Projecting the Impacts of Sugar-sweetened Beverage Warning Labels and Restaurant Menu Labeling Regulations on Energy Intake, Weight Status, and Healthcare Expenditures in US Adults: A Microsimulation

Abstract Background Accurate, readily accessible, and easy-to-understand nutrition labeling is a promising policy strategy to address poor diet quality and prevent obesity. Objective This study projected the impacts of nationwide implementation of sugar-sweetened beverage (SSB) warning labels and restaurant menu labeling regulations. Design A stochastic microsimulation model was built to estimate the impacts of SSB warning labels and menu labeling regulations on daily energy intake, body weight, body mass index (BMI), and healthcare expenditures among US adults. Participants/setting The model used individual-level data from the National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, and other validated sources. Statistical analyses performed The model was simulated using the bootstrapped samples, and the means and associated 95% confidence intervals (CIs) of the policy effects were estimated. Results SSB warning labels and restaurant menu labeling regulations were estimated to reduce daily energy intake by 19.13 (95% CI=18.83, 19.43) and 33.09 (95% CI=32.39, 33.80) kcal, body weight by 0.92 (95% CI=0.90, 0.93) and 1.57 (95% CI=1.54, 1.60) kg, BMI by 0.32 (95% CI=0.31, 0.33) and 0.55 (95% CI=0.54, 0.56) kg/m2, and per-capita healthcare expenditures by $26.97 (95% CI=26.56, 27.38) and $45.47 (95% CI=44.54, 46.40) over ten years, respectively. The reduced per-capita healthcare expenditures translated into an annual total medical cost saving of $0.69 billion for SSB warning labels and $1.16 billion for menu labeling regulations. No discernable policy effect on all-cause mortality was identified. The policy effects could be heterogeneous across population subgroups, with larger effects in men, non-Hispanic Black adults, and younger adults. Conclusions SSB warning labels and menu labeling regulations could be effective policy leverage to prevent weight gains and reduce medical expenses attributable to adiposity.