Front-of-package Research Articles

Comparison of appropriateness of Nutri-Score and other front-of-pack nutrition labels across a group of Moroccan consumers: awareness, understanding and food choices

BackgroundThe front of pack nutrition label Nutri-Score, intended to help consumers orient their choices towards foods that are more favorable to health, was developed in France and applied in several European countries. Consideration is underway for its use in Morocco. This study aims to assess Moroccan consumers’ perception and objective understanding of Nutri-Score and 4 other nutritional information labels (Health Star Rating, Health warning, Reference Intakes and Multiple Trafic Light) and their impact on purchase intentions.Methods814 participants were asked to choose among 3 food classes (yoghurts, biscuits and cold cuts), which ones they would prefer to buy among three products with different nutritional profiles and then to rank them according to their nutritional quality. Participants first performed these tasks without a visible nutritional label, and then, after being randomized to one of five labels tested, with the nutritional label visible on front of packs. Next, the full set of tested labels was presented to the participants who were asked a series of questions regarding their preferences, the attractiveness of the labels, their perceptions, intention to use and the trustworthiness placed in the labels.ResultsCompared to the Reference Intake, the Nutri-Score (OR = 2.48 [1.53–4.05], p < 0.0001), was associated with the highest improvement in the ability to correctly classify foods based on their nutritional quality. The percentage of participants who improved their food choice was higher than those who worsened it for all the labels. For yogurts and cookies, the most significant improvements were observed for the Nutri-Score and the Reference Intakes: Concerning the perception of labels, the Nutri-Score is the label that received the highest number of positive responses, whether concerning the ease of being spotted (82.2%), of being understood (74%), and to provide rapid information (68.8%). The Nutri-Score was ranked as the preferred label by 64.9% of the participants.ConclusionThe Nutri-Score appears to be the most effective nutritional information system to inform consumers about the nutritional quality of foods in Morocco, where it could constitute a useful tool to help consumers in their food choices in situations of purchase.

A cross-country experimental study on consumers’ subjective understanding and liking on front-of-pack nutrition labels

Different Front-of-Pack (FOP) nutritional labels have been implemented in order to increase consumers’ awareness of food nutritional quality and encourage healthier choices. However, few studies have analysed the effects of FOPLs on consumers’ subjective understanding and liking across different socio-cultural contexts. This study tests the effect that the new enriched informative label NutrInform Battery and the summary label Nutri-Score have on subjective comprehension and liking across 2776 respondents of seven European countries (France, Germany, Greece, Italy, Portugal, Romania and Spain). Main effects regarding socio-demographic differences are also explored according to extant literature and highlighting significant effects of education and income. This study therefore extends the current research on subjective understanding and liking with a cross-country analysis. Findings suggest that NutrInform Battery can help consumers in understanding information in a relevant way, obtaining the highest performance across countries and showing limited impact of socio-cultural differences.

What consumers actually know: The role of objective nutrition knowledge in processing stop sign and traffic light front-of-pack nutrition labels

Examining the effects of what consumers actually know (i.e., objective knowledge) is an important gap in front-of-pack (FOP) nutrition research. In experiments with over 2,000 primary food shoppers, we examine the moderating impact of objective nutrition knowledge on key FOP nutrition symbols (Stop Sign labels, Traffic-Light labels, and a control) for effects on nutrient perceptions, nutrition use accuracy, disease risk, brand attitudes, and purchase intentions. Results support the effectiveness of the Stop Sign label over the Traffic Light label for key outcome measures, with the Traffic Light label performing better on nutrition use accuracy. Importantly, those with greater objective nutrition knowledge performed better than those with lower knowledge, controlling for subjective knowledge and demographics. These results are robust across three food nutrition profiles (healthy, moderately healthy, unhealthy), and more accentuated for the unhealthy profile. Serial mediation analyses are offered, as well as implications for marketing practice, theory, and public health.

Basing a claim on “negatives free”: when does it serve as a quality cue?

