Health warning labels on sugary drinks

Results of a survey of more than 2300 parents of children aged from 6 to 11 years suggest that warning labels on sugar sweetened beverages (SSBs) may be an important way to educate parents about the health risks of SSBs and to encourage parents to purchase fewer of them.

The first of a series of tasks in the online survey required parents to choose a beverage for their child from a portrayed vending machine selection of 20 beverages with a wide range of added sugar content. For the 9 beverages that met State of California criteria for a sugar-warning label (legislation has been introduced in the state to require SSBs to display health warning labels), several types of labels were used. One group of parents was provided with the proposed California label: “Safety warning: Drinking beverages with added sugar[s] contributes to obesity, diabetes, and tooth decay.” Three other participant groups were provided with 1 of 3 variations of the California label, each of which emphasized 1 particular risk of SSBs, namely, their contribution to weight gain, preventable disease, or type 2 diabetes. A fifth group saw on their screens labels showing caloric content, and the control group chose from beverages with neither a caloric content nor a warning label.

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Next, participants answered questions about some of beverages used in the vending machine task to determine their perceptions about the drinks for their child (delicious? healthy? energizing?), willingness to pay for the beverage, and support for a warning label policy. Finally, participants viewed the same 20 beverages they saw in the vending machine task and indicated all beverages they would buy for their child for which they would like to receive a coupon.

A comparison of intended beverage purchases in the no-warning-label group, calorie-label group, and the 4 warning-label groups combined showed that compared with parents in the no-label groups, significantly fewer parents in the warning-label groups would choose an SSB for their child-40% in the warning-label groups versus 60% in the no-warning-label group. (However, calorie labels did not have a significant effect vis-à-vis having no warning label.) Finally, compared with those in the no-warning-label group, parents in the warning-label groups also chose significantly fewer SSB coupons; believed that SSBs were less healthy for their child; and indicated they were less likely to intend to purchase SSBs. Investigators found no consistent differences in reactions to different versions of the warning labels (Roberto CA, et al. Pediatrics. 2016;137[2]:e20153185).

Commentary: Recently, the Baltimore, Maryland, commissioner of health proposed a bill that would require warning labels similar to those in this study for SSBs sold in the city. The local newspaper editors opposed the proposal, in part because of lack of evidence of this approach’s effectiveness. This study provides the evidence. Warning labels on SSBs could help parents choose wisely. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.