Food Policy 28 (2003) 213–219www.elsevier.com/locate/foodpol

The relationship between the use of sugarcontent information on nutrition labels and the

consumption of added sugars

D. Weaver, M. Finke∗

Department of Consumer and Family Economics, University of Missouri, 239 Stanley Hall, Columbia,MO 65211, USA

Accepted 24 February 2003

Abstract

Increased consumption of added sugars in the US diet has led to calls for renewed publicnutrition efforts including more detailed nutrition labels. This study models the effectivenessof the current nutrition label as a means of reducing the proportion of calories from addedsugars in diets among respondents to the 1994–96 Continuing Survey of Food Intakes byIndividuals. Results show a significant relationship between frequent use of sugar informationon the label and reduced added sugar density, suggesting that labeling is effective as a meansof assisting consumers to moderate sugar consumption. However, as it is not possible to dis-count that individuals who wish to moderate or limit their intake are more likely to read labels,the study cannot show whether or not reducing intakes of products likely to contain addedsugars precedes reliance on food labels for that purpose. 2003 Elsevier Science Ltd. All rights reserved.

Keywords: Labelling; Consumption; Sugar; US

Introduction

In accordance with USDA recommendations, Americans are now consuming lesstotal fat and cholesterol than they were 20 years ago. This is evidence that Americansare aware of dietary risks and are taking the initiative to improve their health. At

∗ Corresponding author. Tel.:+1-573-882-9343; fax:+1-573-884-8381.E-mail address: finkem@missouri.edu (M. Finke).

0306-9192/03/$ - see front matter 2003 Elsevier Science Ltd. All rights reserved.doi:10.1016/S0306-9192(03)00028-9

214 D. Weaver, M. Finke / Food Policy 28 (2003) 213–219

the same time, sugar has become an increasingly larger component of the Americandiet (Putnam and Allshouse, 2000). This trend appears counter-intuitive and suggeststhat individuals are not as health savvy as they seem. A portion of the increase insugar consumption is due to increased consumption of grain-based goods and fruitsas suggested. Individuals are also consuming larger amounts of sugar sweetenedgoods and beverages. For example, between 1977 and 1996 soft drink consumptionincreased 130% (Tippett and Cleveland, 2000). Moreover, the use of nutritive sweet-eners in processed foods, such as high fructose corn syrup, has also greatly increasedand is now widely used in a variety of food products (Putnam and Allshouse, 2000).

Per capita data from the food supply show added sugar consumption by Americansincreased 28% between 1982 and 1997 (Bowman, 1999). Consumers have now beenadvised to “choose beverages and foods to moderate their intake of sugars” (Krebs-Smith, 2001). The current nutrition label includes information regarding the totalcarbohydrate content of the product and then breaks it down into more specific categ-ories such as fiber and sugar. For any food for which sugar is not present in insignifi-cant amounts, the nutrition label clearly identifies the number of grams of total sugarsin the food. Health and consumer groups have petitioned for the implementation ofnew nutrition labels that would clearly identify the amount of added sugar in foods(CSPI, 1999). Nutrition knowledge and availability of information can affect currentand future dietary choices. Information policy may have played a role in the shiftaway from cholesterol rich foods in recent decades, and may also help reverse a trendtoward increased added sugar consumption. Recent interest in promoting labeling ofadded sugars on foods warrants an evaluation of the impact use of the current labelhas on total added sugar consumption.

Literature review

According to the 1994–96 Continuing Survey of Food Intakes by Individuals(CSFII), Americans are now eating roughly 20 teaspoons of added sugars a day(Consumer Reports on Health, 1999). To avoid excessive calories from sugar, theUSDA suggests limiting added sugar consumption to an average of about ten tea-spoons a day for an individual needing 2000 calories a day (USDA, 1996). Researchevaluating the possible dietary and health risks associated with excessive sugar con-sumption has yielded inconsistent results. In the past, it has been recommended thatconsumers moderate their consumption of sweets in order to minimize the develop-ment of dental caries (Lewis et al., 1992). New health concerns associated with highintakes of sugar include excessive energy consumption and decreased diet quality.Lewis et al. (1992) found that increased consumption of added sugar is associatedwith an increase in total energy consumption. An observational study of sixth andseventh grade Boston school children showed evidence of a relationship betweensugar sweetened drink consumption and increased Body Mass Index and frequencyof obesity (Ludwig et al., 2001). Sugar sweetened foods can also crowd out morenutritious foods from an individual’s diet. Reynolds and Finke (2002) found thatindividuals who consumed larger amounts of soft drinks were less likely to meet

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the RDA of several essential vitamins and minerals, especially vitamin A, calcium,and folate. Moreover, diets high in added sugar are lower in fruits, vegetables, andmeat than diets low in added sugar, resulting in lower levels of micronutrient con-sumption (Bowman, 1999).

