Beyond Added Sugar Reduction: A Narrative Review of Policies to Address Nonsugar Sweeteners

This perspective provides policymakers, advocates and researchers with a description of proposed and enacted policies that assist consumers in identifying products with nonsugar sweeteners (NSSs) and/or reduce NSS exposure. Consumption of NSSs is associated with multiple chronic diseases. NSS exposure is increasing as food and beverage manufacturers replace added sugars with NSSs. We conducted a narrative review to identify public policies addressing NSSs, focusing on the United States while also considering the international context. A policy scan identified relevant polices through: 1) review of a United States sweetened beverage policy database, 2) systematic searches of 5 online United States policy databases and PubMed, 3) review of a World Health Organization food policy database, 4) survey of NSS policy experts, and 5) review of policies known to the research team. Searches were conducted between November 2024 and February 2025. We describe a selected subset of identified policies in more detail as illustrative examples based on adequacy of NSS definition, impact, feasibility, equity, and comprehensiveness (extent of products included). We identified 416 proposed or enacted policies and classified them into 9 groups: bans and restrictions on NSS use (n = 26), excise taxes (n = 106), sales taxes (n = 67), food package labels and disclosures (n = 47), healthy retail (n = 2), procurement and nutrition standards (n = 71), Supplemental Nutrition Assistance Program benefit restrictions (n = 54), Special Supplemental Nutrition Program for Women, Infants, and Children nutrition standards (n = 7), restaurant healthy default beverages (n = 34), and marketing restrictions (n = 2). Innovative policy options included banning NSSs in products sold to minors, prohibiting misleading sweetener labeling, closing United States Food and Drug Administration approval loopholes permitting the use of NSSs that may lack adequate and transparent safety data, and restricting NSS advertising on public transportation. We conclude that many options for reducing potential harms from NSSs are available. Public policies with the greatest potential impact are bans or restrictions on use, excise taxes, and front-of-package warnings and disclosures.