Abstract
Background: Overweight and obesity rates in Latin America are much higher than the global prevalence. Front-of-pack (FOP) nutrition label systems are gaining momentum in Latin America and being implemented as a strategy to tackle obesity among children and adults. This study investigates the usage and preference of three FOP nutrition labels among Argentinian, Chilean, Costa Rican, and Mexican adult parents.
 Methods: From March to May 2016, a questionnaire was administered to 966 parents of elementary school aged children in Argentina (89), Chile (304), Costa Rica (258) and Mexico (315). Guideline Daily Amounts (GDA), traffic light (TL), and warning label FOP systems were compared and analyzed. Statistical analysis was conducted using frequencies and proportions. Median differences tests, ANOVAs and logistic regression models were performed. A thematic analysis of qualitative data was conducted using a deductive process.
 Results: Parents with low education levels and poor health conditions (i.e., overweight) preferred the FOP warning labels over the GDA and TL systems. The GDA FOP nutrition labels were preferred by parents with higher education levels. Overall, the TL system was preferred with no significant differences across countries.
 Conclusion: FOP warning labels are preferred by parents with vulnerable conditions (i.e., low education levels and overweight) across four Latin American countries. An easily understandable, readable and acceptable label may facilitate usage by vulnerable groups to make healthy food purchases. These results have important policy implications by providing evidence to government policymakers to enact legislation to implement or enhance existing FOP nutrition label policies as a viable strategy to reduce obesity risk.
Highlights
Poor quality diets of children and adults have contributed to a rapid increase of obesity and dietrelated non-communicable diseases (NCDs) worldwide and are considered a major public health problem (Ezzati and Riboli 2013)
The increasing rates of obesity throughout this region have been associated with the nutrition transition currently taking place in which dietary patterns have shifted toward energy-dense foods and beverages that are high in fat, sugar, and salt, while low in other essential nutrients (Popkin and Reardon 2018)
When zooming-in into groups stratified by education level and Body Mass Index (BMI) category we found significant differences
Summary
Poor quality diets of children and adults have contributed to a rapid increase of obesity and dietrelated non-communicable diseases (NCDs) worldwide and are considered a major public health problem (Ezzati and Riboli 2013). A study from Rivera et al (2014) estimated that 3.8 million children younger than 5 years, 22.2-25.9 million school-age children, and 16.5-21.1 million adolescents were overweight or obese in the region. In this region, obesity has increased more rapidly among the most vulnerable populations (i.e., low socioeconomic groups) (Jiwani et al 2019). Latin America represents 16.8% of the ultra-processed market share globally followed by North America and Asia Pacific (Pan American Health Organization 2019). These foods have a high caloric content and high levels of sugar, salt and fat. This study investigates the usage and preference of three FOP nutrition labels among Argentinian, Chilean, Costa Rican, and Mexican adult parents
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