D'Angelo Campos Aline, Grummon Anna H, Ng Shu Wen, Puhl Rebecca M, Golden Shelley D, Hall Marissa G
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
Carolina Population Center, University of North Carolina at Chapel Hill.
JAMA Netw Open. 2025 Jun 2;8(6):e2516821. doi: 10.1001/jamanetworkopen.2025.16821.
Front-of-package food labels (FOPLs) about nutrient content and health effects are a promising policy to improve diet quality but may also contribute to harmful weight stigma.
To assess whether different types of FOPLs impact perceived weight stigmatization, whether weight-neutral label content mitigates stigmatization, and possible trade-offs between perceived stigmatization and effectiveness.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial with a between- and within-participant design used a single-exposure online survey conducted from January 18 to 26, 2024. Participants were US adults aged 21 years or older recruited using an online crowdsourcing research platform.
Participants were randomly assigned 1:1:1:1 to 1 of 4 types of FOPLs applied to sugary beverages: control labels, nutrient warnings (ie, indicating beverages high in calories or added sugar), text-only health warnings, or graphic health warnings (ie, indicating beverages were linked to obesity, diabetes, and tooth decay). In random order, participants viewed 2 versions of their assigned label type differing on whether the content referenced calories and obesity (ie, standard version) or not (ie, weight-neutral version).
The primary as-treated outcome was perceived weight stigmatization. Secondary outcomes were perceived message effectiveness, attributional judgments of responsibility for weight, and explicit weight bias.
A total of 2522 participants completed the experiment (1262 [50%] women; mean [SD] age, 44.3 [15.2] years). Among standard labels, graphic warnings (mean differential effect [MDE], 0.81; 95% CI, 0.71-0.92) and text-only warnings (MDE, 0.41; 95% CI, 0.30-0.51) were perceived as more stigmatizing than control labels, while nutrient warnings were not (MDE, 0.003 [95% CI, -0.10 to 0.11]; P = .96). Weight-neutral labels were perceived as less stigmatizing than their respective standard versions (range: MDE, -0.66 [95% CI, -0.72 to -0.60] for graphic health warnings to -0.08 [95% CI, -0.14 to -0.02] for nutrient warnings). Weight-neutral versions were perceived as less effective than standard versions for nutrient warnings (MDE, -0.11; 95% CI, -0.16 to -0.06) and graphic health warnings (MDE, -0.05; 95% CI, -0.10 to -0.001) but not for text-only warnings. Graphic and text-only warnings did not affect explicit weight bias, while nutrient labels led to a small bias reduction (MDE, -0.08; 95% CI, -0.16 to -0.002).
In this randomized clinical trial of FOPLs, nutrient warnings performed best compared with other FOPL types at simultaneously maximizing perceived effectiveness and minimizing perceived stigmatization. Labels perceived as more stigmatizing were not consistently perceived as more effective. Removing references to obesity from health warnings reduced stigmatization without meaningfully reducing perceived effectiveness.
ClinicalTrials.gov Identifier: NCT06179043.
关于营养成分和健康影响的食品包装正面标签（FOPL）是改善饮食质量的一项有前景的政策，但也可能导致有害的体重歧视。
评估不同类型的FOPL是否会影响感知到的体重歧视，体重中性标签内容是否能减轻歧视，以及在感知到的歧视和有效性之间可能存在的权衡。
设计、背景和参与者：这项采用组间和组内设计的随机临床试验使用了2024年1月18日至26日进行的单次暴露在线调查。参与者是通过在线众包研究平台招募的21岁及以上的美国成年人。
参与者被随机1:1:1:1分配到应用于含糖饮料的4种FOPL类型中的1种：对照标签、营养警告（即表明饮料高热量或添加糖含量高）、纯文本健康警告或图形健康警告（即表明饮料与肥胖、糖尿病和龋齿有关）。参与者按随机顺序查看其分配的标签类型的2个版本，这两个版本在内容是否提及卡路里和肥胖方面有所不同（即标准版本）或未提及（即体重中性版本）。
主要的实际治疗结局是感知到的体重歧视。次要结局是感知到的信息有效性、对体重责任的归因判断以及明确的体重偏见。
共有2522名参与者完成了实验（1262名[50%]为女性；平均[标准差]年龄为44.3[15.2]岁）。在标准标签中，图形警告（平均差异效应[MDE]，0.81；95%置信区间，0.71 - 0.92）和纯文本警告（MDE，0.4
