TCS Daily

Consider Yourself Warned

By John Luik - January 3, 2006 12:00 AM

Ever since the obesity "epidemic" became a media staple, the public health community -- along with pundits on both sides of the Atlantic -- have been coming up with ever more alarming prescriptions for fixing this alleged health disaster.

The recent Institute of Medicine report in the US has suggested that restrictions or bans on food advertising to children may be necessary. The UK previously has raised that option, and heard calls for mandated reductions in the salt content of foods, a perennial policy favorite of the Center for Science in the Public Interest in the US.

But by far the most radical policy proposal to date has come from the new head of Britain's Food Standards Agency, Dame Deirdre Hutton, who has recently launched a consultation about whether to introduce a system of warning labels for foods with high salt, sugar or fat (HSSF) content. According to Hutton and the FSA, such a warning system is the best way to inform consumers about the differences between healthy food and "junk" food.

Leave aside the unanswered question of whether the distinction between good and "junk" food is a genuinely scientific difference as opposed to an ideological or even aesthetic preference. Dame Deirdre's proposal to place warning labels on many ordinary foods that are consumed daily by millions of people is troubling not just because of its simple-mindedness, but because this so-called solution to obesity runs counter to much of the best scientific evidence. Indeed, there is substantial evidence that no only will it fail to work in changing consumer's food preferences, but that it will also, with certain key high risk groups, be counterproductive.

The case for food warning labels, whether coming from the Hutton and the FSA or from food activists here at home appears to be based entirely on a set of assumptions that are common sense. People want to avoid disease and death. Once they know that a certain behavior or product can lead to disease and death they will avoid it. So providing an appropriate warning will provide people with the information necessary to change their behavior. The reality, however, confirmed in extensive social science evidence, is that assumptions two and three are for many people in many instances false.

There are three principal reasons for this. First, people often miss warnings because we all filter out much of the information that comes our way because we find it neither relevant nor interesting. Second, even warnings that we do attend to are often not processed because we tend to avoid information that has negative self-implications. Through a process known as cognitive re-adjustment people tend to exempt themselves as individuals who should be concerned with the warning. Seatbelt use is fine, though it isn't necessary for me. So even though someone has read and remembered a warning they also discount its personal applicability. Finally, even warnings which are read and processed are often discounted due to what experts call "warning fatigue" where the overabundance of warnings or the familiarity of a specific warning diminishes its effectiveness. In short, the ubiquity of the very act of warning tends to diminish the power of all warnings.

The scientific evidence about warnings failure is extensive. For example, almost a decade after the US mandated warnings on alcohol products, according to researchers like Dr. Janet Hankin ("FAS prevention strategies: Passive and active measures" Alcohol Health and Research World, 1994), neither the risk perception nor the drinking behavior of those drinkers most likely to be a risk to themselves or others has changed. As Hankin noted: "Among high risk drinkers, the label law clearly has NOT (emphasis in original) affected drinking behaviour."

A study by the Centers for Disease Control and Prevention found that the percentage of women drinking during pregnancy had actually risen since the introduction of the warnings labels, even though the labels warn about the risks of drinking during pregnancy. And a study in The American Journal of Public Health (MacKinnon et al "The alcohol warning and adolescents" 2000), which followed a group of 16 661 high school students from 1989-1995, reported that "there was no beneficial change attributable to the warning in beliefs, alcohol consumption, or driving after drinking."

Again, the World Health Organization's 2003 study on alcohol noted that warnings failed to increase young people's perceptions of alcohol risks and had "no direct impacts" on consumption. Studies have also found that heavy drinkers, while aware of the warnings, are more likely to consider them less believable and to discount them more than other drinkers.

There is equally compelling evidence about the failure of food warnings. The Department of Agriculture's Economic Research in an analysis of food labeling (Elise Golan et al., "Economics of Food Labeling," Agricultural Economic Report 793, 2001) noted that "labeling may not be an effective policy tool." There are several reasons for this. Some researchers, for example, have found that warnings or a large list of detailed product information causes many consumers to disregard the warnings and the information completely. Again, studies of consumer behavior in food stores have found that consumers often make hasty food choices and fail to scrutinize warnings and food labels. One such study by Lorna Aldrich ("Consumer Use of Information," Agricultural Handbook, 1999) discovered that a consumer's income, not warnings or labels, was the key factor in determining which foods were purchased, and that income cancelled out the effects of information.

Moreover, a decade of food labeling in the US has failed to have any significant impact on obesity. As former Food and Drug Administration Commissioner Lester Crawford noted "What we did in making nutrition labeling mandatory did not help obesity. In fact, some people would say it hurt..." A 2002 study, for example, found that nutritional information made no difference in food density choices. As the authors noted: "In this population, explaining the concept of energy density and providing nutritional information during meals had no overall impact on the weight of food consumed." (Kral et al., "Does nutritional information about the energy density of meals affect food intake in normal-weight women?" Appetite, 2002)

Another study which was conducted in a restaurant setting the UK found that providing information about unhealthy and healthy food "did not substantially affect expectations of sensory quality and acceptance, or overall energy and fat intake." What it did succeed in doing was decrease the number of people selecting the "healthier," lower-fat option. (K. Stubenitsky et al., "The influence of recipe modification and nutritional information on restaurant food acceptance and macronutrient intakes," Public Health Nutrition, 2000).

A 2003 study (Sproul et al., "Does point of purchase nutrition labeling influence meal selection," Military Medicine) which looked at the effectiveness of nutrition labeling and warning in an Army cafeteria found no significant difference in the sales of the labeled items. As Jayachandran Variyam of the USDA noted earlier this year, "These findings suggest that the benefits of labeling may be small or uncertain at best" ("Nutrition labeling in the food away from home sector," Economic Research Service, USDA, April, 2005)

But the danger is not simply that food warnings or labels will fail, it is also that they will be counterproductive. For instance, large numbers of excessive risk-takers display what psychologists call reactance in which there is a high level of resistance to the demands of outside authority and control. For these individuals a warning label represents an attempt to unreasonably shape their behavior and makes them more likely to ignore rather than to heed the warning. Warning labels also highlight risk and for those attracted to risk-taking, this serves to make the very thing warned about more, rather than less attractive.

All of this suggests that Dame Deirdre and the Food Standards Agency's campaign for food warning labels is very much uninformed by the evidence of whether such a scheme can be effective. Like so much of what is described as "common sense" thinking on obesity, there is nothing common sensical about these proposals. Instead, we are being treated to yet another intellectually challenged and ineffective regulatory framework put forward by people who desperately want to impose their food preferences on everyone else.

John Luik is a frequent TCS contributor. He is writing a book about health policy.


1 Comment

COnsider Yourself Warned
The most important factor that is forgotten in the debate is that the state looks only at the costs of certain behaviours and never at the benefits. In relation to so-called junk food, the benefit is obvious - a Big Mac tastes good!

People are able to make their own choices: those who value health (supposedly)highly don't go to MacDonalds, those who value a filling, tasty, quick meal do. Forget the warnings and the psychological mumbo-jumbo and focus on benefits versus costs.

Of course children aren't very good at assessing costs and benefits, particularly when they are told that the benefits are in fifty years time versus pleasure now. That is why we have parents.

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