Front-of-Package Food Labels and Perceived Weight Stigmatization: A Randomized Clinical Trial.

Importance: 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. Objective: 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. Interventions: 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). Main Outcome and Measures: 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. Results: 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). Conclusions and Relevance: 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. Trial Registration: ClinicalTrials.gov Identifier: NCT06179043.