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"Calories in must equal calories out," was the central premiseof the initial March 2004 report of the Obesity Working Group (OWG) of theFood and Drug Administration (FDA). Despite the popularity of"carb-counting" and similar diet trends, the FDA maintains thatweight management still boils down to balancing caloric intake andexpenditure. And for the general public, understanding nutrition labels onpackaged food can help.
On December 1, 2004, Acting Commissioner Lester M. Crawford, DVM, PhD,speaking at the Health Care Research Innovations Congress in Washington, D.C.,outlined the FDA's proposed changes. First, the FDA is aiming to increase therequired type size for calories on the Nutrition Facts Panel and add a"percent daily value" column for calories. It also is consideringeliminating the column listing "calories fromfat."
HHS and USDA Release New Dietary Guidelines
Released on January 12, the Dietary Guidelines for Americans 2005 urgesindividuals to "eat fewer calories, be more active, and make wide foodchoices." Key recommendations include:
Revised every 5 years, Dietary Guidelines for Americans 2005 is publishedby the Dietary Guidelines Advisory Committee, which is appointed by theDepartment of Health and Human Services and the Department of Agriculture. TheDietary Guidelines for Americans 2005 is available in PDF format atwww.healthierus.gov/dietaryguidelines.A joint statement on the guidelines from the American Cancer Society, AmericanDiabetes Association, and American Heart Association can be found athttp://www.diabetes.org/for-media/2005-press-releases/Dietary-Guidelines.jsp.
Also on the agenda: displaying serving sizes more prominently to avoidconfusing consumers who might glance at the facts panel and dig in, notrealizing that they're eating multiple servings in a single sitting.
For "multiple-serving packages that could reasonably be labeled as asingle serving," the FDA is considering a rule requiring dual-columnnutrition labeling—giving nutritional values for each serving and forthe entire package.
RULE CHANGES AND VOLUNTARY COMPLIANCE
The process of publishing an "advanced notice of proposed rulemaking," undergoing a 60- to 120-day period for public comment, andevaluating the comments can be lengthy. What's more, new rules can takeseveral years to be fully implemented. This is one reason the FDA welcomesvoluntary cooperation from food manufacturers and seeks similar cooperationfrom the restaurant industry.
Kraft Foods, for example, is already providing dual-column labeling forsnack items containing up to four servings per package, and the Coca-ColaCompany plans to provide dual-column labeling for 20-ounce sodas, listinginformation for both an 8-ounce serving and the full bottle.
Serving sizes are based on "reference amounts commonlyconsumed" (RACCs), which were established in the early 1990s. Makingserving sizes more realistic—reflecting portion sizes Americans actuallyeat—would require an FDA rule change, explains Barbara Schneeman, PhD,director of the Office of Nutritional Products, Labeling, and DietarySupplements.
"Once we make changes, we know we're putting something in place thatall food manufacturers will need to comply with, and [that they] will need tochange their packaging and labeling," she says.
To help people dining out select healthier choices, the FDA wants therestaurant industry to make available at the point of sale "voluntary,simple, and understandable" nutritional information—includingcalorie counts. In June 2004, the FDA signed a contract with the KeystoneGroup, a third-party facilitator, hoping to come to a consensus with therestaurant industry. The industry has been resisting, in part, because of thedifficulty in updating nutritional information for frequently changingmenus.
Enough Is Enough
The size of the serving on a food package influences the number of caloriesand all the nutrient amounts listed on the Nutrition Facts label. You canadvise your patients to pay attention to the serving size, especially how manyservings there are in the food package. Suggest they ask themselves,"How many servings am I consuming?" (e.g., 1/2 serving, 1 serving,or more).
For example, if the label says a serving equals one cup, and there are twoservings in the container, then eating the whole package would mean eating twocups. That doubles the calories and other nutrient numbers, including the %Daily Values as shown on the label.
Source: Food and Drug Administration
Clinicians can play an important role by helping educate patients aboutappropriate serving sizes and the importance of understanding nutrition labelswhen making food choices. 
Footnotes
FDA guidance on how to understand and use the Nutrition Facts label isavailable athttp://www.cfsan.fda.gov/~dms/foodlab.html.
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