By Susan Burke March, MS, RD

Consumer education and information are key to making healthful choices. Many countries mandate that packaged foods carry Nutrition Facts Labels depicting nutrients and other ingredients in the food, including energy (calories and kilojoules), additives and potential allergens. The US and EU present the information differently.

The updated 2022 US NFL is superior showing sugars, saturated fats, salt, and additives per serving size. The label is easy to read, with bold text and readable fonts. The EU label is less useful and difficult to read where the print is quite small with very close line spacing. Calories and all nutrients are expressed per 100 g or 100 ml, not serving size, and the label is not required to list as much information about nutrients. Instead of spelling out the name of the food additive, the EU assigns food additives a three- or four-digit code, requiring the consumer to look up the information. Nonetheless, many consumers do not have the time or education to utilize the NFL to make healthful choices. Front-of-package labeling has been shown to help consumers make more nutritionally meaningful choices within acceptable ranges of sugar, fat, saturated fat and salt. Globally, just a few countries mandate FOP labeling. Instead, there is a myriad of schemes in use
to help consumers understand which packaged foods are “healthy” and which are excessively high in calories, sugar, salt or saturated fats. In the US, there is no mandate for FOP labeling, although the FDA is finalizing an update to the term “healthy” to help consumers “build a healthy eating pattern.”

In 2017, the WHO predicted an “obesity crisis of vast proportions by 2030,” and urged governments to do more to restrict unhealthy food marketing and make healthful food more affordable. The European Action Plan on Childhood Obesity plans to limit the marketing and advertising of junk food to children. They concluded, “Experience and evidence point to the fact that voluntary action may require regulatory measures in order to be more effective.”

In Peru, mandatory FOP warning labels were shown to incentivize the food industry to reduce the content of regulated nutrients in products. While in 2016, Chili was the first country to implement FOP warning labels, leading to a 73% drop in children’s exposure to TV
advertisements for food exceeding legal thresholds for calories, sugar, salt or saturated fat.

In May 2020, the European Commission published its Farm to Fork Strategy, promising FOP labeling by the fourth quarter of 2022. One such FOP labeling scheme is the Nutri-Score, “a five-color nutrition label and nutritional rating system,” however, Italy has rejected this scheme and established its own FOP labeling. It is critiqued negatively by others.

Spain leads the EU in obesity where 40% of children are living with obesity or overweight and these rates have doubled in the past 20 years. There is also a significant decrease in physical activity as Spanish adolescents spend an average of 294 minutes daily on screens.
In October 2021 Spain announced a proposed ban on junk food advertisements targeting children on TV, radio, print media, websites, electronic applications, and social media; however, it has not yet been implemented. Further, despite the pronouncements, as of yet, none of the EU countries have mandated FOP labeling.

Research published in May 2023 showed that although there is not one labeling scheme recommended, mandatory FOP labeling does influence food manufacturers’ product reformulation, lowering sodium, sugar, and calories in problematic foods.


After 15 years in car sales and insurance, Susan returned to university in her thirties obtaining her certified diabetes educator credential. She then used her business experience with start-up, helping them become a leading online weight management company.

After working and volunteering for six years in Cuenca, Ecuador, Susan and her husband Ken retired to Valencia, Spain. Susan was the first country representative to Ecuador, and as of June 2021 to Spain. Before moving to Ecuador she volunteered with the Academy of Nutrition and Dietetics’ Weight Management Dietetic Practice Group, serving first as secretary and then as sponsorship relations director.

Susan and her husband are home exchangers, having completed more than 77 exchanges in the past 11 years in the US, Canada, South America, Europe and Oceania. In 2022, they completed seven exchanges in Spain and France, summer exchanges in the Netherlands where Susan met up with the Netherlands’ CR, and with a “digital nomad dietitian” in Amsterdam and Brussels. Susan hopes to meet with more traveling RDNs and CRs this year!