Doctor’s Orders to ‘Eat Healthy’ Bolstered by Updated FDA Metrics
By Jessica Ridge

The Food and Drug Administration’s (FDA) new “healthy” labeling approach, refined to better align with nutrition science, provides an entry point for physicians to begin conversations with their patients about establishing a healthy dietary pattern, although challenges in the form of access and education persist.

FDA’s revised definition of the nutrient content claim for “healthy” aims to restrict misleading labels on food packaging and provide consumers with a clearer way to identify nutritious foods.

The updated requirements mesh with the Texas Medical Association’s policy of promoting a healthy lifestyle that reduces the public health burden of cardiovascular disease. The policy already supports both FDA regulation of sodium and recommendations by the Texas Public Health Coalition to label foods and post nutrition information.

Hattie Henderson, MD, a member of TMA’s Council on Science and Public Health, applauds the FDA’s inclusion of serving sizes in the new rule and believes the new requirements for labeling foods as healthy means those labels are less likely to be misleading.

Dr. Henderson has encountered the confusion sown by the former label standards in exchanges with her patients, who frequently live alone or in two-person households, rendering cooking large meals from scratch impractical. These patients sometimes might resort to eating calorie-dense frozen foods laden with sodium and preservatives, says the geriatrician. 

“It tastes great, and it says healthy on the package. So why shouldn’t I eat this, Dr. Henderson?” she hears. Then she explains: “That one meal gave you half the calories that you should actually take in a day, and 70% of the sodium that you can have in one day, and that’s just a small amount of food. So now, the rest of your day, what are you going to eat?” 

The FDA’s reformulated rule on what constitutes “healthy,” last updated in 1994, hopefully makes the labels more useful for consumers and patients like Dr. Henderson’s.

The new rule is set to take effect Feb. 25, 2025 with compliance slated to be required by Feb. 25, 2028. It mandates foods labeled as healthy to contain a minimum amount of one of the six “core” elements of a healthy dietary pattern:

• Vegetables;
• Fruits;
• Grain;
• Dairy;
• Protein foods; and
• Oils.

The previous definition allowed foods that fulfilled the daily recommended value of one nutrient to be labeled “healthy,” even if they contained sodium, saturated fat, or added sugars that far exceeded recommended daily values. The revised standards limit those amounts. Additionally, the rule standardizes the serving size for each of the six core elements and adjusts the allowed amounts of sodium, saturated fat, and added sugars based on whether an item is an individual food, mixed product, main dish, or meal product.

However, Dr. Henderson cites two areas with room for improvement: education and access. 

“I see the big picture, and I understand the goal. But you haven’t solved the main issue – access to food. You can label, but the public health issue is there’s not enough access to food. I live in Houston, and there are plenty of neighborhoods that don’t have grocery stores,” she said.

She emphasized the role food pantries can play in mitigating access issues, especially with the provision of fresh produce. 

Aside from food deserts’ substantial footprint, Dr. Henderson says, patient education presents another challenge. The new rule could be challenging for a layperson to parse, given the lack of nutrition education most consumers receive from early childhood on.

“It would be great to have a dietitian in every clinic who could explain it to our patients,” she said.

Dr. Henderson praises the new rule as a supplement to the USDA’s current dietary guidelines, which can work in tandem with the rule toward the goal of decreasing obesity, cardiovascular disease, and diabetes by educating consumers on what constitutes a healthy diet over a life span.

“The two together will be helpful in our patients having better outcomes, better health over time,” Dr. Henderson said.

For more information on public health topics, check out TMA’s dedicated webpage.