Front-of-package Labels Research Articles

The Impact of Using Combined Front of Pack Labelling on the Food Stakeholders

The Impact of Using Combined Front of Pack Labelling on the Food Stakeholders

Association between a dietary quality index based on the food standard agency nutrient profiling system and cardiovascular disease risk among French adults

BackgroundIn France, the implementation of a front-of-pack (FOP) nutrition label–the 5-Colour Nutrition Label (5-CNL) is currently under consideration as a strategic tool to allow consumers making healthier food choices. This FOP label is based on the British Food Standards Agency Nutrient Profiling System (FSA-NPS), reflecting the overall nutritional quality of foods. At the individual level, an energy-weighted mean of all FSA-NPS scores of foods usually consumed has been elaborated (FSA-NPS DI). Our objective was to investigate the prospective association between the FSA-NPS DI and cardiovascular disease (CVD) risk. Methods75,801 participants to the NutriNet-Santé cohort, who completed at least three 24h dietary records during the first 2y of the follow-up, were followed between 2009 and 2016. Multivariable Cox proportional hazards models were used to characterize the associations between FSA-NPS DI and the incidence of CVDs. Results509 major cardiovascular events were diagnosed (262 coronary heart diseases and 247 strokes). A higher FSA-NPS DI, characterizing lower dietary quality, was associated with increased CVD risk (HRfor a 1-point increment=1.08 (1.03–1.13); HRQ4vs.Q1=1.40 (1.06–1.84), Ptrend Q4-Q1=0.01). This association tended to be stronger in overweight subjects (HRfor a 1-point increment=1.12 (1.04–1.19); Pinteraction=0.003). ConclusionsThese results suggest that lower dietary quality, as reflected by a higher FSA-NPS DI, may be associated with a significant increase in cardiovascular risk, especially in at-risk individuals (overweight population). They support the public health relevance of developing a front-of-pack nutrition label based on this score.

The relative ability of different front-of-pack labels to assist consumers discriminate between healthy, moderately healthy, and unhealthy foods

The degree to which different front-of-pack labels (FoPLs) can assist consumers to make healthy choices seems to depend on the extent to which the FoPLs provide an interpretation of the nutrition information presented. The aim of this study was to assess the effectiveness of three FoPLs that vary by interpretive content in allowing consumers to discriminate between products of varying healthiness. Australian consumers (n=2058) rated the perceived healthiness of mock food pack images that varied according to: nutritional profile (healthy, moderately healthy, unhealthy); FoPL (Daily Intake Guide (DIG), Multiple Traffic Lights (MTL), Health Star Rating (HSR), or control); and food type (cookies, cornflakes, pizza, yoghurt). Respondents were most accurate at differentiating unhealthy products from healthy (p<0.001) and moderately healthy products (p=0.015) when the HSR appeared on packs. The MTL was marginally (p=0.052) effective at helping respondents distinguish between healthy and unhealthy products. When the DIG or no FoPL was used, however, respondents were unable to discriminate between a healthy and an unhealthy nutritional profile. Findings indicate that the HSR is more effective than other commonly used FoPLs in assisting consumers to accurately evaluate the healthiness of food products.

Do Health Claims and Front-of-Pack Labels Lead to a Positivity Bias in Unhealthy Foods?

Health claims and front-of-pack labels (FoPLs) may lead consumers to hold more positive attitudes and show a greater willingness to buy food products, regardless of their actual healthiness. A potential negative consequence of this positivity bias is the increased consumption of unhealthy foods. This study investigated whether a positivity bias would occur in unhealthy variations of four products (cookies, corn flakes, pizzas and yoghurts) that featured different health claim conditions (no claim, nutrient claim, general level health claim, and higher level health claim) and FoPL conditions (no FoPL, the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL), and the Health Star Rating (HSR)). Positivity bias was assessed via measures of perceived healthiness, global evaluations (incorporating taste, quality, convenience, etc.) and willingness to buy. On the whole, health claims did not produce a positivity bias, while FoPLs did, with the DIG being the most likely to elicit this bias. The HSR most frequently led to lower ratings of unhealthy foods than the DIG and MTL, suggesting that this FoPL has the lowest risk of creating an inaccurate positivity bias in unhealthy foods.

