Abstract
Excessive consumption of energy-dense food increases the risk of obesity, which in turn increases the risk of non-communicable diseases, including heart disease, type 2 diabetes and most non-smoking-related cancers. Health warning labels (HWLs) that communicate the adverse health consequences of excess energy consumption could reduce intake of energy-dense foods. The aim of the current study was to estimate the impact on selection of energy-dense snacks of (a) image-and-text HWLs (b) text-only HWLs and (c) calorie information. In a between-subjects, 3 (HWL: image-and-text, text-only, no label) x 2 (calorie information: present, absent), factorial experimental design, participants (N = 4134) were randomised to view a selection of energy-dense and non-energy-dense snacks with one of five label types or no label. The primary outcome was the proportion of participants selecting an energy-dense snack in a hypothetical vending machine task. The proportion of participants selecting an energy-dense snack was reduced in all label groups, relative to the no label group (no label: 59%; calories only: 54%; text-only HWL: 48%; text-only HWL with calories: 44%; image-and-text HWL: 37%; image-and-text HWL with calories: 38%). Compared to the no label group, participants were least likely to select an energy-dense snack in the image-and-text HWL group (OR = 0.46, 95%CI = 0.40, 0.54, p < 0.001). Health warning labels – particularly those including an image and text - have the potential to reduce selection of energy-dense snacks in an online setting. Their impact on selection and consumption in real-world settings awaits testing.
Highlights
The prevalence of obesity worldwide has nearly tripled since 1975 (WHO, 2018b)
The primary aim of the current study was to assess the impact on selection of energy-dense snacks of: (a) Health warning labels (HWLs) communicating the adverse health consequences of excess energy consumption placed on energy-dense snacks, presented as text, with and without images, and (b) labels communicating energy content placed on all snacks
The 3 × 2 ANOVA model indicated there was a main effect of HWL type (F (2, 4128) = 619.34, p < 0.001), with a larger increase in negative emotional arousal compared to no label in the image-and-text HWL groups (MD [mean difference] = 2.16, 95%CI = 2.04, 2.28, p < 0.001, d = 1.32), than in the text-only HWL groups (MD = 1.48, 95%CI = 1.36, 1.60, p < 0.001, d = 0.85)
Summary
The prevalence of obesity worldwide has nearly tripled since 1975 (WHO, 2018b). In the UK, 61% of adults and 29% of children were classified as overweight or obese in 2016 (HSCIC, 2017). There is a substantial body of evidence demonstrating their impact on a range of outcomes including cessation-related behaviours (Hammond, 2011), with evidence indicating labels that generate negative emotions are most effective (Cho et al, 2018). Further research is needed to examine the potential impact of food HWLs on behaviour and to elucidate the types of HWLs – such as text-only vs image-and-text or labels illustrating different consequences – likely to be most effective. The primary aim of the current study was to assess the impact on selection of energy-dense snacks of: (a) HWLs communicating the adverse health consequences of excess energy consumption placed on energy-dense snacks, presented as text, with and without images, and (b) labels communicating energy content (calorie information) placed on all snacks. Secondary aims were to assess the impact of HWLs on emotional and cognitive responses - including negative emotional arousal, reactance, avoidance, and acceptability
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