PurposeIndividuals concerned about safety comprise a significant share of the consumer market today. This paper aims to provide the results of a study on when a front-of-package (FOP) claim about “no added negatives” can serve as a quality cue.Design/methodology/approachFour between-subjects experiments examine consumers’ quality perceptions in responses to the absence-focused claims and also identifies brand parity (Studies 1a and 1b) and the associated launch of inconsistent alternatives as moderators (Study 2) and investigate the extent to which the quality signaling value of absence-focused claims varies as a function of message regulatory focus (Study 3).FindingsResearch shows that a unique absence-focused claim indicates product quality (Studies 1a and 1b). However, there could be a cost in terms of reduced perceived quality when adding an inconsistent alternative to a brand (Study 2). Furthermore, consumers associate greater product quality with absence-focused FOP claims if an appeal is framed as prevention-focused rather than promotion-focused benefits (Study 3).Originality/valueThis study advances knowledge on the effects of front-of-package claims on consumer behavior and benefits marketers in determining effective front-of-package messages for product promotion.

Stop! Graphic Health Warnings Enhance Inhibitory Control in Adolescents: An Event-Related Potential Study.

The majority of smokers begin consumption in adolescence and the earlier initiation of cigarette smoking is associated with a greater likelihood of cigarette dependence. Graphic health warnings (GHW) are one of the most used strategies to communicate the consequences of cigarette smoking, but little is known about their ability to increase inhibitory control and thus prevent consumption. The objective of the present study was to evaluate the effects of different sizes of GHWs on inhibitory control in adolescents. We hypothesized that GHWs promote inhibitory control, and increasing GHW size, enhance inhibitory control. Fifty-nine participants completed a Go/No-Go task during electroencephalographic recording. The No-Go stimuli were pictures of cigarette packs without GHWs, and cigarette packs with GHWs that covered 30% or 60% of the front (main side) of the pack. The event-related potential N200 component and behavioral measures in the Go/No-Go task were analyzed. Separate mixed-model analysis of variance (ANOVAs) were used for N200 component (amplitude and latency) and behavioral data. The GHWs increased the amplitude of the N200 potential, especially GHWs that covered 60% of the front of the pack. The behavioral data showed that GHWs that covered 60% of the front of the pack generated higher a percentage of accuracy in No-Go trials (ie, fewer commission errors). These results suggest that GHWs increase inhibitory control in adolescents, especially when the GHWs cover 60% of the front of the cigarette pack. GHWs with an increased size (60% of the front of the cigarette pack vs. 30%, the minimum size, proposed by the World Health Organization) recruit additional cognitive resources and thus can effectively increase inhibitory control both in adolescent smokers and nonsmokers. Accordingly, the use of larger GHW has the potential of becoming an effective public policy strategy to inhibit smoking in adolescents.

Relationship between Marketing to Children on Food Labeling and Critical Nutrient Content in Processed and Ultra-Processed Products Sold in Supermarkets in Lima, Peru.

Consumption of ultra-processed foods has increased alarmingly, representing a risk to children’s health. Different techniques in marketing to kids (M2K) used on food labels are influencing the purchasing decisions of these products. This study aims to provide useful information about M2K found in labeling of food products sold in a supermarket chain in Lima, Peru and to determine its relationship with critical nutrient content. This was an observational, correlational, descriptive study. Data were collected by photographing the front-of-pack (FoP) of 2747 product labels sold in three supermarkets in Lima, but only those that met all the inclusion criteria were evaluated (n = 1092). A relationship was found between the use of techniques in marketing to kids and the level of critical nutrient regarding saturated fat (PR = 0.56; CI95%: 0.52–0.63), total sugar (PR = 1.70; CI95%: 1.64–1.77), and sodium (PR = 1.05; CI95%: 1.03–1.07). Particularly with sugar, the presence of M2K is a risk factor. New regulatory policies for the use of these food labeling techniques should be implemented to improve children’s health at the population level.