The types and aspects of front-of-pack food labelling schemes preferred by adults and children

There is strong interest in front-of-pack labels (FoPLs) as a potential mechanism for improving diets, and therefore health, at the population level. The present study examined Australian consumers' preferences for different types and attributes of FoPLs to provide additional insights into optimal methods of presenting nutrition information on the front of food packets. Much research to date has focused on two main types of FoPLs – those expressing daily intake values for specific nutrients and those utilising ‘traffic light’ colour coding. This study extends this work by: (i) including the new Health Star Rating system recently introduced in Australia and New Zealand; (ii) allowing a large sample of consumers to self-nominate the evaluation criteria they consider to be most important in choosing between FoPLs; (iii) oversampling consumers of lower socioeconomic status; and (iv) including children, who consume and purchase food in their own right and also influence their parents' food purchase decisions. A cross-sectional online survey of 2058 Australian consumers (1558 adults and 500 children) assessed preferences between a daily intake FoPL, a traffic light FoPL, and the Health Star Rating FoPL. Across the whole sample and among all respondent subgroups (males vs females; adults vs children; lower socioeconomic status vs medium-high socioeconomic status; normal weight vs overweight/obese), the Health Star Rating was the most preferred FoPL (44%) and the daily intake guide was the least preferred (20%). The reasons most commonly provided by respondents to explain their preference related to ease of use, interpretive content, and salience. The findings suggest that a simple to use, interpretive, star-based food label represents a population-based nutrition promotion strategy that is considered helpful by a broad range of consumers.

Impact of explained v. unexplained front-of-package nutrition labels on parent and child food choices: a randomized trial.

The present study investigated whether parent/child pairs would select more healthful foods when: (i) products were labelled with front-of-package (FOP) nutrition labels relative to packages without labels; (ii) products were labelled with colour-coded Multiple Traffic Light (MTL) FOP labels relative to monochromatic Facts up Front (FuF) FOP labels; and (iii) FOP labels were explained via in-aisle signage v. unexplained. Participants were randomly assigned to one of five conditions: (i) FuF labels with in-aisle signs explaining the labels; (ii) FuF labels, no signage; (iii) MTL labels with in-aisle signage; (iv) MTL labels, no signage; (v) control group, no labels/signage. Saturated fat, sodium, sugar and energy (calorie) content were compared across conditions. The study took place in a laboratory grocery aisle. Parent/child pairs (n 153) completed the study. Results did not support the hypothesis that MTL labels would lead to more healthful choices than FuF labels. The presence of FOP labels did little to improve the healthfulness of selected foods, with few exceptions (participants with v. without access to FOP labels selected lower-calorie cereals, participants with access to both FOP labels and in-aisle explanatory signage selected products with less saturated fat v. participants without explanatory signage). Neither MTL nor FuF FOP labels led to food choices with significantly lower saturated fat, sodium or sugar. In-aisle signs explaining the FOP labels were somewhat helpful to consumers in making more healthful dietary decisions. New FOP labelling programmes could benefit from campaigns to increase consumer awareness and understanding of the labels.

Front‐of‐Pack Food Labeling and the Politics of Nutritional Nudges

This article examines the potential for new front‐of‐pack (FOP) nutrition labeling initiatives to nudge consumers toward healthier food choices. The libertarian‐paternalist approach to policy known as nudge initially developed by Thaler and Sunstein is discussed, with its emphasis on designing spaces (including the space of the food label) to shape the behavior of individuals while not restricting consumer choice or imposing restrictions or penalties on producers. In the context of concerns over diet‐related chronic diseases and obesity, new FOP interpretive nutrition labels have been proposed or implemented in an attempt to shift consumer dietary choices, including the Multiple Traffic Light labeling system in the United Kingdom and the Health Star Rating system in Australia. We identify some of the characteristics, the underlying nutritional philosophies, and the limitations of these FOP labeling schemes. We suggest that the potential of these schemes is compromised by the coexistence on the food label of many other forms of nutrition information and food marketing. Some alternative ways of labeling and communicating the nutritional quality of foods are also discussed.

