Abstract
To stem the increasing incidence of non-communicable diseases (NCDs) and obesity, front-of-pack labels (FOPLs) have been developed since 1989. Whereas several countries have already adopted one voluntarily, the European Community wants to harmonize an FOPL system that will be mandatory for all member states. The purpose of this narrative review is to describe what could be achieved or not by FOPLs, and to discuss if there is enough evidence to establish whether such labels are effective in modifying purchasing behavior, in directing individual dietary patterns towards a healthy and sustainable diet, and in reformulating food products by the food industry. Non-directive FOPLs, which are still under study, appear to be informative and well-accepted by consumers even if they require a cognitive effort. Conversely, directive FOPLs are supported by several studies, but they are mostly conducted in simulated scenarios and/or performed as retrospective studies. Nevertheless, directive FOPLs are rated as an intuitive tool, and they have demonstrated a high capacity to help consumers rank food products as more or less healthy. In conclusion, directive and non-directive FOPLs convey different messages. No FOPL individually can be considered exhaustive in relation to all the objectives outlined in this narrative review, and therefore, the development of a model synthesizing both messages is advisable. Many questions remain open, such as the possibility of reformulating pre-packaged products, how to deal with traditional products, and the impact on the incidence of NCDs and obesity. In the light of the complexity of factors that condition consumption choices and health, none of the current FOPLs can be considered a health policy tool on its own. The possibility of development remains open, but as the state of the art, these tools do not seem to be able to achieve all the European Community goals together. We can speculate that they could meet these goals only if they are integrated into a multi-tiered, structured health policy intervention.
Highlights
To stem the increasing incidence of non-communicable diseases (NCDs) and obesity, frontof-pack labels (FOPLs) have been developed since 1989
The Joint Research Centre (JRC) [3] reports an estimate from 2008–2009, when about 48% of products displayed an FOP label
It is essential to underline that: the European Commission plans to adopt a harmonized FOP labeling system that will be mandatory for all member states by 2022, this system should be based on an nutrient profile (NP) that is still awaiting validation and definition; with regard to the nutrients relevant to public health, according to EFSA’s opinion, it is worth highlighting that different labels currently take into account different compounds, including nutrients that are not directly recommended by national dietary guidelines or by WHO; with regard to the reference quantity, most of the evaluative/directive FOPLs refer to 100 g or 100 mL, which is not useful for directing the consumer towards a choice that is congruent with personal needs
Summary
The Codex Alimentarius Commission has identified three types of information to be included in nutrition labeling [8]: nutrient declarations, health and nutrition claims, and supplementary nutrition information. The NP (Regulation (EC) 1924/2006 Article 11) is a tool for identifying the intake thresholds of specific nutrients NP was used as a basis for the development of some FOP labeling models (e.g., Multiple Traffic Light, Health Star Rating, Nutri-Score), resulting in the attribution of specific symbols, colors, or nutritional scores They can be useful for regulating the marketing of products to specific population groups (e.g., children), preventing NCDs, and promoting consumer health [11]. There are some inherent difficulties in establishing nutrient profiles at the EU level, such as the application of nutrient intake recommendations for the general diet to individual foods, the lack of uniform data on the composition and consumption of foods across the EU, and differences in nutrient intake recommendations and dietary guidelines within EU countries [9]
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