Executive Summary

Obesity is an increasing problem for children and adolescents in the United States. Childhood obesity contributes to short and long-term negative health outcomes, including an increased risk for type 2 diabetes, high blood pressure, high cholesterol, poor self-esteem, anxiety, depression, and a higher risk of obesity in adulthood. In 1999-2000, the prevalence of obesity among children and adolescents ages two to nineteen was 13.9 percent. By 2020, it had risen to 19.7 percent. Although childhood obesity in the United States is increasing overall, the highest prevalence in 2017–2020 was among Latinas/os (26.2 percent). The racial/ethnic disparities in obesity prevalence continue into adulthood. Like youth in the United States, Latin American children and adolescents consume an excessive amount of highly processed beverages and foods.

Innovative policies have been implemented in Latin American countries over the past few decades to prevent and manage childhood obesity, including taxation of sugar-sweetened beverages (SSBs), menu labeling, restrictions on television advertising, and efforts to encourage portion control. In the mid-2010s, regulatory schemes centered on front-of-package (FoP) labeling spread rapidly in Latin America. A mandatory federal FoP labeling policy has been debated, but legislation has not been adopted. In 2022, the White House announced new initiatives to address hunger, food insecurity, and food accessibility, thereby acknowledging that these food-related issues impact millions of people in the United States, especially low-income families, rural communities, and racial/ethnic minorities.

The specific aims of this brief are to:

• Examine existing evidence from studies of regulatory and fiscal policies in Latin America and the United States that were designed to prevent and reduce childhood obesity: labeling policies, taxation on SSBs, restrictions on TV advertising, and efforts to control portion size.
• Identify the challenges that have and are likely to affect the implementation of front-of-package (FoP) labeling policies in Latin America and the United States.
• Discuss the policy lessons that can be drawn not only from efforts to establish regulatory and fiscal policies but also from the policies themselves.

 

Policy Considerations and Potential Solutions

1. FoP labeling schemes implemented in Latin America can serve as models in the United States. Mandatory FoP labeling could encourage consumer reliance on the information provided by the labels, and it could also motivate food manufacturers to reformulate their products, leading to healthier food and beverage options. A recent study determined that only mandatory labeling would have a critical impact on the public’s health. Implementation of a mandatory system certainly be challenged by food and beverage companies as a violation of their First Amendment rights. Although commercial speech is protected, certain components of FoP labeling might withstand scrutiny. Nutrient-specific summary information meets First Amendment requirements because it is purely factual. Interpretative nutrient-specific summary information that employs colors and designs, such as those used for warning labels, could also withstand First Amendment scrutiny65. Regardless of the approach, any attempt to regulate FoP labeling would be met with pushback from the food and beverage industry.
2. Preemption laws that exist in some states are an indicator of the food policy climate.
3. Lobbying from the food and beverage industry will likely include intense opposition to FoP labeling, particularly since criticism from the FDA prompted the discontinuation of the Smart Choices Program. To combat the enactment of local ordinances that regulate SSBs, the American Beverage Association spent millions of dollars to promote a ballot measure that would have required local jurisdictions in California to obtain a two-thirds margin to enact any local tax change, impairing their ability to fund public services.
4. Restrictions and bans on TV advertisements of unhealthy foods and beverages to children and adolescents is another approach that can be used in the United States, but constitutional challenges would be certain. Food and beverage companies would argue that proposals aimed at restricting or banning TV advertisements to children and adolescents would violate their right to commercial speech.
5. The US Congress should consider granting jurisdictional authority to federal agencies that would oversee TV advertising targeted at children and adolescents. Currently, the restrictions and regulations on TV advertisements for children are mostly industry-led, which poses multiple challenges, including ensuring accountability.
6. Implementing portion control is another approach to prevent and reduce childhood obesity. The food and beverage lobby will likely present strong opposition47, as it did in New York in 2012, when it successfully challenged the city’s prohibition on the sale of SSBs in large containers in the city’s food service establishments.
7. Consumers who believe that food consumption is an individual choice may reject any regulation seen as an interference.
8. Preemption laws can hobble local efforts to address obesity through SSB taxes. Even when a state preempts a city’s authority to levy SSB taxes, however, ballot initiatives and legislation can be used to reinstate them. Local ordinances and community support is critical when a FoP labeling policy is pursued. Implementation Lessons to Prevent and Reduce Childhood Obesity in the United States
9. Evidence from Mexico, Chile, and other Latin American countries indicate that SSB taxes can produce cost savings and improve health outcomes, but the benefit of FoP labeling is not as clear. The research does not support claims that nutrition warnings discourage consumer purchases of sugary drinks and processed foods. Assessments of FoP labeling in Chile, however, offer sound evidence that can be translated into the US context. Considerations for policymakers include choosing regulatory thresholds for categories that represent a large share of consumers’ intake of critical nutrients. It is also important to recognize that FoP labeling and SSB taxes are complementary policies50.
10. The absence of consensus among stakeholders poses an important challenge to efforts that implement FoP packaging mandates. The active participation of academic and nonacademic researchers, policy makers, and community-based organizations is crucial to the success of policies that aim to improve public health. Negotiations over mandatory FoPs in Latin America brought together all the stakeholders: food and beverage companies, legislative groups, health departments, and the community. This approach could also be successful in the United States.
11. The passage of SSB laws has been successful in part because of the involvement of a broad coalition of supporters. Academics, NGOs, and community members worked to generate knowledge about fiscal measures, systematize and disclose scientific evidence, and increase the visibility of the problem, which brought the issue before the public.
12. Generating the momentum that initiatives need to succeed can require years of preparation. In the case of the SSB tax in Mexico, a national obesity prevention policy succeeded in positioning obesity as a policy issue that merited the public’s attention as early as 2007. Although Mexico’s SSB tax was not implemented until 2014, the focus on preventing obesity as a national priority raised awareness and provided an environment in which public support for the measure could grow. Similar events occurred in Chile. In the United States, the White House has recently showed strong interest in addressing the childhood obesity epidemic, but political and institutional factors may undermine crucial congressional support.

Conclusions

Mexico, Chile, and other Latin American countries are employing a multipronged approach to combat childhood obesity that employs FoP labeling, bans on TV advertisements for unhealthy foods and beverages, portion control, and taxes on SSBs. US policymakers, researchers, and community members should consider a similar strategy, one that includes FoP labeling. Efforts to reduce and prevent childhood obesity should also address racial and ethnic disparities. Latino children are disproportionally impacted by obesity, which increases the risk of chronic conditions, such as type 2 diabetes, and heightens the risk for obesity in adulthood.