The combined effect of front-of-pack nutrition labels and health claims on consumers’ evaluation of food products

The majority of studies examining the effect of nutrition information on food packets (such as the nutrition information panel (NIP), front-of-pack labels (FoPLs) and health claims) have examined each in isolation, even though they often occur together. This study investigated the relationship between FoPLs and health claims since (i) they both appear on the front of packs and typically receive more attention from consumers than the NIP, (ii) they can convey contradictory messages (i.e., health claims provide information on nutrients that are beneficial to health while FoPLs provide information on nutrients associated with increased health risks) and (iii) there is currently scant research on how consumers trade off between these two sources of information. Ten focus groups (n=85) explored adults’ and children’s reactions when presented with both a FoPL (the Daily Intake Guide, Multiple Traffic Lights, or the Health Star Rating) and a health claim (nutrient content, general-level-, or high-level). A particular focus was participants’ processing of discrepant information. Participants reported that health claims were more likely to be considered during product evaluations if they were perceived to be trustworthy, relevant and informative. Trust and ease of interpretation were most important for FoPLs, which were more likely than health claims to meet criteria and be considered during product evaluation (especially the Health Star Rating and Multiple Traffic Lights). Results indicate that consumers generally find FoPLs more useful than health claims.

Consumers' responses to front-of-pack labels that vary by interpretive content

Previous research has shown that front-of-pack labels (FoPLs) can assist people to make healthier food choices if they are easy to understand and people are motivated to use them. There is some evidence that FoPLs providing an assessment of a food's health value (evaluative FoPLs) are easier to use than those providing only numerical information on nutrients (reductive FoPLs). Recently, a new evaluative FoPL (the Health Star Rating (HSR)) has been introduced to Australia and New Zealand. The HSR features a summary indicator, differentiating it from many other FoPLs being used around the world. The aim of this study was to understand how consumers of all ages use and make sense of reductive FoPLs and evaluative FoPLs including evaluative FoPLs with and without summary indicators. Ten focus groups were conducted in Perth, Western Australia with adults (n = 50) and children aged 10–17 years (n = 35) to explore reactions to one reductive FoPL (the Daily Intake Guide), an existing evaluative FoPL (multiple traffic lights), and a new evaluative FoPL (the HSR). Participants preferred the evaluative FoPLs over the reductive FoPL, with the strongest preference being for the FoPL with the summary indicator (HSR). Discussions revealed the cognitive strategies used when interpreting each FoPL (e.g., using cut offs, heuristics, and the process of elimination), which differed according to FoPL format. Most participants reported being motivated to use the evaluative FoPLs (particularly the HSR) to make choices about foods consumed as part of regular daily meals, but not for discretionary foods consumed as snacks or deserts. The findings provide further evidence of the potential utility of evaluative FoPLs in supporting healthy food choices and can assist policy makers in selecting between alternative FoPL formats.

Effectiveness of Front-Of-Pack Nutrition Labels in French Adults: Results from the NutriNet-Santé Cohort Study.