The effect of front-of-package labels or point-of-sale signage on consumer knowledge, attitudes and behavior regarding sugar-sweetened beverages: a systematic review.

Globally, the use of labels or signage targeting SSBs remains in its infancy and there is limited evidence available regarding its ability to decrease purchase and consumption of SSBs. This systematic review aimed to synthesize the evidence on the effect of sugar- or health-related sugar-sweetened beverage (SSB) warning labels or signage on knowledge, attitudes, and beliefs, and SSB purchase and consumption. Nine databases - Ovid Medline, Emerald Insight, Scopus, Informit, Business Source Complete, CINAHL, Global Health, PsychINFO, and SocIndex - were searched along withgrey literature from inception to December 2019. The PRISMA guidelines were applied for reporting this systematic review. Studies examining the impact of front of pack (FOP) labels and/or point of sale (POS) signage highlighting added sugar content or its health risks were included. Two authors independently extracted data on items, including study details, study design, population characteristics, intervention label details (type, duration, and settings), and outcomes measures. The Effective Public Health Practice Project tool was used to assess the study quality. Findings were synthesized narratively. Twenty-one studies published between 1992 and 2019 were included. Of these, 16 studies examined the impact of FOP labels and 5 studies examined the impact of POS signage. Both FOP labels and POS signage were associated with improved health knowledge, attitudes, and beliefs regarding SSBs and reduced SSB purchases. Warning labels with diet-related health consequences were found to be particularly effective. Overall quality of studies was assessed as mixed. Health- or sugar-related FOP labels and POS signage for SSBs are promising public health measures and may improve consumers' health behaviors toward reduced SSB purchase and consumption.

Are food and drink available in online and physical supermarkets the same? A comparison of product availability, price, price promotions and nutritional information.

Online supermarkets are increasingly used both by consumers and as a source of data on the food environment. We compared product availability, nutritional information, front-of-pack (FOP) labelling, price and price promotions for food and drink products between physical and online supermarkets. For physical stores, we collected data on price, price promotions, FOP nutrition labels and nutrition information from a random sample of food and drinks from six UK supermarkets. For online stores, we used foodDB, a research-ready dataset of over 14 million observations of food and drink products available in online supermarkets. Six large supermarket stores located near Oxford, UK. General sample with 295 food and drink products, plus boost samples for both fruit and vegetables, and alcohol. In the general sample, 85 % (95 % CI 80, 90 %) of products found in physical stores could be matched with an online product. Nutritional information found in the two settings was almost identical, for example, concordance correlation coefficient for energy = 0·995 (95 % CI 0·993, 0·996). The presence of FOP labelling and price promotions differed between the two settings (Cohen's kappa = 0·56 (95 % CI 0·45, 0·66) and 0·40 (95 % CI 0·26, 0·55), respectively). Prices were similar between online and physical supermarkets (concordance correlation coefficient > 0·9 for all samples). Product availability, nutritional information and prices sourced online for these six retailers are good proxies of those found in physical stores. Price promotions and FOP labelling vary between the two settings. Further research should investigate whether this could impact on health inequalities.

Reformulation of Packaged Foods and Beverages in the Colombian Food Supply.

Public discussion, advocacy, and legislative consideration of policies aimed at reducing consumption of processed foods, such as sugar-sweetened beverage (SSB) taxes and mandatory front-of-package (FOP) warning labels, may stimulate product reformulation as a strategy to prevent regulation. In Colombia, there have been major legislative pushes for SSB taxes and FOP labels, although neither has passed to date. In light of the ongoing policy debate and successful implementation of similar policies in Peru and Chile, we explored manufacturer reformulation in the Colombian food supply. We compared the quantities of nutrients of concern (including sugar, sodium, and saturated fat) from the nutrition facts panels of the same 102 packaged foods and 36 beverages from the top-selling brands in Colombia between 2016 and 2018. Our analyses showed a substantial decrease in median sugar content of beverages, from 9.2 g per 100 mL to 5.2 g per 100 mL, and an increase in the percentage of beverages containing non-nutritive sweeteners (NNS), from 33% to 64% (p = 0.003). No meaningful changes in the quantities of nutrients of concern among foods were observed. Our findings suggest little reformulation has occurred in Colombia in the absence of mandatory policies, except for the substitution of sugar with NNS among beverages.

