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Understanding Nutrition Labels Latest Vital Sign?

As health professionals, we often assume that our patients understand what we tell them and can read the information sheets we expect them to understand.

But surprisingly often, even in a country like Canada, this is not the case. Thus, there is an increasing movement to make the assessment of a patient’s ability to follow health care instructions part of any first-time medical assessment of any patient (From personal experience, I would even include people with higher secondary college or university degrees in this).

In fact, health literacy, defined as the ability to read, understand, and act on health information has now been designated a new vital sign – the assessment of which, may be as important as measuring blood pressure, heart rate, or temperature.

To patients, failure to understand and appropriately act on health information (e.g. appropriate use of prescription drugs, self-monitoring, following a diet plan, etc.) may be as dangerous and detrimental to health as having any of the other vital signs out of whack.

To address this issue, the Public Health Group of Pfizer Inc., has developed a bilingual (English and Spanish) screening tool that assesses basic literacy and numeracy skills and identifies patients at risk for low health literacy. The tool can be administered in a clinical setting in just three minutes and provides valid information about the patient’s ability to understand simple health information.

The test called The Newest Vital Sign (NVS) has been studied by health literacy experts at the University of Arizona College of Medicine and the University of North Carolina and is described in a paper published in the Annals of Family Medicine.

Interestingly, the test is based on a nutrition label from an ice cream container. Patients are given the label and then asked 6 questions about how they would interpret and act on the information contained on the label.

Patients can and should retain the label so they can refer to it while answering questions. It is not necessary to give the patient time to review the label before asking the questions. Rather, they will review the label as they are asked and answer the questions.

The questions are asked orally and the responses recorded by a health care provider on a score sheet, which contains the correct answers. Based on the number of correct responses, the health care provider can assess the patient’s health literacy level.

If the test results indicate a patient has limited health literacy skills, providers can resort to simple health communication techniques to help patients better understand their medical issues and follow instructions.

It may be a good idea to spend these three minutes in any health care encounter with a new patient prior to embarking on explaining even the simplest care plan (like keeping a food diary), no word of which the patient may actually understand.

Edmonton, Alberta

Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, & Hale FA (2005). Quick assessment of literacy in primary care: the newest vital sign. Annals of family medicine, 3 (6), 514-22 PMID: 16338915


  1. As somene who generally reads all food labels and scored as literate on this questionnaire I would also add that it is a lot of work and very confusing. Many things that can throw me off e.g. serving sizes that are not realistic.

    Also – what kind of ice cream is this? The ingredient list is actual food (except carageenan which is debatable) – very unlike most of the ice cream in our supermarkets. And that’s another confounding factor: incomprehensible ingredients lists – usually a sign to put the item back on the shelf..

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  2. What a great resource! Thank you! You have reminded me that failure to follow advice may not be all about being stubborn or lazy. It’s likely I have been wasting my patient’s time by not realizing his comprehension is reduced. You have led me to an in-depth resource for MY learning!

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  3. I am a conscientious reader of labels and follower of instructions, but have found that as printing technology advances , labels on drugs and foods become smaller and smaller, and my eyes are getting worse,I can’t read them unaided, so I have to go digging around for a magnifying glass in addition to my glasses. Inevitability, sometimes I do not get it together to do what I have to do to read the label. Over the counter drugs are the worst. Greater compliance could be gained by simply setting and enforcing standards of readability.

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  4. Maybe health professionals should test eye sight at the same time. When I was in the UK recently, I had to strain to read the food information on the back of packets, because it was all in 3-point type. They really don’t want you knowing what’s in the packet!

    What’s wrong with all of this is that we now need a degree in nutrition before we can eat anything.

    I live in central Europe, where there are very strong food laws. Things have to be what they say they are – a sausage has to be 80% meat, not a tube filled with one part offal to nine parts chemical flavourings. Baby food that advertises itself as apple and banana has apple and banana in it, with some ascorbic acid for preservation e.g. it’s not apple and banana flavouring on something else.

    Compare that to the Anglophone world, where nothing is what it seems and you have to be constantly vigilant to make sure what you’re buying is actual food. All the onus is on us, the consumers – there is no corporate responsibility at all. They are allowed to say a strawberry drink is ‘all natural flavours’, even if the ‘natural’ flavours come from beetroot and crushed bugs. They have adhered to the letter of the law, even though most of us would assume that something called ‘strawberry’ and ‘natural’ has strawberries in it.

    And, having swallowed the beetroot and crushed bugs, we’re told we’re stupid for not being more nutritionally aware!

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  5. Just wondering, had anyone evaluated this tool?

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