Dr. Richard Harris
Effects of 4 Interpretive Front-of-Package Labeling Systems on Hypothetical Beverage and Snack Selections A Randomized Clinical Trial
It's estimated that 60% to 70% of the calories Americans consume consist of ultra- processed foods. These foods have been linked to obesity, diabetes, cardiovascular disease, dementia, cancer, and multimorbidity (having more than one chronic disease). Nutrition is a pillar of lifestyle medicine, and there is much debate on how we can encourage people to make healthier food choices. This randomized controlled trial examined four different food labeling interventions on beverage and snack choices and attitudes and perceptions regarding the labeling.
Participants were asked to choose a virtual beverage or snack from an online vending machine that was labeled with five different types of labels: control (calorie labels), green label on healthy products indicating choose often, traffic light style labeling with red (choose rarely), yellow (choose sometimes), green (choose often), physical activity (showing how many minutes of activity required to burn those calories), and warning labels for products high in sugar, sodium, saturated fat, or calories.
In the beverage test, participants in the labeling groups selected lower calorie options (22% to 31% reduction) compared to the control group, with little differences between the labeling strategies. In the snack arm, participants in the labeling groups selected lower calorie options (7% to 10%) compared to the control arm, with little difference between the labeling strategies. They found no difference when they examined the data by educational status. None of the labeling systems elicited a high amount of stigma or disgust towards those with obesity. The warning labels, followed by the physical activity and traffic lights, garnered the most attention, thought about health effects and emotions. These elements are key in instituting behavioral change.
If you are familiar with behavioral economics, you know that small changes can result in significant changes. More research is necessary, but I favor simple, effective labeling to nudge (excellent book by Richard Thaler) people into making health-conscious decisions.
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Consumption of ultra-processed foods and risk of
multimorbidity of cancer and cardiometabolic diseases:
A multinational cohort study
Multimorbidity is having more than one chronic illness. According to the CDC, 40% of American adults have two or more chronic diseases. Multimorbidity increases with age, but the young are not spared. A 2023 estimated that in the 20-29 age group, 22% had more than one chronic illness (PMID: 37189096). High intake of ultra-processed foods (UPF) is associated with several chronic illnesses, but its effect on multimorbidity is not as clear. This study examined the association of UPF intake with the co-occurrence of two chronic conditions involving cancer, cardiovascular disease, and diabetes.
UPF found intake in this study population was much lower than in the US population (32%-34% vs 60%-70%). This study found that for every one standard deviation increase (about 260 g/day) of UPF, the risk of multimorbidity increased by 9% after adjustment for several confounding factors, including total energy (calorie) intake.
We have covered several studies on this channel recently, showing associations of UPF with various health conditions. How much you eat and what you eat matters, which is why nutrition is a cornerstone of lifestyle medicine.
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Life expectancy associated with different ages at diagnosis
of type 2 diabetes in high-income countries: 23 million
person-years of observation
Type 2 diabetes prevalence has continued to increase. An estimated 15% of the US adult population is diabetic. Up to half of adults are insulin-resistant, and people are being diagnosed at younger ages. This study analyzed data from 97 long-term prospective studies looking at life expectance after diagnosis of type 2 diabetes.
The authors observed a linear association between earlier age of diabetes diagnosis and increased risk of cardiovascular, all-cause, and mortality from other causes. Compared to those without diabetes, someone diagnosed in their 30s had a 169% increased risk of all-cause mortality, and those diagnosed in their 40s had a 126% increased risk of all-cause mortality. Overall, the risk decreased as the age of diagnosis increased.
An individual diagnosed with diabetes at age 30, on average, lived 14 fewer years than someone who wasn't diagnosed with diabetes at age 30. This number was 10 years for someone diagnosed at age 40. Deaths due to cardiovascular disease accounted for 30- 45% of the reduction in life expectancy. The authors hypothesized that the larger excess mortality in younger individuals is due to cumulative exposure to poor metabolic health.
Nutrition, exercise, and sleep are the big 3 of lifestyle medicine important for regulating blood sugars. We have to reverse the trend in diabetes by utilizing these strategies because medications alone are often insufficient.
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