Cost-Effectiveness of the US Food and Drug Administration Added Sugar Labeling Policy for Improving Diet and Health

Abstract

Background.-Excess added sugars, particularly from sugar-sweetened beverages, are a major risk factor for cardiometabolic diseases including cardiovascular disease (CVD) and type 2 diabetes. In 2016, FDA mandated the labeling of added sugar content on all packaged foods and beverages. Yet, potential health impacts and cost-effectiveness of this policy remain unclear. Methods.-A validated microsimulation model (IMPACT) was used to estimate CVD and type 2 diabetes cases averted, quality-adjusted life-years (QALYs), policy costs, healthcare, informal care and lost productivity {health-related) savings and cost-effectiveness of two policy scenarios: (1) implementation of the FDA added sugar labeling policy (sugar label), and (2) further accounting for corresponding industry reformulation (sugar label+reformulation). The model utilized nationally representative demographic and disease data from CDC Wonder Database, dietary intake from NHANES, policy effects and diet-disease effects from meta-analyses, policy and health-related costs from established sources. Probabilistic sensitivity analysis accounted for model parameter uncertainties and population heterogeneity.

Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages and Risk of Cardiovascular Disease: A Meta-Analysis and Systematic Review

“…These results emphasize SSBs as an important modifiable risk factor associated with adverse cardiometabolic health. As such, several population-based strategies have been proposed to target SSBs, including taxation ( 68 ) and health warning labels ( 69 ) among others, which have been further assessed and showed significant health gains and societal cost savings ( 70 ). This evidence has provided further support for recommendations to limit intake of SSBs.…”

Cost-effectiveness Analysis of Nutrition Facts Added-Sugar Labeling and Obesity-Associated Cancer Rates in the US

“…The association with consumer behavior was obtained from a meta-analysis of food labeling interventions that reported a 6.6% (95% CI, 4.4%-8.8%) reduction in calories from menu calorie labeling. 7 , 29 We assumed that the policy would result in a 1-time reduction in added sugar consumption during the first year of policy implementation, with no further increases or decreases thereafter. We further assumed no policy association with cancer risk within the first 5 years of implementation.…”

Strengthening national nutrition research: rationale and options for a new coordinated federal research effort and authority

“…Examples include the determination that partially hydrogenated oils (high in industrial trans fat) were no longer Generally Recognized As Safe (GRAS), for which NIH- and USDA-funded research, CDC surveillance data, and HHS regulatory reviews supported the FDA determination ( 206 ); and FDA's amendment of the food additive regulations to change the standard of identity of enriched flour and corn masa flour ( 207 ) to allow folic acid fortification to help prevent neural tube defects in developing infants, which required similar inputs from diverse federal research, surveillance, and regulatory efforts. Another example is the 2016 Nutrition Facts updates (e.g., requiring labeling of added sugar) based on new scientific research, updated DGAs, consensus reports, and national survey data, along with input obtained through proposed rulemaking processes ( 208 , 209 ).…”