CSPI’s Sugar Reduction Summit: “lowering sugar intake should be a high public health priority”

The summit featured discussions on the USDA’s sugar reduction efforts and its alignment with CSPI and National Salt and Sugar Reduction Initiative’s (NSSRI) petition to the FDA urging the reduction of added sugar in food and beverages.​

About 80% of the populations’ added sugar is from 10 major food categories and sugar-sweetened beverages are the primary source, followed by sweet bakery products, candy, RTD cereals and other desserts, according to CSPI. With rising obesity, heart disease and diabetes cases in the US, “lowering sugar intake should be a high public health priority​,” said Peter Lurie, president and executive director, CSPI.

While Dietary Guidelines recommend only 10% of total daily calories come from added sugar, 54-80% of adults and children depending on age exceed this recommended. CSPI’s petition also coincides with the FDA’s draft guidance​ for “healthy” ingredients on food labels, which outlines specific nutrient criteria—although neither are directly informing the other, but also indicating a significant need to revise policies surrounding health and nutrition.

CSPI looks at FDA and NSSRI as models to implement sugar reduction initiatives across all food and beverage categories. The petition seeks different reductions based on technological feasibility.

CSPI’s efforts in reducing SSB consumption, including the sugary drink tax, is now broadening to address all sources of added sugar through its partnership with the New York Department of Hygiene and Mental Health. USDA’s efforts in strengthening food and nutrition security complements this partnership, which was elaborated by keynote speaker, Stacy Dean, Deputy Undersecretary for USDA Food, Nutrition and Consumer Services.

USDA’s proposal to strengthen food and nutrition security for assistance programs​

Dean discussed USDA’s initiatives to strengthen food and nutrition security by modernizing its assistance programs that “reach one in four people in America…and proposing ways to reduce added sugars​.”

Starting with school meals, USDA released proposed updates in February 2023 based on current nutrition science to reduce added sugars in school nutrition programs. Notably, the proposed standards are the first of its kind for added sugar reduction in school breakfasts and lunches. The comment period ends May 10, 2023.

In addition to the proposed updates, USDA launched a $100 million incentive program to encourage school districts to improve nutritional quality of meals and recognition for schools who are making changes. USDA also initiated its Equipment Assistance Program, providing $1 million for schools to purchase kitchen equipment.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is one of USDA’s most comprehensive public health programs. Its prescription food packages are also included in the proposed update to focus on current dietary guidelines for its participants. USDA proposed reducing the total sugars permitted in yogurt, breakfast cereal and soy-based beverages in the package—which garnered more than 15,000 comments.

“In November of 2022, we proposed changes to the amounts and types of foods prescribed to participants to food packages. The idea was to update food packages to align with the latest dietary guidelines and these proposed changes will… ensure that foods reflect the latest nutrition science that supports healthy eating and brighter futures​,” Dean detailed.

These food packages are customized to meet participants’ needs on nutrition, education, breastfeeding support, immunization screening and referrals to other essential health and social services.

Yet, there are more gaps to fill in terms of program accessibility, Dean explained. Current USDA data shows that the program only reaches half of eligible participants.

“We’re committed to modernizing the program, making it easier for those who are eligible to access the program and improving their experience throughout their time on the program all while delivering benefits rooted in data,”​ Dean said.

In partnership with the Department of Health and Human Services, USDA will develop the next edition of the Dietary Guidelines. This includes, Dean explained, appointing 20 new experts to the 2025 Dietary Guidelines Advisory Committee who will review scientific evidence on nutrition and public health for Americans, “while [considering] socio economic status, race, ethnicity and culture to the greatest extend possible.”​

“Those wanting to consume less sugar can do so more easily​”​

Referencing FDA’s initiatives to reduce sodium consumption “all the way down to the dietary guideline recommended limit,” ​Peter Lurie outlined four requests in the proposal:

• Voluntary short (two years), middle (five years) and long-term (10 years) added sugar production targets in processes and packaged foods
• Interim public progress reports that assess industry compliance on two targets, a sales weighted mean for each category and a maximum for each category which the products are not to exceed
• Online database of products targeted at the baseline to give the public an opportunity to evaluate which industry is complying with the FDA guidance
• Extend to restaurant meals the current proposal for added sugar disclosure requirements on menus

Americans added sugar intake is 14% of daily calories—the DGA recommends no more than 10%, explained NYC Department of Health and Mental Hygiene Commissioner, Dr. Ashwin Vassan.

CSPI’s sugar reduction initiatives were modeled after New York City’s Health Department, 2009 National Salt Reduction Initiative (now NSSRI) when the organization initially addressed salt reduction. Vassan added that based on the success of NSRI, setting targets for companies to limit sugar in products is a more feasible ROI for improving public health:

“New York City is the second largest purchaser of food behind the US military. When we set policies in New York City, it comes a gold standard for the nation. We’ve set target reductions for 15 categories of foods and beverages. We released targets in early 2021, ask companies to meet short-term targets by 2023 and longer-term targets by 2026. We plan to track these targets over time, and I think this represents a unique approach encouraging companies to make gradual, achievable, meaningful reductions meeting those targets.”​

For CPG manufacturers, the allotted time targets are intended to allow for enough time to reformulate existing products, remove products entirely and/or introduce new products to shift consumer choices and behaviors so that “those wanting to consume less sugar can do so more easily,” ​Vassan explained.

“Given the similarities between sodium and sugar in the food supply, both are pervasive. We encourage the FDA to take a similar approach…White House strategies: asked the FDA to assess evidence on added sugar and at a minimum hold a public meeting about future steps that the federal government can take to reduce added sugar intake, including developing targets for categories of food, which is similar to the targets FDA developed for sodium. So, the petition in essence is consistent with what the FDA has done in a different setting, sodium, and consistent with what the White House strategy itself seeks,” ​Vassan added.

Along with a group of researchers from Tufts University Friedman School, NSSRI studied the potential impact and cost effectiveness of sugar reduction in 2021. If, Vassan explained, the industry is able to meet the voluntary targets set by NSSRI, its health impact will be potentially preventing up to 2.5 million cardiovascular events, just under a half a million cardiovascular disease deaths and three quarters of a million of diabetes cases.

According to the study, these policies would result in $161 billion in net costs from a societal perspective over a lifetime. The study estimated almost $9.5 billion in savings to the healthcare system by year 10, nearly $50 billion over the course of a lifetime.  

The study, Vassan added, showed that the policy was predictably cost effective.