. 2020 Aug 1:222:112930.

doi: 10.1016/j.physbeh.2020.112930. Epub 2020 May 11.

Ethical Considerations for Food and Beverage Warnings

Anna H Grummon¹, Marissa G Hall², Jason P Block³, Sara N Bleich⁴, Eric B Rimm⁵, Lindsey Smith Taillie⁶, Anne Barnhill⁷

Affiliations

¹ Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health. Address: 9 Bow Street, Room 306, Cambridge, MA, 02138, United States. Electronic address: agrummon@hsph.harvard.edu.
² Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, and UNC Center for Health Promotion and Disease Prevention, University of North Carolina Chapel Hill. Address: 312 Rosenau Hall, 135 Dauer Drive, Chapel Hill, NC, 27599, United States. Electronic address: mghall@unc.edu.
³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute. Address: 401 Park Drive, Suite 401 E, Boston, MA, 02215, United States. Electronic address: jblock1@partners.org.
⁴ Department of Health Policy and Management, Harvard TH Chan School of Public Health, and Radcliffe Institute for Advanced Study. Address: 677 Huntington Avenue, Kresge 405, Boston, MA, 02115, United States. Electronic address: sbleich@hsph.harvard.edu.
⁵ Department of Epidemiology and Department of Nutrition, Harvard TH Chan School of Public Health. Address: 655 Huntington Avenue, Building II Room 373a, Boston, MA, 02115, United States. Electronic address: erimm@hsph.harvard.edu.
⁶ Department of Nutrition, University of North Carolina Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina Chapel Hill. Address: 123 W. Franklin St, Room 2107, Chapel Hill, NC, 27514, United States. Electronic address: taillie@unc.edu.
⁷ Berman Institute of Bioethics, Johns Hopkins University, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, United States. Electronic address: anne.barnhill@gmail.com.

PMID: 32434747
PMCID: PMC7321920
DOI: 10.1016/j.physbeh.2020.112930

Ethical Considerations for Food and Beverage Warnings

Anna H Grummon et al. Physiol Behav. 2020.

. 2020 Aug 1:222:112930.

doi: 10.1016/j.physbeh.2020.112930. Epub 2020 May 11.

Authors

Anna H Grummon¹, Marissa G Hall², Jason P Block³, Sara N Bleich⁴, Eric B Rimm⁵, Lindsey Smith Taillie⁶, Anne Barnhill⁷

Affiliations

¹ Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health. Address: 9 Bow Street, Room 306, Cambridge, MA, 02138, United States. Electronic address: agrummon@hsph.harvard.edu.
² Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, and UNC Center for Health Promotion and Disease Prevention, University of North Carolina Chapel Hill. Address: 312 Rosenau Hall, 135 Dauer Drive, Chapel Hill, NC, 27599, United States. Electronic address: mghall@unc.edu.
³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute. Address: 401 Park Drive, Suite 401 E, Boston, MA, 02215, United States. Electronic address: jblock1@partners.org.
⁴ Department of Health Policy and Management, Harvard TH Chan School of Public Health, and Radcliffe Institute for Advanced Study. Address: 677 Huntington Avenue, Kresge 405, Boston, MA, 02115, United States. Electronic address: sbleich@hsph.harvard.edu.
⁵ Department of Epidemiology and Department of Nutrition, Harvard TH Chan School of Public Health. Address: 655 Huntington Avenue, Building II Room 373a, Boston, MA, 02115, United States. Electronic address: erimm@hsph.harvard.edu.
⁶ Department of Nutrition, University of North Carolina Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina Chapel Hill. Address: 123 W. Franklin St, Room 2107, Chapel Hill, NC, 27514, United States. Electronic address: taillie@unc.edu.
⁷ Berman Institute of Bioethics, Johns Hopkins University, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, United States. Electronic address: anne.barnhill@gmail.com.

PMID: 32434747
PMCID: PMC7321920
DOI: 10.1016/j.physbeh.2020.112930

Abstract

Several countries have implemented warnings on unhealthy foods and beverages, with similar policies under consideration in the U.S. and around the world. Research demonstrating food warnings' effectiveness is emerging, but limited scholarship has evaluated the ethics of food warning policies. Using a public health ethics framework for evaluating obesity prevention policies, we assessed the ethical strengths and weaknesses of food warnings along multiple dimensions: 1) Health behaviors and physical health, 2) Psychosocial well-being, 3) Social and cultural values, 4) Informed choice, 5) Equality, 6) Attributions of responsibility, 7) Liberty, and 8) Privacy. Our analysis identifies both ethical strengths and weaknesses of food warnings, including that: 1) warnings are likely to generate important benefits including increased consumer understanding and informed choice, healthier purchases, and potential reductions in obesity prevalence; 2) warnings evoke negative emotional reactions, but these reactions are an important mechanism through which food warnings encourage healthier behaviors and promote informed choice; 3) warnings appear unlikely to have ethically unacceptable effects on social and cultural values, attributions of responsibility, liberty, or privacy. Current research suggests we continue to pursue food warnings as a policy option for improving public health while simultaneously conducting additional research on the ethics of these policies. Future research is especially needed to clarify warnings' effects on stigma and to characterize the balance and distribution of costs of and benefits from implementing warning policies.

Keywords: Food and beverage warnings; ethical considerations; ethics; health warnings; obesity prevention; warning labels.

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Figures

**Figure 1.**
Mock-up of the sugar-sweetened beverage warning proposed by California in 2019.

**Figure 2.**
One of the four health warnings implemented in Chile in 2016. The warning text translates to “HIGH IN SODIUM.”

**Figure 3.**
Summary of evidence that food warnings may be ethically defensible.

See this image and copyright information in PMC

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Ethical Considerations for Food and Beverage Warnings

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Ethical Considerations for Food and Beverage Warnings

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