Labels versus obesity: Graphic images on soda packaging curb sugar consumption, study finds

02 Feb 2022 --- Deliberately shocking consumers with gruesome images depicting obesity-related wounds, disease and illness could be the key to tackling the obesity crisis, flags one recent study into sugar drink beverage labels.

In a similar move to the tobacco industry, where graphic images have been shown on cigarette packets for several years now, the research examined what could happen if health warnings were also applied to sugary drinks packaging.

Researchers at the University of North Carolina, US, have analyzed the impact of picture health warnings on sugary drinks in a simulated supermarket setting, in an landmark attempt to find solutions to curb childhood obesity. 

“Showing that warnings can cut through the noise of everything else that’s happening in a food store is powerful evidence that they would help reduce sugary drink purchases in the real world,” says senior author Lindsey Smith Taillie, assistant professor in the UNC Gillings Department of Nutrition.

The experiment findings show that exposing parents to actual images of the effects of sugar on the body led to a 17% reduction in purchases of sugary drinks such as juice or soda.

The study took place in a laboratory modeled as a convenience store, “UNC Mini Mart,” where participants could shop. The experiment was conducted by researchers at the Chapel Hill Gillings School of Global Public Health department. 

“We created this store because we saw a major need for research that tests the impact of policies in a food store setting that is much more realistic,” says Taillie.

“When people make choices about what food to buy, they are juggling dozens of factors like taste, cost and advertising and are looking at many products at once.”Sugary drinks are a significant contributor to global obesity.

Slashing sugar-induced obesity
The positive findings documented in “The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial,” PLOS Medicine, about the effects of pictorial warning labels, shed light on a growing approach in the global struggle with obesity.

Children in the US, and many other countries, consume more than the recommended amount of sugary drinks, which increases their risk of obesity and diet-related chronic diseases such as Type 2 diabetes and heart disease.

Significant gaps exist in the research, based on ethnicity, with higher rates of sugary drink consumption and obesity among Black and Latino children compared with White children. These disparities have been attributed to factors such as targeted marketing. Taillie researched warning labels and taxes on sugar-sweetened beverages and junk food in Chile, Mexico and South Africa.

The UK is already set to take concrete action on tackling child obesity, as the issue has become more severe, particularly in light of lockdown lifestyles.

Simulated supermarket analysis
Researcher Marissa Hall believes the paper could be useful for policymakers in the US and globally. “This evidence supports strong front-of-package warnings to reduce children’s sugary drink consumption,” she says.

The experiment saw 325 parents of children aged 2 to 12 years randomly assigned to two different groups and asked to choose a drink and a snack for their child and one household item in the store laboratory. The research sought to discover if health warnings applied to sugary drinks could have similar impacts to the graphic imagery depicted on tobacco products.

The intervention group had pictorial health warnings about heart disease displayed on drinks, while a control group had regular barcode labels.

Participants were instructed to choose one drink and one snack for their child, along with one household good; this shopping list was designed to mask the purpose of the study. After shopping, participants completed a survey about their selections and left with their drink of choice and a cash incentive.

The picture warnings led to 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm.

The picture warnings also reduced calories purchased from sugary drinks and led to parents feeling more in control of healthy eating decisions and thinking more about the harms of sugary drinks.

The benefits of the picture warnings were similar for parents from different ethnic backgrounds and socioeconomic statuses, suggesting that it could be effective across diverse populations. 

More extensive studies are needed to see how well warnings work for the highest risk of diet-related disease groups.

International frozen foods giant Birds Eye stresses that a ramped-up focus on nutrition is an opportunity for food brands. Cutting down on salt, sugar and fat is a crucial part of the company’s analysis, which zeroes in on how government-led strategies are targeting the obesity crisis.

By Inga de Jong