Defining 'Unhealthy': A Systematic Analysis of Alignment between the Australian Dietary Guidelines and the Health Star Rating System.

Alexandra Jones,Bruce Neal,Karin Rådholm

doi:10.3390/nu10040501

Abstract

The Australian Dietary Guidelines (ADGs) and Health Star Rating (HSR) front-of-pack labelling system are two national interventions to promote healthier diets. Our aim was to assess the degree of alignment between the two policies. Methods: Nutrition information was extracted for 65,660 packaged foods available in The George Institute’s Australian FoodSwitch database. Products were classified ‘core’ or ‘discretionary’ based on the ADGs, and a HSR generated irrespective of whether currently displayed on pack. Apparent outliers were identified as those products classified ‘core’ that received HSR ≤ 2.0; and those classified ‘discretionary’ that received HSR ≥ 3.5. Nutrient cut-offs were applied to determine whether apparent outliers were ‘high in’ salt, total sugar or saturated fat, and outlier status thereby attributed to a failure of the ADGs or HSR algorithm. Results: 47,116 products (23,460 core; 23,656 discretionary) were included. Median (Q1, Q3) HSRs were 4.0 (3.0 to 4.5) for core and 2.0 (1.0 to 3.0) for discretionary products. Overall alignment was good: 86.6% of products received a HSR aligned with their ADG classification. Among 6324 products identified as apparent outliers, 5246 (83.0%) were ultimately determined to be ADG failures, largely caused by challenges in defining foods as ‘core’ or ‘discretionary’. In total, 1078 (17.0%) were determined to be true failures of the HSR algorithm. Conclusion: The scope of genuine misalignment between the ADGs and HSR algorithm is very small. We provide evidence-informed recommendations for strengthening both policies to more effectively guide Australians towards healthier choices.

Highlights

Unhealthy diets—high in salt, harmful fats, added sugar and energy—are a leading cause of death and disability in Australia [1]
In the absence of endorsed Health Star Rating (HSR) cut-offs for healthy or unhealthy, we identified products as ‘apparent outliers’ when the product was categorised ‘core’ by the Australian Dietary Guidelines (ADGs) but received a HSR ≤ 2.0, suggesting an unhealthy nutritional profile, or the product was categorised as ‘discretionary’ by the ADG but received a HSR ≥ 3.5, suggesting a healthy nutritional profile
65,660 packaged products available in Australian supermarkets between 1 January 2013 and 30 June 2017 were identified in the FoodSwitch database

Summary

Introduction

Unhealthy diets—high in salt, harmful fats, added sugar and energy—are a leading cause of death and disability in Australia [1]. Australia has some of the highest obesity rates in the world: nearly two-thirds of Australian adults and one in four children are overweight or obese. Unprecedented availability and aggressive marketing of processed and pre-packaged foods and beverages are a key driver of obesity and diet-related conditions including high blood pressure, heart disease, stroke, Nutrients 2018, 10, 501; doi:10.3390/nu10040501 www.mdpi.com/journal/nutrients. Obesity alone is estimated to cost Australia more than $8.6 billion annually [3]. The World Health Organization recommends a comprehensive suite of population health approaches to promote healthier diets. These include laws and regulations, tax and price interventions, community-based measures in facilities such as schools and hospitals, and public education through social marketing campaigns [4]. Despite the increasing impact of poor diet on Australia’s health, few of these preventive strategies have been taken up at a federal level

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