BackgroundTo date, no consensus has emerged on the most appropriate front-of-pack (FOP) nutrition label to help consumers in making informed choices. We aimed to compare the effectiveness of the label formats currently in use: nutrient-specific, graded and simple summary systems, in a large sample of adults.MethodsThe FOP label effectiveness was assessed by measuring the label acceptability and understanding among 13,578 participants of the NutriNet-Santé cohort study, representative of the French adult population. Participants were exposed to five conditions, including four FOP labels: Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), 5-Color Nutrition Label (5-CNL), Green Tick (Tick), and a “no label” condition. Acceptability was evaluated by several indicators: attractiveness, liking and perceived cognitive workload. Objective understanding was assessed by the percentage of correct answers when ranking three products according to their nutritional quality. Five different product categories were tested: prepared fish dishes, pizzas, dairy products, breakfast cereals, and appetizers. Differences among the label effectiveness were compared with chi-square tests.ResultsThe 5-CNL was viewed as the easiest label to identify and as the one requiring the lowest amount of effort and time to understand. GDA was considered as the least easy to identify and to understand, despite being the most attractive and liked label. All FOP labels were found to be effective in ranking products according to their nutritional quality compared with the “no label” situation, although they showed differing levels of effectiveness (p<0.0001). Globally, the 5-CNL performed best, followed by MTL, GDA and Tick labels.ConclusionsThe graded 5-CNL label was considered as easy to identify, simple and rapid to understand; it performed well when comparing the products’ nutritional quality. Therefore, it is likely to present advantages in real shopping situations where choices are usually made quickly.

To See or Not to See: Do Front of Pack Nutrition Labels Affect Attention to Overall Nutrition Information?

BackgroundFront of pack (FOP) nutrition labels are concise labels located on the front of food packages that provide truncated nutrition information. These labels are rapidly gaining prominence worldwide, presumably because they attract attention and their simplified formats enable rapid comparisons of nutritional value.MethodsEye tracking was conducted as US consumers interacted with actual packages with and without FOP labels to (1) assess if the presence of an FOP label increases attention to nutrition information when viewers are not specifically tasked with nutrition-related goals; and (2) study the effect of FOP presence on consumer use of more comprehensive, traditional nutrition information presented in the Nutritional Facts Panel (NFP), a mandatory label for most packaged foods in the US.ResultsOur results indicate that colored FOP labels enhanced the probability that any nutrition information was attended, and resulted in faster detection and longer viewing of nutrition information. However, for cereal packages, these benefits were at the expense of attention to the more comprehensive NFP. Our results are consistent with a potential short cut effect of FOP labels, such that if an FOP was present, participants spent less time attending the more comprehensive NFP. For crackers, FOP labels increased time spent attending to nutrition information, but we found no evidence that their presence reduced the time spent on the nutrition information in the NFP.ConclusionsThe finding that FOP labels increased attention to overall nutrition information by people who did not have an explicit nutritional goal suggests that these labels may have an advantage in conveying nutrition information to a wide segment of the population. However, for some food types this benefit may come with a short-cut effect; that is, decreased attention to more comprehensive nutrition information. These results have implications for policy and warrant further research into the mechanisms by which FOP labels impact use of nutrition information by consumers for different foods.

Front of Pack Nutrition Labelling, Nutrition, Quality and Consumer Choices

This article reviews recent research on front of pack (FoP) nutritional labelling systems and their relationship to consumer choice. The mechanics of the major FoP label types are described, and recent research that tests the impact of these FoP systems on consumer choice is reviewed. Recent theoretical developments in food consumer choice are then discussed. The implications of these developments for the major FoP label types are then developed. The article concludes that several major types of FoP labels, falling into two major groups, evaluative and reductive, are now fully developed and are being deployed. FoP research that is developmental in nature is thus redundant. There is no possibility that evaluative and reductive types can both be effective. Therefore, there is a critical need for a research that tests these FoP labels and that identifies whether evaluative or reductive labels are compatible with food consumer choice before further deployment occurs.

Front of pack labels enhance attention to nutrition information in novel and commercial brands

Objectives(1) To assess whether Front-of-Pack (FOP) nutrition labels garner attention more readily than more complete, mandated nutrition information (the Nutrition Facts Panel (NFP), required in the US), and (2) To determine whether label design characteristics, specifically, color coding and/or coding with facial icons, increase attention to the FOP label. MethodsIn two experiments, we tracked the allocation of attention while participants (n=125) viewed novel and commercial packages with varied FOP designs using a change detection methodology. ResultsWe found empirical evidence that FOP labels are attended more often, and earlier, than the currently mandated NFP, and that this benefit is due both to its placement on the front of the package and to the design characteristics of the FOP. Specifically, the use of color in FOPs increased attention to the label, but there was no evidence that coding information via facial icons impacted attention. ConclusionsOur work supports a growing body of evidence supporting the use of FOP labels to attract attention to nutritional information. Findings may be relevant to inform policy decisions on labeling standards.