A randomized controlled trial testing the effects of a positive front-of-pack label with or without a physical activity equivalent label on food purchases

BackgroundPositive front-of-pack (FOP) labels, including Singapore’s Healthier Choice Symbol (HCS), target a subset of healthier products whose consumption is to be encouraged. However, this may inadvertently lead to excess caloric intake, which could be addressed by including an additional label identifying calories per serving. We test this hypothesis by adding a Physical Activity Equivalent (PAE) label, an indicator of calorie content, to all products available in an on-line grocery store. MethodsWe conducted a randomized controlled trial using a 3 arm within-subject crossover design in adult Singapore residents recruited online. Participants shopped once in each condition in an experimental online grocery store in random order: 1) no FOP label (Control); 2) Select products displaying HCS labels (HCS-only); 3) Condition 2 with additional information displaying PAEs per serving on every product (HCS+PAE). 117 participants were recruited and data from 317 shops were analyzed. We used first-differenced regressions to assess the impact of the conditions on calories per serving (primary) and on other measures of diet quality. ResultsThe HCS-only condition led to a statistically significant five-percentage point increase in the proportion of HCS products purchased (95% CI, 1%: 9%). However, neither the HCS-only (3.45; 95% CI, −12.52: 19.43) nor HCS + PAE (8.14; 95% CI, −5.25: 21.54) condition led to a change in the number of calories per serving purchased or changes in other measures of diet quality. ConclusionsPositive labels, like the HCS, are likely to increase purchases of labelled products. However, these changes may not lead to improvements in diet quality or calorie intake. Combining positive labels with additional PAE information does not appear to address this concern.

The Value of Front-of-Package and Point-of-Purchase Summaries in the Cold Cereal Industry

ABSTRACT This study explores the relationship between perceived quality as indicated by the front of package (FOP) and point of purchase (POP) summaries, objective quality, price, and value among 270 cold cereals. Findings reveal organic and whole-grain summaries are associated with higher objective quality; however, organic cereals offer lower value as these cereals are overpriced. Wholegrain-certified cereals are priced more affordably and offer better value. Cereals marked as “heart-healthy” at the point of purchase have better objective quality and lower price and better value. Cereals with POP and FOP gluten-free claims are associated with lower value; low objective quality and a higher price. Cereals with the gluten-free certification were found to offer the lowest value among all summary categroies. Kids’ cereals were of lower objective quality, the same price, and lower value, compared to other targets. Implications for consumer, cereal manufacturers and public policy are discussed.

The efficacy of 'high in' warning labels, health star and traffic light front-of-package labelling: an online randomised control trial.

To examine the impact of front-of-package (FOP) labels on perceived healthfulness, purchasing intentions and understanding of common FOP systems. A parallel, open-label design randomised participants to different FOP labelling conditions: 'high in' warning labels (WL), multiple traffic light labelling (TLL), health star ratings (HSR) (all displayed per serving) or control with no interpretive FOP labelling. Participants completed a brief educational session via a smartphone application and two experimental tasks. In Task 1, participants viewed healthy or unhealthy versions of four products and rated healthiness and purchasing intention on a seven-point Likert-type scale. In Task 2, participants ranked three sets of five products from healthiest to least healthy. Online commercial panel. Canadian residents ≥ 18 years who were involved in household grocery shopping, owned a smartphone and met minimum screen requirements. Data from 1997 participants (n 500/condition) were analysed. Task 1: across most product categories, the TLL and HSR increased perceived healthiness of healthier products. All FOP systems decreased perceived healthiness of less healthy products. Similar, albeit dampened, effects were seen regarding purchasing intentions. Task 2: participants performed best in the HSR, followed by the TLL, WL and control conditions. Lower health literacy was associated with higher perceived healthiness and purchasing intentions and poorer ranking task performance across all conditions. All FOP labelling systems, after a brief educational session, improved task performance across a wide spectrum of foods. This effect differed depending on the nutritional quality of the products and the information communicated on labels.Trial Registration: NCT03290118.

