How labels can reduce the purchases of high-added sugar beverages


In a recent study, sugar warnings and a lack of misleading front-of-package marketing reduced the proportion of caregivers who selected sugar-sweetened beverages for young children.

Sugar warnings on front-of-package (FOP) marketing may reduce the prevalence of high-added sugar drinks parents purchase for young children, while percentage juice labels do not seem to change purchase rates, according to a recent study.

Sugar-sweetened beverages (SSBs) can increase risks of obesity, type 2 diabetes, tooth decay, and other chronic diseases, but they are still consumed by most young children in the United States. Fruit drinks are the most common SSBs consumed by children aged 1 to 8 years, making up 20% of sugar consumed by children aged 1 year and 11% by children aged 2 to 8 years.

Misleading FOP claims and imagery are a possible source of fruit drink consumption. Imagery on these drinks often includes fruit, and nutrient content claims are often provided as well. These claims and imagery are not accurate to the healthiness and juice content of the product.

There is little data on the effects of regulatory options for reducing misleading FOP marketing. Potential solutions include sugar warnings, restricted nutrient content claims or misleading fruit imagery, and FOP percentage juice content disclosures.

To compare the effects of different FOP marketing tactics, nutrient disclosures, and sugar warnings, investigators conducted a randomized clinical trial from May 2021 to July 2021. Participants completed a survey through Qualtrics, discussing their experience with US educational distribution based on 2010 census data.

In the survey, participants reported their race and ethnicity. Black and Hispanic individuals made up a greater proportion of the study population, as children in these groups are more likely to consume SSBs.

There were 5005 participants, all aged 18 years and older and primary caregivers of 1 or more children aged 0 to 5 years. Participants were presented with 12 commonly purchased drinks in a randomized order, then told to select the beverage they would purchase for their oldest child aged 0 to 5 years.

At the end of the survey, participants would either have their chosen beverage shipped to them or receive $5. This promoted realistic shopping behavior.

There were 6 high-added sugar beverages and 6 low- or no-added sugar beverages for participants to choose from. Parents would be presented with a larger image of their beverage upon selection, then given the option to confirm their choice or return to selection.

Afterward, participants answered questions on 4 fruit drinks, viewing 1 at a time in a randomized order. While the same brands as prior were used in this section of the study, different drinks were presented. Patients also provided demographic information and whether they noticed different packaged elements.

The prevalence of caregivers selecting high-added sugar drinks was the primary outcome, with participants’ estimated total sugar in grams and the proportion of participants choosing beverages from each category also analyzed. Fruit drink knowledge and perceptions were recorded as secondary outcomes.

Participants in the control group had an average 9.4 grams of added sugar in the beverages they purchased, while participants seeing warnings about added sugar had reduced added sugar and calories in their beverages. Warning conditions also led to a significant reduction in added sugar compared to the control group.

Caregivers presented with no FOP claims or imagery were also significantly less likely to select high-added sugar beverages. However, presenting a percentage juice disclosure did not change the proportion of caregivers selecting SSBs.


Musicus AA, Roberto CA, Moran AJ, Sorscher S, Greenthal E, Rimm EB. Effect of front-of-package information, fruit imagery, and high–added sugar warning labels on parent beverage choices for children: arandomized clinical trial. JAMA Netw Open. 2022;5(10):e2236384. doi:10.1001/jamanetworkopen.2022.36384

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