However, not all consumers are eating the same amount of sugar. Research hasbeen conducted to identify the type of consumer more likely to consume excessiveamounts of added sugar, and therefore to have a greater risk of developing healthproblems. Krebs-Smith (2001) notes that the total mean intake of added sugars ishigher for males than it is for females. Consumption also tends to increase with agethroughout the teen years and then slowly declines. The same study found thatAfrican-American non-Hispanics have the highest level of consumption. Income,education level, and region also affect added sugar consumption. A study conductedby Bowman (1999) had similar findings. This research does not explain why someconsumers are more likely to consume large amounts of sugar. Though more empha-sis has been placed on the importance of limiting total fat intake, consumers havebeen aware for some time of the need to monitor their sugar intake. A survey conduc-ted by Jones and Weimer (1981) found that of the families interviewed who madechanges in their diets due to health concerns, half of them talked about reducingtheir sugar intake. Such concern was expressed more often in larger households withhigher incomes.

The new nutrition label on food packages, implemented in 1994, provides moredetailed information on carbohydrates that may allow consumers to moderate theiradded sugar intake. Guthrie et al. (1995) found that 71% of main meal planners didreport using the nutrition labels at least “sometimes.” The same study found thatwomen were more likely than men to read nutrition labels. Education, previousnutrition knowledge, and concerns over food safety were all positively related tolabel use. Studies have also been done to evaluate the positive effect of label useon consumers’ diets. The same study by Guthrie et al. (1995) showed that mealplanners who used food labels had diets lower in cholesterol and higher in VitaminC. Several studies have demonstrated a link between the use of food labels and adiet lower in total fat intake. Kim et al. (2000), in comparing the difference in nutrientintakes of consumers when they did and did not use food labels, discovered thatusing food labels decreased the consumer’s percentage of total calories received fromfat and saturated fat. A similar study that focused on the effect of the new nutritionlabel established in 1994 found that in 1995 individuals who used the food labelmost often were about 32% more likely to eat a diet low in fat than individuals whosaid they only sometimes used the label (Finke, 2000). A study of Washington Stateresidents also found that, even when controlling for other influential variables, therewas a significant relationship between label use and decreased fat intake (Neuhouseret al., 1999).

Previous research has not evaluated the direct effect of nutrition label use on sugarconsumption. Some studies have shown that consumers on special diets are morelikely to use nutrition labels to monitor their nutrient intake, including sugar. Asurvey of individuals from Missouri showed that consumers with high-blood pressureand high cholesterol were more likely to use the labels to identify the amount of

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fat, sodium, and cholesterol in their food (Kreuter et al., 1997). A comparable studyconducted in New Jersey found that diabetics used nutrition labels more than otherconsumers, and used it most often to check for added sugar content (Kessler andWunderlich, 1999). This study focuses on the use of food package nutrition labelsin order to understand the impact label use has on the consumption of added sugars.

Data and methods

Data for this study were collected as part of the 1994–96 Continuing Survey ofFood Intakes by Individuals (CSFII) and the Diet and Health Knowledge Survey(DHKS) conducted by the United States Department of Agriculture. The CSFII is anationally representative sample of individuals of all ages living in the United States.Information regarding food and nutrient intakes of each respondent was gatheredover two nonconsecutive days of dietary recalls. Daily intakes are also expressed interms of servings per Pyramid food group, including subgroups such as fat and addedsugar. Individuals 20 years of age and older also completed the DHKS which con-tains information regarding the dietary health knowledge and attitudes for each indi-vidual. Included are questions regarding the knowledge of specific health risks asso-ciated with foods, personal health information, and frequency of use of food labelinformation. This study examines a sample of 5765 respondents 20 years of age andolder who completed both the CSFII and the DHKS.

This study models total consumption of added sugar. According to the CSFII,added sugars are sugars added to foods during processing, preparation, and at thetable, such as white sugar, corn syrup, brown sugar, molasses, honey, etc. It doesnot include naturally occurring sugars found in foods such as lactose and fructose.The respondent’s consumption of these added sugars was originally measured inteaspoons. As a dependent variable in this model, added sugar consumption is meas-ured as a percentage of food density. The variable is calculated by dividing caloriesfrom added sugars by the amount of total calories consumed. This measure is usedso that individuals with different caloric needs and intakes can be more accuratelycompared. The results indicate which individuals are receiving a larger proportionof their daily energy intake from sugar.

In the DHKS, respondents were asked to identify how often they use nutritionlabels for sugar content information. For this model, the variable is coded into twocategories. Those who claim always to use the nutrition label for sugar informationare compared to all other respondents. Use of the nutrition panel for any food contentinformation is also included. If general nutrition panel use proxies a desire to con-sume a healthier diet, individuals who use nutrition labels may, in general, eat lessadded sugar than those who do not independent of whether they pay attention tosugar content information on the food label. This model also controls for severaldemographic variables. Age is measured as a continuous variable, as is income.Income is measured as a percentage above the poverty level. A measure of 300 isequal to 300% above or more. This measure of income is a more appropriate indi-cator of wellbeing as it incorporates certain factors such as household size and

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inflation between sample years. Four categories for education are used, high schoolnot completed, high school graduate, some college, and college graduate. Race iscoded into four categories, White/European American, African American,Asian/Pacific Islander, and Other. Region is also divided into four categories,Northwest, West, Midwest, and South. Urbanization is recoded into three categoriesbased on MSA status, city, suburb, and rural. Gender is included as well. Othervariables related to variation in sugar consumption included in the model are whetheror not a respondent has ever been informed by a physician that they are diabetic,whether or not the respondent is currently on a low calorie/weight reduction diet,and whether or not the respondent feels it is important to limit the consumption ofadded sugars.