Evaluation of the Nutritional Quality of Processed Foods in Honduras: Comparison of Three Nutrient Profiles.

Obesity is considered a global pandemic. Different countries have worked to implement front-of-package (FOP) labeling systems that define thresholds for critical nutrients (CN) as part of their public health policies. The objective of this study is to identify the proportion of Processed (PF) and Ultra-Processed (UPF) Foods marketed in Honduras, which meet or fall short of the criteria of three Nutrient Profile Models (NPM): PAHO (2016), Chile (2017) and the Central American Technical Regulation Proposal-Nutritional Warning Front Labeling (CATRP-NWFL 2017). This study is descriptive; 1009 products from 206 brands were collected nationwide. Descriptive statistics were performed. The mean CN compliance with the three models was 49.3% for sodium, 30.6% for sugars, 63.1% and 96% for saturated and trans fats. The PAHO and Chilean (NPM) similarly concentrated on the lower compliance with the established criteria, unlike the CATRP, which has less stringent criteria. This is the first assessment of CN content in PF and UPF in Honduras under three different NPMs. We highlight the importance of defining or adopting criteria for the implementation of NWFL as information for the consumer and thereby contribute to reducing the risks of obesity and related diseases.

Nutrition Claims on Fruit Drinks Are Inconsistent Indicators of Nutritional Profile: A Content Analysis of Fruit Drinks Purchased by Households With Young Children

BackgroundFruit drinks are the most commonly consumed sugar-sweetened beverage among young children. Fruit drinks carry many nutrition-related claims on the front of package (FOP). Nutrition-related claims affect individuals’ perceptions of the healthfulness of products and purchase intentions, often creating a “health halo” effect. ObjectiveThe aims of this study were to describe the prevalence of FOP nutrition-related claims on fruit drinks purchased by households with young children and to examine the association between claims and the nutritional profile of fruit drinks. DesignThe sample included 2059 fruit drinks purchased by households with children 0 to 5 years old participating in Nielsen Homescan in 2017. FOP labels were obtained from 2 databases that contain bar code–level information on all printed material on product labels. A codebook was used to code for presence of FOP nutrition-related claims. The coded claims data were linked by bar code with Nutrition Facts label data. Claim type prevalence was calculated, and the association between claim types and median calories and total grams of sugar per 100 mL was analyzed using Wilcoxon rank-sum tests. The percentages of products containing noncaloric sweeteners (NCSs) with and without each claim type were also calculated and compared. ResultsAlmost all (97%) fruit drinks sampled had at least 1 nutrition-related FOP claim. Implied natural claims such as “natural flavors” were the most common (55% of products), followed by claims about the presence of juice or nectar (49%). Claims about vitamin C (33%), sugar (29%), and calories (23%) were also common. Fruit drinks with vitamin C, juice or nectar, fruit or fruit flavor, and overt natural claims were higher in calories and sugar and less likely to contain NCSs compared with products without these claims. Fruit drinks with calorie, sugar, NCS, implied natural, and other claims were lower in calories and sugar and more likely to contain NCSs compared with products without these claims. ConclusionsClaims are prevalent on fruit drinks purchased by households with young children. This is concerning given prior research demonstrating that claims can mislead consumers. Regulatory actions such as requiring a warning or disclosure on drinks that contain added sugars or NCSs should be considered.

Supermarket Circulars Promoting the Sales of 'Healthy' Foods: Analysis Based on Degree of Processing.

