Picture warnings on fizzy drinks? A promising tool to fight childhood obesity

A study published in the journal PLOS Medicine is the first to examine whether pictorial health warnings on sugary drinks, like juice and fizzy drinks, influence whether or not parents purchase these types of beverages for their children.

The study’s results found that these warnings reduced parental purchases of sugary drinks for their children by 17%.

Researchers at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health ran the study in a unique laboratory by creating the “UNC Mini Mart”. This space was set up to mimic a convenience store and simulate a realistic setting for a shopping experience.

“We created this store because we saw a major need for research that tests the impact of policies in a food store setting that is much more realistic,” said senior author Lindsey Smith Taillie, PhD, assistant professor in the Department of Nutrition at the Gillings School and a member of UNC’s Carolina Population Center (CPC). “When people make choices about what food to buy, they are juggling dozens of factors like taste, cost, and advertising and are looking at many products at once. Showing that warnings can cut through the noise of everything else that’s happening in a food store is powerful evidence that they would help reduce sugary drink purchases in the real world.”

Taillie’s and her co-authors’ positive findings about the effects of image-based warning labels highlight a recent approach to combating the global struggle with obesity. Children in the United States and many other countries, including the UK, consume more than the recommended amount of sugary drinks, which increases their risk for obesity and other diet-related chronic diseases, including Type 2 diabetes. 

Taillie has conducted research on warning labels and taxes on sugar-sweetened beverages and junk food in Chile, Mexico and South Africa. Marissa G. Hall, PhD, one of the study’s co-authors, researches the impact of warnings on tobacco and food as well as effectiveness of obesity prevention policies.

In their study, 326 parents of children between the ages of 2 to 12 years old participated in a randomised trial with 1) a pictorial warning arm (in which drink labels had images representing heart damage and Type 2 diabetes), and 2) a control arm (in which drinks labels displayed a barcode).

Participants were instructed to choose one drink and one snack for their child, along with one household good, the latter being added to the shopping list to potentially mask the purpose of the study. After shopping, participants completed a survey about their selections and left with their drink of choice and a cash incentive.

The picture warnings led to a 17% reduction in purchases of sugary drinks, with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm.

The warnings also reduced calories purchased from sugary drinks and led to parents feeling more in control of healthy eating decisions and thinking more about the harms of sugary drinks. 

“We think the paper could be useful for policymakers in the U.S. and globally,” Hall says. “This evidence supports strong, front-of-package warnings to reduce sugary drink consumption in children.”