PHILADELPHIA – Health warning labels similar to those found on tobacco products may have a powerful effect on whether parents purchase sugar-sweetened beverages (SSB) for their children, according to a new study led by the Perelman School of Medicine at the University of Pennsylvania. The study is the first of its kind to examine the influence of SSB warning labels. Results show that regardless of a parent’s level of education, they may be significantly less likely to purchase an SSB when a label warning that consuming beverages with added sugar may contribute to obesity, diabetes, and tooth decay is present, compared to a label that only bears the calorie count of the beverage, or no label at all. Additional results suggest health warning labels improve parents’ understanding of the health dangers associated with overconsumption of such beverages. The results, which come just one week after the U.S Department of Agriculture issued new eating guidelines recommending added sugar be limited to ten percent or less of daily calories, are published online in the journal Pediatrics.

Figure 1: Different label conditions. A, Calorie label; B, California label; C, Weight gain label; D, Preventable label; E, Type 2 diabetes labelImage courtesy of the University of Pennsylvania Research shows that SSBs including soft drinks and juices marketed for children contain as many as seven teaspoons of sugar per 6.5 ounces–nearly twice the recommended daily serving of sugar for that age group.

“In light of the childhood obesity epidemic and studies suggesting that more than half of children under the age of 11 drink SSBs on a daily basis, there is a growing concern about the health effects associated with consumption of these beverages,” said lead author Christina Roberto, PhD, an assistant professor of Medical Ethics & Health Policy at Penn Medicine. “Some states have introduced bills requiring SSBs to display health warning labels, but to date, there is little data to suggest how labels might influence purchasing habits, or which labels may be the most impactful.”

In the first study to examine the influence of sugar-sweetened beverage warning labels, researchers conducted an online survey of 2,381 parents with at least one child between six and 11 years old. Participants had diverse backgrounds, and many identified as racial and ethnic minorities–groups which have the highest obesity rates in the United States. After being divided into one of six groups–the control group, which saw no warning label on beverages, the “calorie label” group which only saw a label displaying the beverage’s calorie count, and four “warning label” groups, which saw one of four variations of content warning about possible negative health effects–participants were asked to choose a beverage to purchase for their child.

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Results showed that while the specific text of the health warning labels did not affect a parent’s purchase choice, the presence of the label was significant. Overall, 40 percent of parents in the groups exposed to health warning labels said they would choose an SSB for their kids, compared to 60 percent of participants who saw no labels on the beverages, and 53 percent of parents who saw the calorie labels.

“Regardless of the specific wording, results show that adding health warning labels to SSBs may be an important and impactful way to educate parents about the potential health risks associated with regular consumption of these beverages, and encourage them to make fewer of these purchases,” Roberto said. “The findings are in line with similar studies conducted on the effects of warning labels on tobacco products, which have been shown to increase consumer knowledge of health risks related to tobacco use, and encourage smoking cessation.

The study also evaluated consumer support for sugar-sweetened beverage warning labels and found that nearly 75 percent of participants would support adding them to the containers. The authors hope the results will encourage future research focused on determining how these labels influence beverage choice for a variety of consumers, and dietary choices beyond SSBs.

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“We can now say that warning labels have the potential to educate parents and motivate behavior change when it comes to purchasing SSBs, which could help gain support for bills requiring labels to be added to beverage containers, but there are also many unanswered questions that require further study,” Roberto said. “For example, it would be interesting to see if people who choose not to purchase a sugary beverage that contains a warning label end up compensating for those calories by purchasing other high-sugar foods that are unlabeled.”

Funding for the study was provided by the Robert Wood Johnson Foundation.