The health and wellness food sector grew 98% from 2009 to 2014 in Brazil, the world’s fourth-biggest market. The trend has reached supermarket circulars, which recently started to feature whole sections advertising health and wellness-enhancing foods. This study identified food items advertised in circulars’ specific sections of two Brazilian supermarket chains (one regional, one national) during a 10-week period. Foods were classified according to degree of food processing and presence/type of claims on their front-of-pack (FoP) labels. Comparison between groups of Unprocessed/Minimally Processed foods vs. Ultra-processed foods and presence/type of claims employed Pearson chi-square test. From the 434 alleged health and wellness-enhancing foods advertised, around half (51.4%) were classified as Ultra-processed. Presence of reduced and increased nutrient-content claims was significantly higher in labels of Ultra-processed foods. Most frequent claims addressed sugar and fibre content. Brazilian supermarket circulars were found to be promoting the sale of Ultra-processed foods in their health and wellness sections, leading to a situation that can mislead the consumer and bring negative health outcomes.

Analysis of the moderating effect of front-of-pack labelling on the relation between brand attitude and purchasing intention

Nutritional labelling is an instrument to generate eating patterns. The establishment of means to support nutritional labelling is encouraged via a Front-of-Pack (FOP) labelling which facilitates consumers’ comprehension and improves their choices. The aim of this work is to establish the impact that FOP labelling has on the relation between brand attitude and purchase intention, as well as to determine the effect of gender on these relations. Two surveys have been done. The first (129 responses) analyzes the relation between brand attitude and purchase intention without the presence of FOP labelling. The second (111 respondents) presents the FOP labelling. Multigroup analysis establishes the existence of differences in the relation between brand attitude and purchase intention due to the existence of FOP labelling in the case of the male sample. The effectiveness of FOP labelling is conditioned by the consumers’ brand attitudes and by the impact of gender.

Competitive Effects of Front-of-Package Nutrition Labeling Adoption on Nutritional Quality: Evidence from Facts Up Front–Style Labels

“Facts Up Front” nutrition labels are a front-of-package (FOP) nutrition labeling system that presents key nutrient information on the front of packaged food and beverage products in an easy-to-read format. The authors conduct a large-scale empirical study to examine the effect of adoption of FOP labeling on products’ nutritional quality. The authors assemble a unique data set on packaged food products in the United States across 44 categories over 16 years. By using a difference-in-differences estimator, the authors find that FOP adoption in a product category leads to an improvement in the nutritional quality of other products in that category. This competitive response is stronger for premium brands and brands with narrower product line breadth as well as for categories involving unhealthy products and those that are more competitive in nature. The authors offer evidence regarding the role of nutrition information salience as the underlying mechanism; they also perform supplementary analyses to rule out potential self-selection issues and conduct a battery of robustness checks and falsification tests. The authors discuss the implications of the findings for public policy makers, consumers, manufacturers, and food retailers.

Low-calorie-sweeteners in foods with front-of-package child-directed advertising in Brazil

Abstract Background Low-calorie sweeteners (LCS) are currently found in ultra-processed foods, even in those with high content of sugar, without any front-of-package (FOP) information for LCS content. The aim was to assess the presence of LCS and the combination of LCS and added sugars in foods and beverages with FOP child-directed advertising in the Brazilian packaged food supply. Methods In this cross-sectional study, we used data from the nutrition facts panel (NFP) dataset that includes 11,434 unique foods and beverages collected in 2017 in the five largest food retailers in Brazil. We used information on the NFP and the list of ingredients to determine the presence of LCS and added sugars. A subsample of the packages had the available FOP advertising strategies classified using the INFORMAS methodology (n = 3,491). We estimated the prevalence of LCS and the combination of LCS and added sugar presence in the Brazilian food supply, and assessed the prevalence of foods and beverages with FOP child-directed advertising. Results Out of 3,491 products assessed, 8.9% of the products contained LCS, of which 12.9% were advertised towards children. Regarding the presence of LCS and added sugars, 7.3% of products presented that combination, with 14.6% of those having child-directed FOP advertising. The food groups with the highest prevalence of LCS were: sugary drinks (juices, nectars, fruit-flavored drinks, sodas and other beverages) (40.6%), breakfast cereals and granola bars (31.6%), and sweetened dairy products (23.5%). From those, 5.5%, 6.7% and 17.1%, accordingly, were advertised towards children. Conclusions In this sample, 9% of the foods contained LCS or a combination of LCS and added sugars. In products advertised towards children, we found higher rates of products with LCS and greater presence of LCS in beverages, breakfast cereals and granola bars with children-directed advertising. Key messages This study demonstrates that almost 9% of Brazilian packaged foods have LCS, and that 7% have both LCS and added sugars. In products advertised towards children, such rates were higher (13 - 15%). A clearer information on the front-of-package of foods and beverages regarding the presence of LCS in Brazil is necessary, particularly among those products advertised towards children.

