WASHINGTON, Sept. 26 (UPI) -- Puzzling over the serving size in that bag of pretzels? You're not alone. A new study has found the reading and math skills of the average American may not be enough to understand food labels on common grocery store foods.
In fact, as many as 90 million Americans have poor reading skills, making it "challenging for them to navigate the healthcare environment," said the study's lead author, Dr. Russell Rothman, an assistant professor of internal medicine and pediatrics at Vanderbilt University.
The study, which will appear in the November issue of the American Journal of Preventive Medicine, is one of the first research efforts to examine how patients comprehend nutrition labels.
Rothman and colleagues surveyed 200 ethnically and socioeconomically diverse men and women from June 2004 to April 2005, most of whom reported regularly using food labels. The team determined the subjects' literacy and numeracy through two standardized tests. At least 75 percent reported having a high school education, yet only 37 percent had ninth-grade math skills.
The subjects filled out a 24-item measure of food label comprehension, based on a wide range of common grocery items such as microwave dinners and bottles of soda.
Rothman and colleagues discovered only small percentages of the participants were able to understand the labels. For instance, 68 percent of the 200 patients could not figure out how many calories they consumed in a 20-ounce soda bottle that contained 2.5 servings. Likewise, 78 percent of study participants could not discern the amount of net carbohydrates in one serving of low-carbohydrate spaghetti.
The three most common errors a person made were failures to decipher serving size, simple calculation errors in how much they had consumed and distraction by the complexity of the label.
For example, food labels have percent daily value columns that list how a particular food product would fit into the recommended intake of a person's 2,000-calorie diet. The labels also break down the total allotment of, say, fiber for the day. Some participants were looking at the 25 grams of fiber listing on this percent daily value column and wrongly thinking the product had 25 grams of fiber in it, Rothman said.
Even when the team adjusted for race and education status, basic literary and numeracy skills were correlated with the ability to read labels. People with lower literacy and numeracy skills, not surprisingly, had more trouble understanding the packages. But even patients with higher literacy -- 68 percent had at least some college education -- had difficulties.
However, as with any cross-sectional study, this research does not show causation, only an association between lower literacy and numeracy and poor food label comprehension.
Rothman was also concerned to find the patients who were overweight and suffering from chronic illnesses -- or those who would benefit most from making healthy food decisions -- did worse than the others in comprehending the labels.
Designing diets based on nutrition labels is a crucial tool for many people with illnesses such as diabetes, heart disease and hypertension. Many diet plans from major non-profit organizations such as the American Heart Association as well as individual dieticians require patients to study food labels.
The researchers also looked at patient understanding of low-carbohydrate diets, a relatively new line of products that are not well-regulated by the U.S. Food and Drug Administration.
The participants represented a diverse enough group that the findings can be generalized to the rest of the United States, Rothman said. In fact, greater deficits in nutrition label understanding could have been apparent if the study was done in a larger population.
To Susan Moores, a registered dietician and spokesperson for the American Dietetic Association, it's no surprise people are befuddled by their food choices.
"I see a lot of furrowed eyebrows looking over nutrition labels -- trying to do the right thing, but struggling with the language," Moores said.
Moores pointed out the FDA is already aware of the problems with labeling. For instance, there are some proposals to change the labels on soda bottles. A person is not realistically going to drink one serving of soda in a bottle that has 2.5 servings; he's going to drink the whole bottle, Moores said.
And with all the hubbub over labels, people might overlook the fact that, in general, foods recommended for a healthy diet don't have labels at all. Produce, lean meats and fish -- "the simple foods," as Moore calls them -- are not only better for you, there's no need to jump through hoops to figure out whether they are good choices.
And for the times when people do need to read labels, Moores advises patients to tackle the grocery store aisle by aisle, gradually, and to avoid trying to understand labels from apple sauce to waffles in one shopping trip.
Overall, the study should be a great "aha" for the FDA to really see what people struggle with, as well as inform future policies on nutrition, Moore said.
Rothman agrees, adding there are opportunities for food companies and the FDA to improve food labels. For example, the agency may want to consider removing some of the extra information on the label, since many consumers might be more distracted than informed.
Consumers should also not shy away from consulting their healthcare providers if they have difficulties grasping labels, and likewise providers should be more diligent about educating their patients about nutrition.
Rothman and colleagues intend to continue researching the topic, and they have already begun intervention studies looking at how to better educate people about labels.
