Updated: May 3, 2019
All health claims are misleading. Even if it's about a real food. Here's the reason. If you take a single feature of a food - it could be cereal, chocolate, apple juice, or even an organic apple - it tempts us to focus on an isolated attribute of one thing in our diet, rather than assess the entire pattern of our food choices in relation to our lifestyle. It is still useful to talk about the nutrients in food? Sure, but only if you talk about the nutrients in the context of food. And even then, you still need to think about the nutrient density of all of your foods combined, not just a single food. No one food or compound in it acts in isolation. Even if the claim accurately points to an essential vitamin or mineral, it doesn't tell us about nutrient synergies. It doesn't mention the amount that you'd need to eat to see that health benefit. It doesn't tell us about the effect of the food's production or processing on that nutrient - sometimes, this actually cancels out any benefit that might have originally existed. And it certainly doesn't tell us about the other substances hiding in the food that might not be so fantastic for our bodies. The isolated emphasis distracts our attention and stop us from thinking about the bigger picture. Processed foods are notorious for making misleading health claims. Processed product can be deliberately manufactured to embody the popular health claim of the day. In fact, health claims used to be prohibited for many years to stop food companies from exploiting consumers. This has since changed to permit food companies to make claims about their products, but only if they abide by the rules. Health claims sell. Food companies don't put claims on packaging to help us make an informed, rational decision about our food choices. They do it to entice us to buy it. Each little phrase, image, colour and design feature is deliberately crafted to appeal to your emotions and values in an instant. And it's effective. If health claims didn't do the trick, food companies wouldn't put incredible amounts of money into it. Often, there is no evidence to back this up. Sometimes, there is evidence to support the claim. But if you scrutinise the studies, you may be surprised to find that food companies often fund the research, and the research questions are designed to generate a positive finding. Food companies realise that they can create a 'health halo' effect to boost profits.
The 'health halo' effect: Over estimating the benefits of a food based on a single claim that makes it seem better than it really is. It's fuelled by popular ideas, misconceptions, fad diets and trends, not sound evidence.
'Fat free'. If something has been taken out a food, then something has been added to it to make up for it - usually lots of sugar or chemicals.
'Gluten free', 'all natural', 'made using real ingredients' and 'no artificial flavours or colours' all cast health halos that should ring alarm bells. They are all vague, empty terms that don't mean what you think they do. For example, a 'natural' ingredient may technically have started out as an extract of a natural source, but by the time it’s in your food it's been reconstructed and reassembled to the point that there’s little difference between natural and artificial.
So, who's in charge here? In Australia, Food Standards Australia and New Zealand (FSANZ) sets the standards for food labels (and lots of other things) in the Food Standards Code. Standard 1.2.7 relates to nutrition content and health claims. It's supposed to ensure that consumers and health professionals can trust in the scientific reliability of health claims and use the claims to make informed food choices. The standard offers food companies three different kinds of claims that they can make:
Nutrition content claims about a nutrient in a food, or a substance that's not in a food. This is your classic 'Excellent source of dietary fibre', 'Reduced fat' or 'Gluten free'. There's criteria that the food needs to meet to make a claim about a nutrient. For example, to claim it's a 'Good source of calcium', that food must contain no less than 25 per cent of the RDI for calcium.
General level health claims link a food or a substance in it to a health effect. For example, ‘EPA and DHA contributes to heart health'. The first condition is that the food passes the Nutrient Profiling Scoring Criterion test - basically, if it's too high in saturated fat, sodium or sugar, you can't make a health claim about it (although you might be able to pass the test if there's enough fruits, vegetables, protein or fibre in the food.) If it passes this test, you can choose from a list of more than 200 pre-approved food-health relationships so long as the food meets other criteria too. For example, to claim that 'Calcium is good for bones and teeth', the food must contain more than 10 per cent of the RDI. Or, you can use an original one (keep reading for more on this!)
High level health claims connect a food or a substance in it to its impact on a serious disease (ie, 'A diet high in fruits and vegetables may reduce the risk of heart disease’) or an indicator of a serious disease (ie, 'A diet low in salt or sodium may reduce blood pressure.’) The rules are more strict if your claim refers to disease - the food must fit into certain categories based on a list of 13 pre-approved food-health relationships. That's the reason you see the same old phrases pop up (they live in legislation here.) Let's use calcium for our example. Let's take calcium for our example again. To claim that 'Calcium enhances bone mineral density', the food must contain no less than 200 mg of calcium.
