1. In this study, adding disclosure about amount of added sugar to beverage packaging reduced parental choice of high-sugar beverages.

2. Furthermore, removal of labels such as “100% vitamin C” or fruit imagery reduced parental choice of high sugar beverages but did not modify perception of added-sugar content.

Evidence Rating Level: 1 (Excellent)

Childhood obesity and diabetes are growing public health challenges, with consumption of sugar-sweetened beverages (SSBs) being one risk factor. For children between the ages of one to eight, fruit drinks are one of the most consumed SSBs. Unfortunately, many front-of-package (FOP) labels on such drinks contain images of fruit with claims leading many parents to mistakenly believe that these drinks are healthy. The effectiveness of different options in modifying parental choice of beverages for their children have yet to be extensively studied.

This study was a randomized control trial of 5005 adult parents of children from the United States (US) between the age of zero to five. The racial and ethnic composition of participating parents was established to reflect the 2010 US census. Any parents who completed the survey in less than 5 minutes were excluded. Parents participated in an online survey and were shown no-, low-, and high-sugar beverages and asked to choose one for their child. Parents were randomized to see one of seven types of FOP labels, including a control group. The primary outcome measured were types of beverages chosen and added sugar and calorie of chosen beverage.

This study found that compared to the control group, disclosure of added sugar was the only modification that led to fewer parents (15.6%) choosing beverages with significantly fewer calories and added sugar. When claims of 100% vitamin C or fruit imagery were removed, 18.4% fewer parents chose a high-sugar beverage, choose 100% juice instead. This alternative selection, however, did not lead to any significant decreases in calories. However, this study was limited due to the lack of inclusion of pricing, which can heavily influence consumer choice. Nonetheless, these results suggest that there are packing modifications that can empower parents to choose healthier beverage purchases for their children.

Click to read the study in JAMA Network Open

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