Objective Understanding of Front-of-Package Nutrition Labels among Nutritionally At-Risk Individuals

In the ongoing debate about front-of-package (FOP) nutrition labels, little data exist regarding nutritionally at-risk populations, although they are critical targets of prevention programs. This study aimed to compare the impact of FOP labels on the ability to rank products according to their nutritional quality among French adults potentially at risk of poor dietary quality (N = 14,230). Four labels were evaluated: Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), 5-Color Nutrition Label (5-CNL), Green Tick (Tick), along with a reference without label. Mixed models were used to assess how individual characteristics and FOP labels were associated with the ability to rank products. Older participants and those with a lower educational level, income, nutritional knowledge, and likelihood of reading nutrition facts were less skilled at ranking food products according to nutritional quality. Compared with individual characteristics, nutrition labels had an increased impact on food product ranking ability. Overall, 5-CNL corresponded to the highest rate of correct responses, followed by MTL, GDA, and Tick (p < 0.0001). The strongest impact of 5-CNL was observed among individuals with no nutritional knowledge (odds ratio (OR): 20.24; 95% confidence interval (CI): 13.19–31.06). Therefore, 5-CNL appeared to be effective at informing consumers, including those who are nutritionally at-risk, about the nutritional quality of food products.

Salt Reduction Initiatives around the World - A Systematic Review of Progress towards the Global Target.

ObjectiveTo quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025.MethodsA systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework.ResultsA total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt.ConclusionThe large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake.

Influence of Interpretation Aids on Attentional Capture, Visual Processing, and Understanding of Front-of-Package Nutrition Labels

ObjectiveTo study the influence of 2 interpretational aids of front-of-package (FOP) nutrition labels (color code and text descriptors) on attentional capture and consumers’ understanding of nutritional information. DesignA full factorial design was used to assess the influence of color code and text descriptors using visual search and eye tracking. ParticipantsTen trained assessors participated in the visual search study and 54 consumers completed the eye-tracking study. Main Outcome MeasuresIn the visual search study, assessors were asked to indicate whether there was a label high in fat within sets of mayonnaise labels with different FOP labels. In the eye-tracking study, assessors answered a set of questions about the nutritional content of labels. AnalysisThe researchers used logistic regression to evaluate the influence of interpretational aids of FOP nutrition labels on the percentage of correct answers. Analyses of variance were used to evaluate the influence of the studied variables on attentional measures and participants’ response times. ResultsResponse times were significantly higher for monochromatic FOP labels compared with color-coded ones (3,225 vs 964 ms; P < .001), which suggests that color codes increase attentional capture. The highest number and duration of fixations and visits were recorded on labels that did not include color codes or text descriptors (P < .05). The lowest percentage of incorrect answers was observed when the nutrient level was indicated using color code and text descriptors (P < .05). Conclusions and ImplicationsThe combination of color codes and text descriptors seems to be the most effective alternative to increase attentional capture and understanding of nutritional information.

The impact of front-of-pack nutrition labels on consumer product evaluation and choice: an experimental study.

The present research was an experimental test that aimed to quantify the impact of two dominant front-of-pack (FOP) nutritional label formats on consumer evaluations of food products that carried them. The two FOP label types tested were the traffic light label and the Percentage Daily Intake. A 4×5 partially replicated Latin square design was used that allowed the impact of the FOP labels to be isolated from the effects of the product and the consumers who were performing the evaluations. The experiment was conducted on campus at the University of Otago, New Zealand. The participants were 250 university students selected at random who met qualifying criteria of independent living and regular purchase of the products used in the research. They were not aware of the purpose of the research. The presence of FOP labels led to significant and positive changes in consumer purchase intentions towards the products that carried them. These changes were not affected by the nature of FOP labels used, their size or the product nutritional status (good/bad) that they were reporting. The result is consistent with the participants paying attention to the FOP label and then using it as an adimensional cue indicating product desirability. As such, it represents a complete functional failure of both of these FOP label types in this specific instance. This result supports calls for further research on the performance of these FOP labels before any move to compulsory deployment is made.

