Product Reformulation in Response to the 2016 FDA Updated Nutrition Facts Label.

Importance: In 2016, the Nutrition Facts label was updated to emphasize calories and report added sugars, potentially encouraging manufacturers to improve the nutritional profiles of packaged foods. However, changes in nutritional profiles after adoption of revised Nutrition Facts labels have not been evaluated. Objective: To examine, by food group, whether adoption of the revised Nutrition Facts label was associated with changes in nutrient content or serving size among packaged foods. Design and Setting: This cohort study used a staggered difference-in-differences analysis to compare changes in the nutritional profiles of packaged foods between brands that adopted the revised Nutrition Facts label earlier and those that adopted it later. Products belonging to 1 of 15 mutually exclusive food groups likely to be affected by the label change (eg, bread, candy, and sugar-sweetened drinks) and sold at a large northeastern supermarket chain of 185 stores between January 2016 and December 2019 were included. Data were analyzed between July 2025 and March 2026. Exposure: Adoption of the revised Nutrition Facts label between August 2016 and December 2019. Main Outcomes and Measures: Primary outcomes included changes in serving size and in number of calories and total sugar per serving. Secondary outcomes included calorie density (calories per 100 g or 100 mL) and total sugar density (grams of total sugar per 100 g or 100 mL). Exploratory outcomes included other nutrients not directly targeted by the label changes. Results: The sample included 12 097 products available both before and after their brands adopted the updated label. Among these products, no evidence of substantive reformulation of packaged foods in response to label adoption was found across the primary and secondary outcomes. For example, the largest significant change in calorie density was a decrease of 8.3 (95% CI, -16.4 to -0.1) calories per 100 g among nut products; in most food groups, no changes occurred across the primary outcomes. Additionally, there were few differences between the nutritional profiles of products introduced before (n = 4570) and after (n = 4806) label adoption and between products discontinued before (n = 3510) and after (n = 5852) label adoption. Conclusions and Relevance: This cohort study found that changes to the Nutrition Facts label did not meaningfully alter the nutritional profiles of packaged foods. Stronger interventions, such as front-of-package labels, are warranted to encourage reformulation of packaged foods by the food industry and improve the nutritional quality of packaged foods purchased in the US.