Front-of-pack nutrition labelling to promote healthier diets: current practice and opportunities to strengthen regulation worldwide

Abstract Unhealthy diets are a leading cause of death and disability globally. The WHO recommends Member States implement front-of-pack (FOP) nutrition labels to guide consumers towards healthier food choices, as part of comprehensive strategies to prevent diet-related non-communicable diseases. Interest in FOP nutrition labelling is increasing, but there is limited guidance for policymakers developing regulations necessary for effective implementation. A rapidly evolving evidence base, limited regulatory capacity and possibility of legal challenge by affected food industry stakeholders can create ‘regulatory chill', whereby governments are dissuaded from progressive public health policymaking. We use a framework for analysing public health law and available best-practice guidance to evaluate key components of 31 FOP nutrition labelling regulations endorsed by governments up to June 2019. Analysis of regulatory form shows recent rapid uptake of label formats that are easier for consumers to understand and increasing use of mandatory legislation. However, policymakers must decide much more than whether to apply ‘stars', ‘traffic lights' or ‘stop signs'. The substance of effective regulation must contain strategic regulatory objectives, clear specifications for displaying the label on pack, a valid scoring mechanism and a justified scope for including foods. While there are limited data on current practice, good governance of FOP nutrition labelling regulation also requires transparency and accountability in processes of label development, implementation, evaluation and enforcement to promote continuous improvement and withstand undue commercial interference. Whether developing new FOP nutrition labels or reforming existing ones, our findings support policymakers to design and implement best-practice, evidence-informed regulation.

Trade, standards and politics: global pressures on front-of-pack nutrition labelling interventions

Abstract Although interpretive front-of-pack (FOP) nutrition labelling is rightly considered a national health policy decision, it is also influenced by global trade agreements and international standards. Over the past decade, Specific Trade Concerns have been repeatedly raised at the World Trade Organization (WTO) regarding potential impacts of FOP nutrition labelling initiatives on trade. One of the common concerns raised was regarding the consistency of the measures with international standards. The Codex Alimentarius Commission (Codex), which makes global food standards, is currently developing global guidance for FoP nutrition labelling, which will almost certainly influence national policy making. This presentation draws on qualitative policy analysis research on trade concerns and international standards work regarding FOP nutrition labelling. Two challenges are evident at the global policy level. The first is the potential for constraints on policy space for innovative FOP nutrition labelling due to binding trade agreements. The second is the potential for significant industry input into standard development at Codex, which then constitute the reference point for WTO discussions on labelling. Historically, Codex standards have focussed primarily on acute risks, for example, from foodborne disease. This shift in Codex's activities towards standards to address NCDs presents new risks for achievement of public health goals, as a result of the high level of industry involvement in this forum and thus potential commercial conflict of interest. It is imperative that public health actors engage with Codex processes to ensure policy space for national governments to implement strong and effective regulation and allow scope for innovation. At the national policy level, strategic framing of nutrition labelling policy objectives and proactive policy engagement between trade and health can also minimise trade issues.