Warning Labels With Images May Reduce Sugary Beverage Purchases

Warning labels with scary images may be an effective way to persuade parents of young children not to buy sugary beverages for their children, according to a new study published in the journal PLOS Medicine.

The rate of type 2 diabetes in children and teenagers has nearly doubled over the last couple of decades, rising from 0.34 per 1,000 people in 2001 to 0.67 per 1,000 people in 2017. While there probably isn’t any single factor that explains this increase, childhood obesity has increased during the same period — and obesity is a well-known risk factor for type 2 diabetes. Sugary beverages are believed to be a major driver of weight gain and obesity, and many initiatives around the world have sought to limit how much of these beverages people consume — sometimes by taxing them, and sometimes by trying to persuade people not to buy or drink them. But so far there has been little evidence, anywhere, of any policy leading to a sustained reduction in consumption of sugary beverages. Many researchers believe that it’s especially important to reduce consumption of these beverages in children, since younger people tend to develop habits that last a lifetime — and childhood obesity can lead to lifelong health problems, including a higher risk for type 2 diabetes.

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For the latest study, researchers set up a simulated small grocery store (“mini mart”) environment where parents of children ages 2 to 12 completed a shopping task. There were 325 adult participants, with 25% identifying as Black and 20% as Hispanic. As part of the study, participants were asked to pick out one snack and one beverage for their child, as well as one household good. The researchers were most interested in whether parents selected a sugary beverage for their child, but the participants didn’t know this. They also didn’t know that they were randomly assigned to one of two study groups, with different product labels on sugary beverages for each group. For the first study group, each beverage label contained a simple bar code in one area. For the second study group, this bar code was replaced with a warning label about sugary beverages. One warning stated that “excess consumption of drinks with added sugar contributes to type 2 diabetes, while another stated that this excess consumption “contributes to heart damage.” The warning about type 2 diabetes showed an image of severe necrosis on a foot, and the warning about heart damage showed a heart with excess fatty tissue.

Warning labels decrease likelihood of parents selecting sugary beverages

The researchers found that when warning labels with images were added to sugary beverage labels, parents were significantly less likely to select them for their child — with 45% of parents selecting a sugary beverage when there was no warning label, and 28% selecting a sugary beverage when there was a warning label with an image. These warnings also led to fewer overall calories in the parents’ beverage choices — with an average of 82 calories per beverage when there was no warning label, and an average of 52 calories when there was a warning label with an image. There was no difference in how the warning labels affected parents’ choices based on 13 different characteristics of the parents, including race or ethnicity, income, education level, and age of the child.

In addition to their measurable impact on what parents chose for their children, the warning labels in the study seemed to give parents a sense of empowerment based on their answers to follow-up questions. Compared with parents who weren’t shown the warning labels, those in the group that saw them on beverages reported feeling more in control of healthy eating decisions, thinking more about the harms of sugary beverages, and perceiving sugary beverages as being less healthy for their child.

This study “suggests that pictorial warnings are a promising policy option for reducing parents’ sugary drink purchases for children,” the researchers concluded. “Future […] studies, especially those conducted in real-world settings such as actual grocery stores, will help to establish the generalizability of the observed effects, as well as whether warnings’ effects are sustained over time.”

Want to learn more about eating well with diabetes? Read “Strategies for Healthy Eating,” “Improving Your Recipes: One Step at a Time,” and “What Is the Best Diet for Diabetes?”

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