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

15 April 2019

In May 2016, the US Food and Drug Administration announced that labelling of added sugar content on all packaged food and beverages would become mandatory. A delay to the implementation deadline means this will not come into force until 2020, although some companies have already rolled it out.

The benefits of improved labelling include effectively changing consumer behaviour and allowing people to make informed choices to reduce intakes of free sugars and to stimulate industry reformulation.

A new study published in the journal Circulation looked at the potential health impacts and cost effectiveness of this policy and concluded that implementing an added sugar labelling policy could generate substantial health gains and cost savings for the US population.

Researchers modelled two scenarios:

  • implementation of the FDA added sugar label on all packaged foods and beverages with no change in industry formulations
  • implementation of the added sugar label plus further accounting for corresponding industry reformulation

For both scenarios they made an assumption that recently observed trends in declining added sugar consumption, particularly from sugar-sweetened beverages (SSBs), would continue.

Using a validated microsimulation model (US IMPACT Food Policy model), researchers predicted that between 2018 and 2037, the labelling of added sugar would:

  • Prevent 354,400 cases of cardiovascular disease
  • Prevent 599,300 cases of diabetes
  • Gain 727,000 quality-adjusted life years
  • Save $31 billion in healthcare costs or $61.9 billion societal costs
  • Reduce median added sugar intake by an additional 2.1 g/day

For sugar labelling and reformulation model they predicted that this would:

  • Prevent 708,800 cases of cardiovascular disease
  • Prevent 1.2 million cases of diabetes
  • Gain 1.3 million quality-adjusted life years
  • Save $57.6 billion in healthcare costs or $113.2 billion societal costs
  • Reduce median added sugar intake by an additional 4.8 g/day

Both Scenarios were estimated with greater than 80% probability to be a cost saving by 2023. Over 20 years without any new intervention, median added sugar intake was projected to decrease by 5.8 g/day

In order to generate a synthetic population (adults aged 30-84 years) that was representative of the US their model used demographic information, body mass index (BMI) data, and added sugar intakes from the 2 most recent National Health and Nutrition Examination Survey (NHANES) cycles (2011–2014).

To estimate the effects of the labelling policy on added sugar, a recent systematic review and meta-analysis of labelling interventions was used and consistent with the time period of interventional studies, researchers assumed the time between policy implementation and change in added sugar intake was less than a year and this effect would be sustained throughout the 20 year study simulation.

The potential for industry reformulation was based on the FDA’s impact analysis.  Researchers assumed no reformulation in the first year of implementation and then:

  • 5% to 9% of sugar-containing products being reformulated to achieve 25% reduction in added sugar content in these products each of years 2 to 5 of the intervention
  • No additional reformulation thereafter
  • This represents an 8.25% net reduction in added sugar contents of US products over the 20-year intervention period

The model for predicting the effects of added sugar changes on cardiometabolic risk incorporated:

  • associations of added sugars from SSBs and other foods with BMI
  • subsequent BMI-mediated effects on CHD, stroke, and diabetes mellitus
  • separate BMI independent associations of added sugars from SSBs (but not from other foods) with CHD and diabetes mellitus

Researchers assumed one year from change in sugar intake to change in BMI and one year from change in BMI to change in disease risk.

Cardiovascular disease (CVD) medical and productivity costs per person per year were derived from a Research Triangle institute Reports

CVD informal care, such as unpaid caregiving, costs were estimated by using published data.

CVD productivity costs, which included workplace, home, and leisure time productivity losses, were divided into morbidity (living with diseases) and mortality costs (premature deaths).

Medical and productivity costs for diagnosed and undiagnosed type 2 diabetes mellitus, and informal care costs for diagnosed type 2 diabetes mellitus, were derived from published sources.

Healthcare and societal savings as a result of the added sugar label significantly outweigh policy costs, even when an estimated $2.5 billion of industry reformulation costs were considered

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