An Ordinary Least Squares regression was preformed between the dependent vari-able percentage of energy from added sugars and the independent variables use ofnutrition label for sugar information, use of nutrition label in general, age, education,gender, race, region, urbanization, diabetic, low-calorie diet, and importance. Theregression and frequency analysis was performed using the SAS program.

Results and conclusions

The relationship between explanatory variables and the proportion of food energyfrom added sugar is given in Table 1. Variables that have a positive effect will thusbe associated with an increased proportion of added sugar in the respondents’ diet.The results show that regular use of sugar information on nutrition panels is associa-ted with a significantly lower density of added sugar. A coefficient of 0.0111 suggeststhat individuals who always use labels for sugar information on average consume1.1% less of their total energy from added sugars compared to all other individuals.The coefficient is significant at the 0.05 level. The average proportion of food energyfrom added sugars for the entire sample was 13.2%. General use of the nutritionlabel was not shown to significantly impact the consumption of added sugar.

Demographic variables significantly related to the density of added sugar in dietsinclude education, region, gender, income, and age. Males obtain less of their energyfrom added sugars than women. Individuals living in the South, Midwest, and Westare all more likely to receive more of their total energy from added sugars thanindividuals living in the Northeast. Income is negatively associated with added sugarconsumption, as is age. African Americans receive a greater amount of energy fromadded sugars than white/European Americans, and Asian Americans are less likelyto receive their food energy from added sugars. Education at a college degree level(16 years or more) is associated with a significantly lower proportion of caloriesfrom added sugar. Diabetics, those on a low calorie diet, and those who believe itis important to moderate sugar consumption all consume a diet lower in added sugars.All of these findings are consistent with results from previous research.

Just under a third (32.6%) of respondents always use sugar information onnutrition panels. Independent of age, education, or income, label use for sugar contentinformation has a significant impact on the proportion of food energy obtained from

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Table 1Regression of calories from sugar as a proportion of total food energy

Variable Coefficient

Intercept 0.2033∗∗∗∗

Region (Northeast omitted)South 0.0161∗∗∗∗

Midwest 0.0172∗∗∗∗

West 0.0118∗∗∗

Urbanization (Rural omitted)City –0.0019Suburb –0.00002

Gender (Female omitted)Male –0.0087∗∗∗∗

IncomePercentage of poverty level –0.00003∗∗

Age –0.00202∗∗∗∗

Age squared 0.000012∗∗∗

Race (white/European Americans omitted)African American 0.0112∗∗

Asian/Pacific Islander –0.0534∗∗∗∗

Other –0.0011Education (College graduate omitted)

Less than high school 0.0093∗∗

High school graduate 0.0148∗∗∗∗

Some college 0.0138∗∗∗∗

Low calorie diet (if yes = 1, otherwise = 0) –0.0083∗

Informed diabetic (if yes = 1, otherwise = 0) –0.0347∗∗∗∗

Importance of moderation (if yes = 1, otherwise = 0) –0.0117∗∗∗∗

Label use (if often = 1, otherwise = 0) –0.0047Label use for sugar (if often = 1, otherwise = 0) –0.0111∗∗

∗p � 0.05; ∗∗p � 0.01; ∗∗∗p � 0.001; ∗∗∗∗p � 0.0001.

added sugars. This suggests that the current nutrition label does allow consumers tomoderate their consumption of added sugars. Clearly, the label serves as a usefultool to reduce added sugar consumption when used for sugar information.

Achieving the large scale reduction in added sugar consumption needed to reachrecommended levels must involve both detailed and easily understood added sugarcontent labels and an increase in motivation to reduce overall sugar consumption. Itshould be noted, however, that the effectiveness of the nutrition label on consumers’diets is limited by the absence of such a label on food away from home and certainunprocessed foods. However, individuals who regularly use the nutrition labels toassess added sugar content in a supermarket are likely better able to assess the addedsugar content of unlabeled meals in a restaurant.

There is evidence that stigmatization of a food or food ingredient is more effectivethan recommendations of moderation (Levy, 1985). Increased awareness of the addedsugar content of foods may also spur producers to reduce the added sugar contentof processed foods in response to reduced demand, or to offer reduced sugar variants

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of high-sugar foods. A better understanding of the relationships between sugar con-sumption and disease may increase the proportion of consumers using labels toreduce added sugar intake, and these results confirm that labels enable choice offoods lower in added sugars.

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