August/September 2020 Issue
Ask the Expert: PACE Labeling
By Toby Amidor, MS, RD, CDN, FAND
Today’s Dietitian
Vol. 22, No. 7, P. 10
Q: Lately, I’ve been hearing about PACE labeling as a calorie reduction tool for consumers. Can you explain what it is and the scientific evidence behind it?
A: Physical Activity Calorie Equivalents, or PACE, is a type of food label that lists how many minutes of a specific activity (eg, walking or running) one needs to do to “burn off” the number of calories in a serving of the food. While evidence suggests PACE labeling may help consumers reduce calorie intake, its methods have been criticized by many RDs.
In 2016, the Royal Society for Public Health (RSPH), an independent nonprofit organization based in the United Kingdom, introduced PACE labeling in a position paper as a way to tackle obesity.1 In the paper, which has spurred research on the method, the organization showcased sample PACE labels using 10 calorie-dense foods and drinks and their activity equivalents. For example, a standard chocolate bar with approximately 229 kcal will take 42 minutes to walk off at 3 to 5 MPH and 22 minutes at a slow run at 5 MPH. The objective of PACE labeling is to encourage consumers to be more mindful of the calories they consume and how these calories relate to their everyday lives, and to encourage them to be more physically active.
The Research
A 2020 meta-analysis compiled 15 studies to determine whether PACE labeling encourages more healthful food choices and reduces the risk of chronic disease. Researchers found that when PACE labeling was present on a food, beverage, or menu, participants selected items with significantly fewer calories (about 65 kcal per eating occasion, leading to about 200 kcal fewer per day) compared with other forms of labeling or no labeling.2
In a 2019 study, PACE labeling was compared with calories-only labels in three worksite cafeterias (including 366 participants) for one year. One cafeteria used PACE labeling, while the other two used calories-only labels. The PACE labeling group had a 13% to 26% increase in self-reported physical activity and a 24-minute increase in moderate to vigorous activity compared with the calories-only label group, a small but positive effect.3
In January 2020, RSPH released a statement saying that the organization has refocused its efforts toward understanding how a person’s environment affects his or her lifestyle choices and possibly makes healthful living more difficult.4
RDs Weigh In
Some RDs believe PACE labeling would help their clients more easily conceptualize calories in terms of energy—but only in the context of nutrition counseling on how calorie quality differs between foods.5 Other RDs, however, express concerns about the entire method.
Heather Mangieri, RDN, a nutrition consultant and author of Fueling Young Athletes, says PACE labeling “would do more harm than good, and would create a long list of unintended consequences.” Mangieri believes exercise is meant to support health and happiness and maintain or improve a person’s fitness level and shouldn’t be measured via calories in and calories out. “Exercise should never be portrayed as a way to burn off the calories that we get from food. It’s a privilege, not a punishment that needs to be done in exchange for eating,” Mangieri says.
Cookbook author and certified athletic trainer Dana Angelo White, MS, RD, ATC, agrees with Mangieri and adds, “A system like this adding to an already confusing food labeling system makes me extremely nervous. While I agree most people don’t have a firm grasp on the calorie content of many foods, a system like this emphasizes hyper focus on calorie counting and perpetuates an unhealthy relationship between food and exercise.” White says PACE labeling could create feelings of guilt around eating and, at worst, send those who suffer from or have a history of eating disorders into a tailspin of dangerous thinking and behaviors.
Recommendations for Clients
At this time, it doesn’t appear that PACE labeling will appear on food packaging anytime soon. However, there are other ways for nutrition professionals to help clients understand calories and energy balance. Mangieri says RDs can help clients understand calories vs activity using tools such as a food journal, helping clients evaluate their entries. “Just taking the time to write [in the journal] and evaluate patterns is sometimes enough to identify eating behaviors that can be changed,” she says.
In addition, RDs should help clients understand how calories nourish them, encouraging a wide variety of nutrient-dense foods and exploring how to fit their favorite foods into a healthful eating plan. Mangieri says “understanding how food impacts health, weight management, and mood is where all effort should be, not on trying to balance numbers.”
— Toby Amidor, MS, RD, CDN, FAND, is the founder of Toby Amidor Nutrition (http://tobyamidornutrition.com) and a Wall Street Journal best-selling author. Her cookbooks include Smart Meal Prep for Beginners, The Easy 5-Ingredient Healthy Cookbook, The Healthy Meal Prep Cookbook, The Greek Yogurt Kitchen, and the recently released The Best Rotisserie Chicken Cookbook and The Create-Your-Plate Diabetes Cookbook. She’s a nutrition expert for FoodNetwork.com and a contributor to U.S. News Eat + Run and Muscle&Fitness.com.
References
1. Royal Society for Public Health. Introducing “activity equivalent” calorie labelling to tackle obesity. https://www.rsph.org.uk/uploads/assets/uploaded/26deda5b-b3b7-4b15-a11bea931dabf041.pdf. Published January 2016.
2. Daley AJ, McGee E, Bayliss S, Coombe A, Parretti HM. Effects of physical activity calorie equivalent food labelling to reduce food selection and consumption: systematic review and meta-analysis of randomised controlled studies. J Epidemiol Community Health. 2020;74(3):269-275.
3. Deery CB, Hales D, Viera L, et al. Physical activity calorie expenditure (PACE) labels in worksite cafeterias: effects on physical activity. BMC Public Health. 2019;19(1):1596.
4. Activity equivalent labelling. Royal Society for Public Health website. https://www.rsph.org.uk/our-work/policy/obesity/activity-equivalent-labelling.html. Updated January 2020.
5. Rosenbloom C. Why labeling food items with the exercise needed to burn off their calories is a bad idea. The Washington Post. January 22, 2020. https://www.washingtonpost.com/lifestyle/wellness/why-labeling-food-items-with-the-exercise-needed-to-burn-off-their-calories-is-a-bad-idea/2020/01/21/7490eb62-37e8-11ea-9541-9107303481a4_story.html