Do Food Packaging Health Claims Depict Healthiness or Mislead Patients?

Introduction: Primary care physicians advise patients to select and consume healthy foods. But as patients shop their grocery aisles, will food packaging health claims direct them to healthy foods? The argument has been made that such claims might predominantly appear on unhealthy foods. This study investigated whether health claims on front packaging reliably indicated healthier food choices and thus could be used by physicians to guide their patients' shopping choices. Methods: From Walmart.com, we sampled 597 items spanning 122 categories of the most commonly consumed foods and beverages in America according to the National Health and Nutrition Examination Survey 2017-2020 database. Two researchers analyzed each product's front packaging to identify US Food and Drug Administration-approved health claims, nutritional content claims, and functional claims. We evaluated each product's nutritional facts box to derive an overall numerical nutritional score using the Nutri-Score scheme, representing healthiness. Results: The number of packaging health claims was not associated with healthiness of foods either in aggregate or within any of the 11 standard food and beverage categories. Food categories traditionally perceived as healthy (eg, fruits, vegetables, grains) generally scored higher in healthfulness compared to categories associated with less healthy choices (eg, snacks, sweets, fats, and oils). Conclusions: We cannot recommend that patients rely on food packaging health claims to identify healthy or unhealthy foods. Instead, we encourage physicians to advise patients to choose foods from known healthy categories and ignore front-of-package health claims.