Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial.

Bruce Neal,Nicole Li,Gary Sacks,Rohan Greenland,Jason Wu,Judith Ngai,Jacqui Webster,Simone Pettigrew,Cliona Ni Mhurchu,Michelle Crino,Elizabeth Dunford,Annie Gao

doi:10.3390/nu9121284

Abstract

Background: Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown. Objective: To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions. Design: Individuals were assigned at random to access one of four different formats of nutrition labelling—HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)—or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks. Results: The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all p < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all p < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03). Conclusions: These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases.

Highlights

Poor diet due to inadequate intake of healthy foods and excess intake of unhealthy/junk foods—resulting in excess consumption of adverse nutrients and excess energy—is a leading preventable risk factor for poor health in the world [1]
Following the adoption of the Health Star Rating (HSR) system by the Australian government shortly after trial commencement, the primary objective of the study was modified to test whether this decision was reasonable by testing whether there was any evidence that the HSR system was inferior to the alternative possible choices (MTL, Daily Intake Guide (DIG), or warnings), with superiority of each form of labelling against Nutrition Information Panel (NIP) control being tested as secondary objectives
It is of note that we provided no training on the use of any format of front-of-pack labelling and it is possible that findings might be modified if there was concurrent community education

Summary

Introduction

Poor diet due to inadequate intake of healthy foods and excess intake of unhealthy/junk foods—resulting in excess consumption of adverse nutrients and excess energy—is a leading preventable risk factor for poor health in the world [1]. Front-of-pack interpretive nutrition labels that use graphics and colours to depict nutrient content are likely to be a better option for consumers because they provide information in an understandable format. Front-of-pack nutrition labelling may support healthier packaged food purchases. Objective: To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks. When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). Participants reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03)

Objectives

Results

Discussion

Conclusion