Will Include Added Sugars Information

<10% daily calories

ADDED SUGARS

KEY TAKEAWAYAdded sugars information should be used by consumers to

identify nutrient‐dense choices.



Consumers Are Limiting Sugars, Mainly for Weight Reasons

2012 2013 2014 2015 2016 2017


Sugars

Carbohydrates

FatsProtein

All sources same

Not sure

11%

65%

Yes, avoid Yes, limit No

76%Yes

Are you trying to limit or avoid sugars in your diet?

What source of calories is the most likely to cause weight gain?



Avoiding foods with added sugars could mean avoiding nutrient‐dense foods such as:

But Limiting One Nutrient/Ingredient Can Mean Avoiding Nutritious Foods

FRUITS/JUCIES

PROVIDES:vitamin C

antioxidants

WHOLE GRAIN CEREALS

PROVIDES:fiber

vitamin EB vitamins

YOGURT

PROVIDES:calciumprotein

potassiumprobiotics



The “SnackWell Effect” Is One Example of These Unintended Consequences

AVOIDED

SELECTEDCASE STUDY

In 1980, the DGA advised people to avoid too much fat.

THE RESULT: Consumers began to fear fat and opted for fat‐free alternatives in place of other options.

THE CONSEQUENCE: Avoiding fat led to avoiding nutritious foods that were high in healthy fats (e.g., nuts, avocados, olive oil). Meanwhile, the “fat‐free” selections weren’t necessarily healthy.



Authorities Agree There is Room for Added Sugars in a Healthy Diet

“Healthy eating patterns can accommodate other nutrient‐dense foods with small amounts of added sugars, such as whole

grain breakfast cereals or fat‐free yogurt, as long as calories from added sugars do not

exceed 10 percent per day.”

“Added sugars can be a part of a healthy dietary pattern. But if consumed in excess, it becomes more difficult to also eat foods with enough dietary fiber and essential

vitamins and minerals and still stay within calorie limits.”

Changes to the Nutrition Facts Label (2016)

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Train clients to look at the total nutrient profile when using the NFL for added sugars information.

Educate clients on how to shift from typical, calorie‐dense options to nutrient‐dense options to keep added sugars in check.

Provide tips for controlling frequency of intake and potions (moderation) to keep weight and calories within desired limits.

Education Tips: Aligning Consumer Needs & Values Around Added Sugars

SOURCE: New Nutrition Business 10 Key Trends in Food, Nutrition & Health 2017. CONFIDENTIAL AND PROPRIETARY


1. Look at the Total Nutrient Profile When Using the NFL

0mcg

0mg

0mg

0mg 0%

0%

0%

0%

0%0g

5g 10%

BETTER CHOICE

LESSERCHOICE

Added sugars within recommendations

Variety of nutrients

x Lower in added sugars, but few nutrients



2. Shift from Typical, Calorie-Dense Options to Nutrient-Dense Choices

LOW NUTIENT‐DENSITY HIGH NUTIENT‐DENSITY

For beverages, opt for Greek Yogurt Drink, water, low‐fat

milk, or 100% juice.

Choose whole grains, and look for options high in fiber.

Current diets are far from ideal.

But making small shifts to more nutrient‐dense choices is an easy way to improve diet quality and keep added sugars in check.



3. Control Frequency of Intake and Portions (Moderation)

DOWNSIZING PORTIONSMODERATION IS KEY

A small amount of sweet foods are allowed within a healthy diet, so long as they fit within calorie limits and don’t replace essential

nutrients.

Downsizing portions and moderating intake can help

make this possible.

MODERATION IS KEY

A small amount of sweet foods are allowed within a healthy diet, so long as they fit within calorie limits and don’t replace essential

nutrients.

Downsizing portions and moderating intake can help

make this possible.

IN CONCLUSION


IN CONCLUSION

The new NFL will go into effect within the next 3‐4 years, and clients need to be prepared for the new information.

Proper context around new carbohydrate, fiber and added sugars values are especially important for diabetes educators.

Finding ways to factor in clients’ values (individual, family) into such nutrition education will help ensure positive change in their habits.

“Good” carbs

Plant‐based

Recognizable Ingredients

High fiber

Less sugar

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QUESTIONS? THANK YOU

DR. ROBERT C. POST

[email protected]

Visit

www.Chobani.com

Chobani Nutrition Centerwww.Chobani.com/nutritioncenter

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Chobani-AADEPresentation 07.31