In a newly published Concise Clinical Guidance, the American College of Cardiology (ACC) endorsed front-of-package nutritional labeling, an approach already used in 44 countries designed to steer people toward healthier choices at the grocery store, according to Kim Allan Williams Sr, MD, who is a cardio-nutrition specialist and led the guidance writing committee.

Williams, who is also chair of the Department of Medicine at the University of Louisville School of Medicine, Louisville, Kentucky, spoke with Medscape Medical News about the background and goals of the front-of-package labeling initiative.

In preventive health, eating healthy is a standard refrain, but what are the goals behind the new Concise Clinical Guidance?

Americans are digging their graves with their forks. About 80% of our healthcare budget in the US is spent on preventable diseases, and the majority of that prevention involves better nutrition. Heart disease starts at the grocery store. Yet with inconsistent information about products, further confounded by unsupported or misleading claims on the packaging, informed choices in the grocery aisle are not easy.

What is so important about moving labeling to the front from the back, where it has been mandated for almost all packaged foods in the US since 1994?

Early in 2025, just days after I agreed to head the writing committee for this guidance, the FDA endorsed the same approach. Although the current labels are helpful when studied by educated consumers, front-of-package labeling simplifies the information. The FDA proposed terms like low, medium, and high risk. We recommend color coding or traffic-light labeling. In either case, these labels immediately alert consumers about nutritional value at the first encounter.

What about a product that has multiple ingredients, some of which are healthy or at least impose no risk and others that are not?

Many nutrients are and should be considered as continuous variables in regard to risk and benefit. Front-of-package labeling is about nutrition literacy. We have the data for evidence-based daily recommendations for common food ingredients, such as sodium, added sugar, and cholesterol. With a stoplight-like approach we can use green, yellow, and red to differentiate foods with low risk in normal daily quantities, increased risk when higher quantities exceed a specific threshold, and foods that pose a high risk.

What about heavily salted prepackaged French fries? A red label?

Potatoes are good. Excess salt is bad, but the goal is to help consumers make their own choices in the context of their daily diet once informed about relative risks. Processed meat, for example, is considered a group 1 carcinogen by the World Health Organization. When food is labeled accurately, we would hope that consumers would buy processed meat far less often rather than every day, as many people do. Saturated fats are not unhealthy when consumed in moderation, but it is important to have labels that explain that 6 g of fat might be acceptable for a given meal, but that there are meaningful health risks if 10 g/d is exceeded routinely in a high-risk individual.

Is there any disagreement about what constitutes good nutrition or are there any knowledge gaps?

The 2019 ACC/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease (section 3.1) is a good source of an evidence-based nutritional guidance, particularly as it relates to the cardiovascular system. In the time since that guideline was published, the data supporting these recommendations have only become stronger. The existing data are clear even if there is more to learn. We can lower the risk for many diseases related to the cardiovascular system, the kidneys, and other major organs by a well-balanced diet. We need to act on this information.

Is there sufficient evidence to support current nutritional recommendations even without a long-term randomized trial to definitively show mortality benefits?

The preponderance of evidence is overwhelming. These data include numerous short-term randomized trials showing meaningful reductions in well-established risks for cardiovascular disease, including weight, elevated blood pressure, and hypercholesterolemia. In addition to huge databases that have supported the favorable impact of diet on the risk for disease, we also have large prospective evidence from powerful research conducted over decades, such as Adventist health and Harvard’s Health Professional Follow-Up and Nurses’ Health Studies. Any one of these can be challenged for potential flaws because they are long-term observational studies, but they all point in the same direction. Good nutrition reduces risk factors for major chronic diseases.

In warning labels about unhealthy food, do you envision the type of labeling that is now used to discourage tobacco use?

We could certainly borrow some of the strategies used to reduce smoking, not least of which might be laws to prevent marketing of unhealthy foods to children. In Quebec, Canada, there has been a cigarette-like ban on this kind of advertising since 1980. A similar Canada-wide ban is being considered but has not yet has been implemented. If we can prevent marketing of unhealthy food to children, we could reasonably expect a large favorable impact on national health.

Are there other target populations besides children?

Growing up on the South Side of Chicago, I saw a large racial disparity in access to healthy foods and much higher rates of unhealthy nutrition, but now, living in Kentucky, I can see it is a shared health issue for those with low income not limited by race. More hours in front of the television exposed to advertising of unhealthy foods is likely one factor, but there are other issues, including access to fresh fruits and vegetables. But unhealthy eating is the norm not the exception, even in more well-off individuals. In a 2025 study we published, 40% of cardiologists reported they routinely recommend a plant-based diet to their patients. Only 8% followed this diet themselves.

Will front-of-package labeling help?

It is not the only answer, but, yes, I do think clear labeling, particularly the use of color codes that draw immediate attention to the harm of highly processed foods, will help create momentum for awareness and demand for healthier food.

Now that there are effective weight-loss drugs, does this change the urgency for educating the public about food?

Not at all. Weight is not the only piece of the puzzle. To achieve the types of major reductions in cardiovascular disease, kidney disease, stroke, and many other health problems, we need to actually fix the food chain. Food is medicine, and clear labels can serve as the prescription pad. This is absolutely a critical message.

How do you see this new Concise Clinical Guidance being employed to advance the message?

There would certainly be no harm if the document was widely read by the general public, but we do hope clinicians will reproduce some of the tables and figures to hang on their walls in the clinic or to provide to patients as a handout. We are well aware of how difficult it is in a busy clinical practice to provide detailed advice about pursuing a healthy diet, but raising the topic and providing practical tools to reach nutritional goals could prompt the fundamental change we need. Front-of-package labeling is part of this.