Table 1.

Ethical considerations, summary of ethical analysis, current conclusions, and areas for future research for food and beverage warnings.

Ethical consideration Key question	Summary of ethical analysis	Current conclusion	Possible areas for future research
Health behaviors and physical health To what extent do food warnings encourage healthier behaviors and promote physical health?	Warnings promote healthier purchases.^12–14 Warnings could prompt industry reformulation, which could improve the healthfulness of the food supply^15,44,45 and consumers’ purchases.⁵⁰ Simulation modeling studies project that implementing warnings could reduce obesity prevalence.^40,41	Positive health effects are likely.	What is the trajectory of warnings’ effects on behavior and health over time? To what extent do warnings spur product reformulation? Does reformulation bring additional health benefits? What are warnings’ effects on diabetes, heart disease, and other diet-related diseases? Do warnings have synergistic effects with other nutrition policies such as taxes or marketing restrictions?
Psychosocial well-being To what extent do food warnings promote or diminish positive psychosocial well-being?	Warnings generate short-term negative emotions.^12,13,56 However, these emotional responses are productive reactions that help warnings achieve their beneficial effects such as promoting informed choice^54,59–62 and changing behavior.⁵² Warnings may reduce enjoyment by reducing consumption of foods consumers find pleasurable.⁶³ On the other hand, warnings could improve psychosocial well-being if consumers feel happier after making healthier dietary choices.⁶⁴ Whether warnings’ emotional consequences are ethicallyjustifiable will depend on the magnitude of their long-term costs and benefits as well as their nature, prevalence, intensity, and duration. Graphic warnings depicting images of people with obesity could increase some forms of weight stigma,³⁰ but limited research has examined this question. Food warnings that do not describe obesity may be less likely to increase stigma. Studies have not found that warnings worsen body image³⁰ or contribute to disordered eating,⁷¹ but limited research has examined these outcomes.	Negative psychosocial consequences are possible, but may be justifiable.	To what extent to warnings increase stigma? How can warnings be designed to minimize stigma? To what extent do warnings worsen body image? To what extent do warnings affect disordered eating?
Social and cultural values To what extent do food warnings interfere with cultural or social values?	Studies have not examined whether warnings diminish feelings of identity, community, or belonging that consumers may get from eating particular foods. Research has not yet examined whether warnings differentially affect foods that have cultural or social importance to particular groups. Existing food warning policies use objective nutrient profiling systems to determine what products trigger mandatory warnings.⁷³ These systems are unlikely to single out foods from particular cultural or ethnic groups. Warnings do not prevent people from buying or consuming socially or culturally important products.	Interference with social and cultural values is unlikely.	Do current or proposed warning policies require warnings on foods or beverages with cultural or social importance? If so, to what extent do warnings reduce positive feelings of identity, community, or belonging? What groups are most affected?
Informed choice To what extent do food warnings promote consumers’ informed choosing without subjecting them to unacceptable manipulation?	Warnings increase understanding of products’ healthfulness.^80–85 Warnings also activate this understanding by making it salient in consumers’ minds at the point of purchase.^12,13,56 Warnings evoke emotions, and emotions are part of how warnings change behavior. However, warnings’ emotionality does not make them unacceptably manipulative, because these emotional responses are necessary for warnings to inform,^60–62 are appropriate responses that improve reasoning,^95,96 and could “level the playing field” against manufacturers’ arguably manipulative narratives about their products.^97,98 Warnings may help consumers feel more in control of their eating choices.⁹⁹	Promotion of informed choice is likely.	How can warnings be designed to maximize their effects on consumers’ understanding of product healthfulness? What types of warnings increase consumers’ feelings of control?
Equality To what extent are the costs and benefits of food warnings fairly distributed?	Warnings have similar effects on consumer understanding,^80,81,105 behavioral intentions,^80,81 and purchase behaviors¹² across diverse groups, suggesting they are unlikely to exacerbate underlying disparities in these outcomes. Warnings could reduce disparities in diet-related diseases,⁴⁰ but limited research has examined this question.	Increased equality is possible, but more research is needed.	What is the distribution of costs and benefits of warning policies in real-world settings (i.e., in jurisdictions where warnings have been implemented)? How can warnings be designed to maximize their potential to enhance equality?
Attributions of responsibility To what extent do food warnings imply a fair division of who is responsible for dietary behaviors and health?	Because one goal of warnings is to change individual consumer behavior, warnings might suggest to the public that consumers are primarily responsible for their own diet and health.³² Warnings can also be designed to spur reformulation,^15,50 which could shift implied responsibility for diet and health toward industry. Limited research has examined these two possibilities.	Acknowledgement of responsibilities of various entities is possible, but more research is needed.	Does proposing or implementing a food warning policy increase the public’s perception that individuals are the primary entity responsible for diet and health? Is this reaction attenuated when policies are explicitly designed to encourage reformulation?
Liberty To what extent do warnings constrain liberty or freedom of choice?	Warnings do not ban consumers from buying or consuming products, so warnings have little or no impact on liberty.	Constraints on liberty are negligible.	Not applicable.
Privacy To what extent do food warnings intrude on privacy?	Warnings do not require the government to gather any personal information from consumers, so warnings have little or no impact on privacy.	Intrusions on privacy are negligible.	Not applicable.

Note. Ethical considerations are drawn from ten Have and colleagues’ ethical framework for evaluating obesity prevention programs and policies.³²