Greening the curriculum to foster environmental literacy in human nutrition students

s / Journal of Nutrition & Intermediary Metabolism 1 (2014) 1e55 38 Conclusions: Estimated HSR for the reality television products varied widely. There were no 5 stars products. The most popular product had the minimum possible rating and is not a healthy choice. Front of Pack Labelling with HSR is designed to promote healthier choices. Funding source(s).N/A GREENING THE CURRICULUM TO FOSTER ENVIRONMENTAL LITERACY IN HUMAN NUTRITION STUDENTS S.A. Skeaff . Department of Human Nutrition, University of Otago, Dunedin,

Interpretive front-of-pack nutrition labels. Comparing competing recommendations

Many stakeholders support introducing an interpretive front-of-pack (FOP) nutrition label, but disagree over the form it should take. In late 2012, an expert working group established by the New Zealand government recommended the adoption of an untested summary rating system: a Star label. This study used a best–worst scaling choice experiment to estimate how labels featuring the new Star rating, the Multiple Traffic Light (MTL), Daily Intake Guide (DIG), and a no-FOP control affected consumers' choice behaviours and product perceptions. Nutrient-content and health claims were included in the design. We also assessed whether respondents who used more or less information during the choice tasks differed in their selection patterns. Overall, while respondents made broadly similar choices with respect to the MTL and Star labels, the MTL format had a significantly greater impact on depressing preference as a food's nutritional profile became less healthy. Health claims increased rankings of less nutritious options, though this effect was less pronounced when the products featured an MTL. Further, respondents were best able to differentiate products' healthiness with MTL labels. The proposed summary Stars system had less effect on choice patterns than an MTL label and our findings highlight the need for policy makers to ensure that decisions to introduce FOP labels are underpinned by robust research evidence. These results suggest that the proposed summary Stars system will have less effect on shifting food choice patterns than interpretive FOP nutrition label featuring traffic light ratings.

Nutritional quality, labelling and promotion of breakfast cereals on the New Zealand market

Breakfast cereals substantially contribute to daily energy and nutrient intakes among children. In New Zealand, new regulations are being implemented to restrict nutrition and health claims to products that meet certain ‘healthy’ criteria. This study investigated the difference in nutritional quality, labelling and promotion between ‘healthy’ and ‘less healthy’ breakfast cereals, and between breakfast cereals intended for children compared with other breakfast cereals on the New Zealand market. The cross-sectional data collection involved taking pictures of the nutrition information panel (NIP) and front-of pack (FoP) for all breakfast cereals (n = 247) at two major supermarkets in Auckland in 2013. A nutrient profiling tool was used to classify products into ‘healthy’/‘less healthy’. In total 26% of cereals did not meet the ‘healthy’ criteria. ‘Less healthy’ cereals were significantly higher in energy density, sugar and sodium content and lower in protein and fibre content compared with ‘healthy’ cereals. Significantly more nutrition claims (75%) and health claims (89%) featured on ‘healthy’ compared with ‘less healthy’ cereals. On the ‘less healthy’ cereals, nutrition claims (65%) were more predominant than health claims (17%). Of the 52 products displaying promotional characters, 48% were for ‘cereals for kids’, and of those, 72% featured on ‘less healthy’ cereals. In conclusion, most breakfast cereals met the ‘healthy’ criteria; however, ‘cereals for kids’ were ‘less healthy’ and displayed more promotional characters than other cereal categories. Policy recommendations include: food composition targets set or endorsed by government, strengthening and enforcing current regulations on health and nutrition claims, considering the application of nutrient profiling for nutrition claims in addition to health claims, introducing an interpretative FoP labelling system and restricting the use of promotional characters on ‘less healthy’ breakfast cereals.