Can you make any health claim you like? Yes, if you can 'prove' it. Food companies profit from using health claims, yet the entire process for making claims really relies on food companies to comply. The food company doesn't have to stick to the defined list of general health claims. It can use an original one if it can support its claim using scientific evidence. To do this, the company needs to tell FSANZ of the health effect and certify that the company has conducted thorough research to confirm the relationship. That's pretty much it. No other information about the relationship is required. It's called 'self-substantiating' your health claim. The food company is legally required to conduct a systematic review to back up the proposed relationship between the food and the health effect, but it doesn't have to submit these documents. There's lots of rules about this process, but the only time that the food company actually has to demonstrate any of it if an authorised food agency demands to see its records. FSANZ keeps a public record of food businesses that choose to do this. But it's not its job to evaluate or approve the food-health relationship. FSANZ dutifully processes a notification and adds it to the list of notified food-health relationships if all the boxes are properly ticked. The information then remain on this list until the food company asks FSANZ to remove it. FSANZ clearly says that just because they publish a notification, it doesn't indicate that they have accepted or validated it. FSANZ recommends that food businesses contact their local agency first and offers an online list of agency contact details. But if you click on the link (let's take Victoria for example), it takes you to a generic food safety page for the responsible health department that relates to many different food regulatory issues. There's no clear instructions or contact point specifically related to making health claims. Sure, FSANZ and agencies publish information to help companies get claims right, but in practice it's up to the companies to seek out this information, decipher it and apply it properly. Sometimes, they don't. And it's not just little start ups that break the rules due to an innocent error. The Kraft-Heinz Group, one of the largest food companies on the globe, has been admonished for misleading consumers after selling cute little boxes of fruit pastes, purees and concentrates for kids that stated '99 per cent fruit and veg' on the front of the packaging, yet contained 60 per cent sugar. That's enough sugar to have been marketed as confectionery. The penalty? A $2.25 million fine. Probably of little consequence to a company that generated US $26.3 billion in annual sales in 2018 alone and announced an advertising budget of US $629 million in 2016. It's a minuscule price to pay for the profitable slogans, images and claims that it uses to sell to consumers across its multiple product lines.
If the claims aren't checked before they are approved, then who makes sure that they aren't fake? The safety net is thin. There are health departments and agencies that are responsible for enforcing food standards. It's theoretically possible that sometimes these agencies might check label claims. They have the authority to do that. Or, they could respond to an issue that comes to their attention. In reality though, it's not the sort of issue that's top priority. There's also the Australian Competition and Consumer Commission (ACCC) that can hold companies accountable for using false and misleading information. The ACCC does sometimes take on the behemoth food companies, but they have limited resources. They may be able to catch the blatant breaches, but a single agency can't detect and prosecute every food company that tries to blur the lines.
An example - 6 g of protein to make you fuller?
Kellogg's Nutri-Grain To Go Breakfast Bar displays the general health claim, 'Feel fuller with protein'. This is a self-substantiated health claim that you can find listed online.
If you flip to its nutrition facts and ingredients, you'll notice that it contains 6.5 g of protein from soy, in addition to 31.6 g of carbohydrates and 15.1 g of sugar. It's difficult to believe that this product is going to make you feel fuller at all. Yet that health halo appeals to our intentions to be a little healthier and add protein to our first meal of the day.
The take away message Realise that you're vulnerable to the health halo effect, even if you don't like to admit it. Consumers aren't on rational auto pilot, and food companies fully understand that. That's the beauty of marketing - it's designed to slip under the radar, precisely so you don't detect that it's working. We are all vulnerable to things that make us feel better. To counter this, be sceptical of buzz words, slogans, and images that sell to you based on the 'healthy' attributes of a food. Too often, health claims are based on incomplete and biased industry-funded science, skewed to sell a product and apt to mislead. Don't be too quick to believe what's on the packet, always check the ingredient list and the fine print.
If in doubt, apply Michael Pollan's simple rule and remember that the healthiest foods don't (usually) have labels or health claims. Health claims tend to be the friend of processed foods. While the latest product clamours for your attention, vegetables, fruits, nuts, meats and fish all sit quietly. They don't need to make health claims.